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Todd Dietrick, MD, Huntington HospitalHuntington Hospital is a 619-bed not-for-profit hospital in Pasadena, California. The institute has been named among the top hospitals in California and nationally ranked in two specialties by U.S. News and World Report. I am the medical director of the joint replacement program at Huntington Hospital and following are my thoughts on the trends and challenges existing in the orthopedic space.
The Current Scenario
The current trend in joint replacement surgery is the transition from hospital-based patient care to “ambulatory,” or outpatient surgery away from the hospital setting.
The Existing Challenges
Currently we are working closely in the joint replacement team to collaborate across all disciplines to deliver the best possible care for our patients while keeping a close eye on our resource utilization.
Our challenges are recognizing patents at risk before they get to surgery so that we can optimize their health prior to surgery, thus decreasing the chance that they have complications perioperatively and improving their chance of successful recovery from their surgery. We know that patients who have been educated pre-operatively about the procedure and what they can do to prepare for it will have much higher rates of success than their counterparts. We have done this by creating pre-op screening tools for all physicians so that when they first see their patients they can recognize co-morbidities which place their patients in a higher risk bracket and they can optimize these medical conditions prior to surgery taking place.
Hindrances in Improving Patients Experience
Leadership panels are multi-disciplinary and discussions are always centered around the patient and what is going to be the best way to improve their outcomes. Challenges today often come from discussion regarding status, i.e. inpatient, extended stay, outpatient, etc., which actually have everything to do with reimbursement but nothing to do with actual patient care. Frustration with this aspect of medicine today comes from the fact that there are many aspects of our work which are required but have nothing to do with our patient’s care; precious time and energy is spent discussing things which are not relevant to patient outcomes, and this leaves us with less time to focus on improving our patients experience.
Orthopedics and Technology
With regards to technology, I think that robotics and navigation will continue to play an increasingly larger role in surgery. We now have the ability to gather more information perioperatively than ever before, and our challenge is and will continue to be how to use that information to improve our outcomes.
From a perioperative standpoint, I think that improvements in pain management will continue to evolve, and this will enable more hip and knee replacement procedures to be performed safely and effectively in an outpatient setting. This has the potential to decrease complications and cost, and improve patient satisfaction, which is a winning situation for all parties involved.
From a population standpoint, data we will continue to receive from our national database, the AJRR, will provide information for practicing physicians about trends, techniques and outcomes associated with our procedures and the devices we are using. This “big data” will help us make better decisions for our patients and lead to even better outcomes in the future.
My advice is to always try to look at things from your patient’s perspective. If what you are doing is going to improve their quality of life, then you will always be successful.
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