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ing [certification] to help us there." An investment At Presidio, the entire certification process took about a year, "but I'm slow," says Ms. Scott. "If you have a program up and going, and just need to tweak it, it would probably require less time." There was a modest fee, she says, in part because 2 Joint Commission representatives were onsite for 2 days, including observation of a total joint procedure and the entire continuum of care. There are also some ongoing expenses on the staffing side. A pre-op nurse now spends more time as a patient care coordinator. And a data-entry person spends a few hours a week tracking data and entering it into the American Joint Replacement Registry and the Joint Commission website. But it's been a good investment, says Ms. Scott. The key is having good surgeons and commitment from your team. Because it's work, she says. "People are going to have to change their practice. Everybody needs to understand what you're doing and why you're doing it, and they need to be bought in." Part of that hard work was figuring out how to handle those poten- tially hyperglycemic or hypertensive overnight patients the Joint Commission surgeon asked about. Presidio contracts with an anesthe- sia provider to be the provider on the day of surgery and to be on call for that patient overnight. "If there's a hypertensive crisis or a diabetic crisis, we call the anesthesiologist in, not the surgeon," says Ms. Scott. Improved communication and collaboration are leading to better outcomes at Ohio Surgical. For example, the screening of patients starts with a phone call, extends through the mandatory classes and continues right up until the day of surgery. Not much can fall through the cracks when the anesthesiologist, the pre-op education nurses and the surgeon each interviews the patient, says Ms. Kramer. 8 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 1 7