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Optimizing Your TJR Length of Stay

Optimizing Your TJR Length of Stay. A 10-Step ‘ Do-It-Yourself ’ Technique. Acknowledgements. Tadashi Funahashi, MD Robert Namba, MD Dhiren Sheth, MD Hamid Sabet Depuy/JNJ. Step 1: Define the problem. ?. Center-to-center variation MD-to-MD variation. Step 2: Reality Check.

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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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