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Anesthesia’s Role in Total Joints Success
The right combination of analgesics and anesthetics can get outpatient knee patients out of an ASC about four hours after they arrive.
Adam Taylor | Senior Editor
SPARE THE OPIOIDS Matthew C. Nadaud, MD, a surgeon who helped spearhead the new Knoxville Orthopaedic Clinic, says anesthesiologists must be experts at multimodal pain control.   |   Knoxville Orthopaedic Clinic

Standardization is often the common denominator among successful total joints programs. Take Knoxville Orthopaedic Surgery Center (KOSC), which opened in December 2009 and has had a total joints service line for five years. It attributes its consistently good outcomes largely to its ability to handle each case the same way every time. 

Retaining its staff and fellowship-trained surgeons who are dedicated to outpatient total joints (OTJ), and crafting policies and procedures that are OTJ-specific is the key to the Tennessee facility’s achievements, explains its Executive Director Beth Russell, MSN, RN, CASC. “A total joint is a total joint,” says Ms. Russell. “We set up protocols, do it the same way every time, and that’s how we got good at it — and anesthesia and post-op pain control are a huge part of why we’re successful.” 

KOSC’s sister surgery center, the Advanced Orthopaedic Institute, opened in July and is staffed with surgeons who were trained on surgical robots, using them at the University of Tennessee Medical Center on patients who stayed overnight after their procedures.

They wanted robotics to be part of the new facility and the first robot-assisted joint replacement took place on Oct. 28, says Executive Director Tammy Rowland, RN, MXT, ONC, adding that it’s taken a page from KOSC’s book to strive for consistency in all its affairs. 

“The basic building block of starting a total joints program is to standardize as much as possible by getting providers to agree on what should be in their order sets and their treatment of all patients perioperatively,” she says. “The win from that is huge, and it’s what’s best for patients and for your operations and throughput. When everyone’s doing things best and the same way, it makes it so much easier to train your staff.” 

Ms. Rowland says the more you standardize, even down to the dressings you use and how you close the wounds, the more it helps with your materials and supply chain management, and your budgeting. “You can greatly reduce the cost variance in your cases if you can get everybody to agree on one standardized routine process,” she says.

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