Total Joint Efficiency Program

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Total Joint Efficiency Program

• Total Joint Efficiency Team
• Headed by Dr Melvyn Harrington
• 2006

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Problem Statement

• Objective to increase the Total Joint Program
  efficiency and quality of care
• Background Dr Harrington proposed to improve
  total joint efficiency through improving quality
  of care and increasing OR volume of cases. He
  communicated with fellow surgeons around the
  country to find out more about programs that have
  successfully organized efficiency programs.

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Action

• Dr Harrington and Paul Gorski initiated a Loyola
  Team trip to visit Dr Nimomiyas benchmark joint
  efficiency program at Froedtert Memorial Lutheran
  Hospital in Milwaukee, Wisconsin, to learn about
  their program..
• The LUMC team consisted of Dr Harrington, Dr
  Jellish, hospital administrators, surgical
  nurses, OR processing staff, clinic nurse,
  orthopaedic unit manager, social work, therapy
  department, and nurse practitioner.

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• The Froedert Team was welcoming and had prepared
  presentations for a conference that reviewed
  issues that they had encountered on their journey
  to a joint efficiency program, and ways they
  solved their issues. Team members from both sides
  met and discussed their programs. The following
  day, the LUMC team went to the hospital and
  followed their respective counterparts to learn
  how they functioned. Tours were given and
  questions answered.

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• Following this trip to Froedert, the Loyola team
  met monthly to discuss program actions and
  changes.
• General Goals Improve pain management, reduce
  length of stay, increase OR efficiency, and
  restructure the total joint class
• Operational Goals reduce length of stay, tray
  consolidation, complete 3 cases by 3 pm, and 4
  cases by 4 pm.

 
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• Dr Harrington gathered data on OR timing for room
  cleaning, wheels in/wheels out, preparation time,
  and skin to skin time. This data was used to
  assess for areas for improvement.
• Central Processing worked to consolidate OR trays
  to reduce costs and time to turn around trays.
  14 trays were reduced to 4 trays
• Dr Candido and the anesthesia team worked to
  provide a new pain protocol to enhance pain
  control, reduce side effects, and help patients
  mobilize faster.

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• Total Joint class was restructured to provide the
  same amount of information but in a shorter time,
  allowing patients to go to resident clinic for
  their history and physicals earlier in the
  afternoon.
• Homecare and social work communicate patient
  needs earlier in the hospitalization which allows
  the homecare nurse and therapist to see the
  patient the day after discharge.
• Therapy is seeing patients at their first visit
  on the day of surgery.

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Successful Improvement

• Prior to our Total Joint Efficiency Program
  (TJEP), the average LOS was 3.94 for both
  primary and revisions.
• During the work of the TJEP Committee the LOS was
  initially reduced to 3.75.
• Prior to the week of 8-13, a new pain management
  protocol was developed by the TJEP Committee
  (special thanks to Dr. Candido). As a result of
  better pain management, the patient is able to
  participate with nursing and therapy more
  effectively on POD 0. As a result, the LOS has
  dropped to 2.86. A LOS reduction of 1.1 days.
• The 2.84 includes all primary replacements,
  revisions and bilateral replacements. All
  outliers are included in this total.

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Joint Efficiency Success with a Little Help form
our Friends

• Goals achieved Tray consolidation from 14 to 4
  saves money and time
• LOS reduced through better pain management.
• OR turnover time reduced to achieve 3 cases done
  by 3pm each day
• Next Goal 4 joint surgery cases done by 4 pm!
  Increase the number of cases done each day