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Optimizing Your TJR Length of Stay

Follow these 10 steps by experts to optimize total joint replacement length of stay, reduce costs, and enhance patient satisfaction. Learn strategies such as team formation, defining objectives, and addressing rate-limiting issues. Enhance your TJR care process efficiently!

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Optimizing Your TJR Length of Stay

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  1. Optimizing Your TJR Length of Stay A 10-Step ‘Do-It-Yourself’ Technique

  2. Acknowledgements Tadashi Funahashi, MD Robert Namba, MD Dhiren Sheth, MD Hamid Sabet Depuy/JNJ

  3. Step 1: Define the problem ? Center-to-center variation MD-to-MD variation

  4. Step 2: Reality Check • What should the process be? • Do I ‘buy-in’ to the concept? • How do I benefit? • Is their internal support for this type of innovation?

  5. Surgeon ‘buy-in’ • Be the change you want to see • That alone motivates people to bring their best and most innovative solutions to the table…. Mahatma Gandhi

  6. Surgeon Benefit • Staff satisfaction • Approximately ZERO calls/day • ‘Team’ formation • Goal alignment develops

  7. Step 3: Innovative Team Tadashi Funahashi Robert Namba Dhiren Sheth Kamil Antonios Your name goes here….

  8. Step 4: Define concrete objectives Decrease TJR ALOS (from __) to __ days Maintain baseline SNF utilization at <__% Resultant cost reduction of __% Maintain pt satisfaction in the __th percentile Decrease hospital-based complications

  9. Step 5: ‘Pow Wow’ Time • CEO/Executive • Orthopaedic chief • TJR MDs • Administrators The Big Boys The $$$ folks

  10. Step 6 : Simulation • Get all the front-line stakeholders that directly touch your pt into a room and go thru the entire process with them • Focus on the ‘as-is’ process • Identify areas for improvement Why is someone NOT touching the patient ??

  11. Each of these opportunities becomes a stakeholder-MD relationship (team) building endeavour • Solidify the ‘buy-in’ process • Maintain their interests in the process

  12. Step 7: Identify Rate-limiting Issues • Pain • Physical therapy • Patient expectation • Discharge management These then become the ‘cornerstones’ of your LOS solution

  13. ‘Cornerstone’ Management ……. Is your eventual solution

  14. Step 8: Cornerstone Mgmt • Pain: • Pre-emptive (pre-op) • Intra-op injections • Protocol/time-based RTC administration • Escalation doses for PT sessions

  15. Step 8 : Cornerstone Mgmt • Functional Therapy • PT: 1/3/2 schedule • OT: 2 visits • RN mobilization: 2-3 10 ‘functional’ therapy visits in 2’ish days

  16. Step 8 : Cornerstone Mgmt • Pt Expectation: mandatory preop class • Discharge planning: • Via class • MD-driven process “Ms. Jones, you will be going home at 11 AM on Friday”

  17. Step 9: Solution Development Value-Driven Care TJR LOS Carepath

  18. Step 10 : Implementation • Training sessions • One-on-one stakeholder interaction and appreciation for participating • Hit the button!!

  19. Thank You

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