C19: Patients at Home Hours After Total Joint Surgery Kaiser Permanente Santa Clara Chris Boyd, Area Manager, Senior Vice President Ashima Garg, MD, PhD, Orthopedic Surgeon Session Objectives Implement workflows that will work at your hospital for same-day discharges after total joint replacement Develop strategies to help change behavior and culture around sameday discharges Identify opportunities for other surgeries that can be appropriate for same-day discharge These presenters have nothing to disclose. 1
Kaiser Permanente s History and Mission To provide high quality affordable healthcare and improve the health of our members and the communities we serve. 3 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Kaiser Permanente s History and Mission To provide high quality affordable healthcare and improve the health of our members and the communities we serve. 4 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 2
Kaiser Permanente s Integrated Model Permanente Medical Groups Kaiser Foundation Hospitals 5 December 4, 2017 Health Plan Members Kaiser Foundation Health plan Kaiser Permanente 2010-2011. All Rights Reserved. Kaiser Permanente Santa Clara Members 360,000 Infrastructure Licensed Beds Operating Rooms (IP/OP) Activity 327 21 Average Daily Census ED Visits per year 241 75,000 Deliveries per year 4,500 Surgeries per year 20,500 Prescriptions filled per year 2.1M 6 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 3
Expanding Continuum of Care TELEMEDICINE MICRO CLINIC HOME AS THE HUB MOBILE SERVICES EMPLOYER CLINIC PRIMARY CARE / ANCILLARIES WEB SPECIALTY HUB W/ PRIMARY CARE MOBILE MEDICAL CENTER National Recognition 8 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 4
IHI Triple Aim Population Health Experience of Care Per Capita Cost 9 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. The Problem Surgery Hospital Recovery Care Experience: relative discomfort of hospital vs. home, wasted time Time in Care: > 5 days Adverse Events: more likely Home Recovery 10 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 5
The Solution Surgery PACU Recovery Care Experience: recover in comfort of home, eliminate wasted time Time in Care: < 1 day Home Recovery 11 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Solution Implementation Roadmap Team Engagement and Alignment Standardization of Workflows Communication 12 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 6
Team Engagement and Alignment Patient & Family Goals & Expectations Team 13 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Standardization of Workflows Pre-op TJA Class Hospital Team Initial Surgeon / Patient Visit Preoperative Clinic Home Health 14 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 7
Communication Outpatient Clinics Home Health Health Plan Members Hospital 15 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. The Solution: Key Tenats Pre-Op Intra-Op Post-Op 16 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 8
Pre-Op Key Tenets Pre-Op Intra-Op Post-Op Patient Optimization Smoking cessation, DMI/Hb1AC, BMI, Anemia Set expectation for same day discharge Shorter spinal anesthesia No Foley catheter Tranexamic acid (TXA) Peri-capsular injection IV Tylenol Decrease IVF No PCA Adductor block for TKR No CPM/braces IV Acetaminophen Out of bed to chair before PT HH PT day after discharge 17 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Intra-Op Key Tenets Pre-Op Intra-Op Post-Op Patient Optimization Smoking cessation, DMI/Hb1AC, BMI, Anemia Set expectation for same day discharge Shorter spinal anesthesia No Foley catheter Tranexamic acid (TXA) Peri-capsular injection IV Tylenol Decrease IVF No PCA Adductor block for TKR No CPM/braces IV Acetaminophen Out of bed to chair before PT HH PT day after discharge 18 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 9
Post-Op Key Tenets Pre-Op Intra-Op Post-Op Patient Optimization Smoking cessation, DMI/Hb1AC, BMI, Anemia Set expectation for same day discharge Shorter spinal anesthesia No Foley catheter Tranexamic acid (TXA) Peri-capsular injection IV Tylenol Decrease IVF No PCA Adductor block for TKR No CPM/braces IV Acetaminophen Out of bed to chair before PT HH PT day after discharge 19 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Enhanced Recovery After Surgery (ERAS) 20 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 10
Results: Less Harm 34% 45% Harm = SSI, PNA, DVT/PE, UTI, ARF, MI, CVA, transfusion, sepsis, or cardiac arrest 21 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. Results: Length of Stay & Case Volume 22 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 11
Results: Patient Days 23 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. One Patient s Story 24 December 4, 2017 Kaiser Permanente 2010-2011. All Rights Reserved. 12