catheter-induced infections."
• Decrease length of stay. Over a 3-year period, the hospital
decreased length of stay for TKAs by almost a full day (0.8 day). Instead
of asking a patient if he's picked his short-term care facility, caregivers
excitedly tell patients that they can soon go home if they're well enough.
Changing the patient's mindset and setting the expectation of a speedy
discharge empowers the patient, says Ms. Wied. Gunder-sen also trained
its physical therapists to get patients up and walking as soon as possible.
What good is a fast discharge if you have to readmit the patient?
Gundersen offers patients and caregivers day-of-discharge classes to
help patients recover well at home. The classes focus on keeping up
with assigned exercise routines, watching fluid intake and eating the
right foods.
"TJA patients who take control of their care drastically reduce their
risks for readmission and complications related to infection or dehy-
dration," says Ms. Wied.
Playbook for success
The team at Excelsior Orthopedics in Amherst, N.Y., one of the lead-
ing same-day total joint programs in the country, has developed a
"playbook" for success. The keys include:
• Clinical protocols. Total joints have many moving parts where
profits can go to die. Spell out everything, from pre-op orders and pre-
op testing to post-op pain management and post-op labs. Then there
are credentialing requirements and anesthesia (adductor block and
general, for example) techniques to follow. Detail your perioperative
and pain management protocols. Know what implants and supplies
you're using and keep your preference cards current. There's more
once you discharge the patient: prescriptions, durable medical equip-
ment (DME) orders, discharge instructions, rehabilitation protocols,
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