Total Hip (THA) and Total Knee (TKA) Arthroplasty

Total Hip (THA) and Total Knee (TKA) Arthroplasty are the most prevalent surgeries for Medicare patients, numbering over 400,000 cases in 2014, costing more than seven billion dollars annually for the hospitalization alone. Today, more than seven million Americans have hip or knee implants, and the number is rising. Furthermore, substantial variation in the cost per case has raised questions about the quality of care. At Thibodaux Regional Medical Center, total joint replacement for hips and knees emerged as one of the top two cost-driving clinical areas with variation in care processes.

To address this, Thibodaux Regional maintained its focus on the IHI Triple Aim while developing organizational and clinical strategies to transform the care of patients undergoing THA and TKA. A physician led Care Transformation Orthopedic Team was launched. Also participating on the team was hospital staff and other physicians. The team established standard care processes, created an educational program, redesigned order sets and Thibodaux Regional reduced variability and decreased costs significantly while maintaining high levels of patient satisfaction

Recognition:

Recipient of the 2016 LHA Trust Funds Safety Star Award

Improvements made:

• Standardization of the Preoperative surgical clearance process
• Revision and standardization of preoperative and postoperative order sets
• Design of a evidenced based “Enhanced Recovery after Joint Replacement Surgery” pathway
  • Early mobility
  • Measures to increase compliance with transfusion criteria
• Implementation of regional anesthesia in qualifying patients
  • Reducing complications associated with general anesthesia
  • Resulting in improved pain control and decreased narcotic usage

How have our patients benefited from the improvements Total Joint Care?

• 76.5 % relative reduction in complication rate for total hip and total knee replacement.
• 32% reduction in postoperative blood transfusions for total hip and total knee replacements
• 28% decrease on average morphine equivalents administered for total hip and total knee replacements
• 38.5 % relative reduction in LOS for patients with total hip replacements.
• 23.3% relative reduction in LOS for patients with total knee replacement.