Setting up a total joint program — key lessons learned

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Texas Health Surgery Center Rockwall launched its outpatient total joint replacement program six months ago and to date the multispecialty ASC reports great success.

Currently, orthopedic surgeons represent one-third of the center's volume, which also includes ENT, podiatry and pain management.

At Becker's 17th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference in Chicago, Surgical Care Affiliates hosted a workshop that highlighted the methodology that the team used to develop the program, as well as lessons learned.

Planning stages

Before Texas Health Surgery Center Rockwall took the plunge into the outpatient total joint market, each part of the program was implemented first in the hospital on an outpatient basis. "Whatever you intend to do, be sure to stress test it first in the hospital environment, then you can transition to the surgery center," said Umar Burney, MD, founder of Orthopedic Specialists of Dallas and director of the Total Joint and Sports Medicine Program at Texas Health Presbyterian Hospital of Rockwall.

A major success factor for any healthcare-based project is obtaining physician buy-in. For ASCs, it's important to have a surgeon leader involved and alignment with the medical executive committee, since this group is responsible for capital expenditure decisions.

Next, develop a credentialing process to ensure all surgeons bringing total joint cases will align with the center's mission of care. "As soon as your surgery center opens, doctors will want privileges and credentialing. That's the time to have the discussion about surgeon selection. If you don't have the right doctors doing total joints in the ASC, that can negatively affect your outcomes. Determining the credentialing process has been a big component of our success," explained Dr. Burney.

Finally, anesthesia also plays a central role in outpatient total joint procedures. "You must feel 100 percent confident that you have the right anesthesia providers. We have several doctors that are comfortable with regional anesthesia, but 10 years ago that wasn't the case," said Dr. Burney.

Staffing concerns can extend beyond surgeons and anesthesiologists. Texas Health Surgery Center Rockwall hand-picked techs, nurses and staff who were on board with the vision of the total joint program. During the hiring process, determining the candidates' cultural fit with the ASC should be considered.

"Partnering with great physicians that are 'tried and true' is critical and hiring great teams is one of the most important things. It's a great recipe for success," said Jenny Bloebaum, regional vice president at Surgical Care Affiliates.

Patient selection and education

To ensure that patients are a good match for outpatient total joint procedures, Texas Health Surgery Center Rockwall evaluates individuals with a set patient selection protocol to reduce the risk of poor outcomes. In the future, the ASC is considering surveys to determine if patients are good candidates based on social and psychological considerations.

Patient education also plays a major role in positive outcomes. Texas Health Surgery Rockwall sponsors a "joint bootcamp" where patients can learn more about their procedure and discuss their home environment with staff. This gives the team additional "face time" with patients, which helps determine whether they will do well with outpatient surgery.

"If you can educate your patients preoperatively and you have a sufficient number of touch points with them after, you can ensure good outcomes," said Dr. Burney.

Texas Health Surgery Center Rockwall is building a tool that physical therapists can use to assess whether a patient will do well in the surgery center environment. This includes functional considerations and self-reported measures.

According to Dr. Burney, "Physical therapists have a lot to offer in this realm that we can't glean from 15 or 20 minutes with the patient in the clinical setting."


All operations at Texas Health Surgery Center Rockwall are centered around quality. "We benchmark our outcomes and continuously bring the team along with us. You must have physician partners on board at all times. It's all about communication within the team," said Dr. Burney.


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