interaction and patient engagement prior to surgery have resulted in
dramatically low readmission rates for hip and knee replacement
surgeries at the Hoag Orthopedic Institute (HOI), according to Sopida
Andronaco, RN, director of performance improvement and clinical outcomes
Andronaco told PNN
that HOI physicians have been actively focusing on solving the problem
of patient engagement, and physicians continue to work side by side with
nurses to revise protocols, as well as closely monitor individual
readmission rates. “Better outcomes for patients has always been the
goal of our physician leadership,” said Andronaco, “but it takes
physicians being engaged in the performance improvement process and
willing to listen to the quality department.”
To that end, physicians at HOI decided to focus
on patient education prior to the surgery. All surgeons now take time to
talk to their patients and encourage patients to take a joint
replacement class so they can become active participants and be engaged
in the process from the beginning.
“As patients have given us feedback the class has
improved tremendously,” Andronaco said. “They tell us what they want to
hear, what they are most afraid of. This is not something you can do if
you simply play a video. You can not expect the patient to get the same
result and the same level of engagement they get from live interaction.
You have to put it back on the patient, and you have to have physicians
actively involved,” said Andronaco.
In a prior interview with PNN, Dr. Robert Gorab,
chief medical officer, said he also attributes the lower rates of
readmissions to adopted policies that help prevent infection rates
before, during and after surgeries: The hospital screens patients 25 to
30 days before surgery for MRSA bacteria, and every patient needs to be
cleared before surgery.
A for-profit, physician-owned Institute, HOI
opened in November 2010. It performed approximately 55% of the hip and
knee replacements in Orange County last year. According to the data
recently published by the Centers for Medicare and Medicaid Services
(CMS), readmission rates from October 2012 to October 2013 for total hip
replacement (THA) and total knee replacement (TKA) at HOI were 1.4%
compared to Orange County's aggregated rate of 3.3% and California’s
All-cause readmission rates at HOI are 2.9% compared to the region's 17.7% and California's 18.4%.
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