Total Hip (THA) and Total Knee (TKA) Arthroplasty
Total Hip (THA) and Total Knee (TKA) Arthroplasty are the most prevalent
surgeries for Medicare patients, numbering over 400,000 cases in 2014,
costing more than seven billion dollars annually for the hospitalization
alone. Today, more than seven million Americans have hip or knee implants,
and the number is rising. Furthermore, substantial variation in the cost
per case has raised questions about the quality of care. At Thibodaux
Regional Medical Center, total joint replacement for hips and knees emerged
as one of the top two cost-driving clinical areas with variation in care
processes.
To address this, Thibodaux Regional maintained its focus on the IHI Triple
Aim while developing organizational and clinical strategies to transform
the care of patients undergoing THA and TKA. A physician led Care Transformation
Orthopedic Team was launched. Also participating on the team was hospital
staff and other physicians. The team established standard care processes,
created an educational program, redesigned order sets and Thibodaux Regional
reduced variability and decreased costs significantly while maintaining
high levels of patient satisfaction
Recognition:
Recipient of the 2016 LHA Trust Funds Safety Star Award
Improvements made:
- Standardization of the Preoperative surgical clearance process
- Revision and standardization of preoperative and postoperative order sets
-
Design of a evidenced based “Enhanced Recovery after Joint Replacement
Surgery” pathway
- Early mobility
- Measures to increase compliance with transfusion criteria
-
Implementation of regional anesthesia in qualifying patients
- Reducing complications associated with general anesthesia
- Resulting in improved pain control and decreased narcotic usage
How have our patients benefited from the improvements Total Joint Care?
- 76.5 % relative reduction in complication rate for total hip and total
knee replacement.
- 32% reduction in postoperative blood transfusions for total hip and total
knee replacements
- 28% decrease on average morphine equivalents administered for total hip
and total knee replacements
- 38.5 % relative reduction in LOS for patients with total hip replacements.
- 23.3% relative reduction in LOS for patients with total knee replacement.