Hoag Orthopedic Institute (HOI), the leading provider of joint replacements on the West Coast, has been at the forefront of enhanced recovery protocols that allow patients to be discharged home on the same day of their hip or knee replacement surgery.
Since 2015, an HOI team, combined of orthopedic surgeons, anesthesiologists, internists, physical therapists, nurses and administrators, thoughtfully developed and initiated the Enhanced Recovery Program to maximize patient outcomes and safety while minimizing their hospital stay.
“The key to our Enhanced Recovery Program’s success is ensuring that we have the appropriate criteria for identifying the patients who are candidates for same-day discharge,” shared Nader Nassif, M.D., one of HOI’s premier joint surgeons and committee member for the Enhanced Recovery Program.
The transition to outpatient joint replacement surgery has been especially relevant in 2020 with the COVID-19 pandemic. As elective surgeries resumed after the six-week statewide shutdown in Spring, patients, families and surgeons agreed that recovery at home rather than in the hospital was better. Today, approximately 40% of all total joint replacement patients now go home on the same day as surgery, and 92% are discharged within 48 hours.
With HOI’s foundation and knowledge of enhanced recovery and same-day discharge, HOI surgeons have successfully transitioned more patients to a rapid recovery pathway with the same excellent outcomes.
“It’s important for patients to still seek the medical care they need during the COVID-19 pandemic,” shared Alan Beyer, M.D., orthopedic surgeon and executive medical director, Hoag Orthopedic Institute. “HOI developed additional detailed procedures to ensure the safety of our patients and caregivers, and we believe our commitment to safety, coupled with our continued excellence in outcomes, is why HOI is ranked so highly among premier orthopedic hospitals across the nation.”
As part of the enhanced recovery process HOI developed, orthopedic surgeons evaluate each patient’s medical condition before surgery, and patients with no active or controlled medical issues are determined safe for the program. The length of stay for many patients has been shortened due to the enhanced process and today, the patients who go through HOI’s enhanced recovery protocol spend an average of 6 hours in the hospital after their surgery before going home.
“Patients must have social support, so they can return home safely, and they must have assistance for the first few days following surgery,” Dr. Nassif said. “Those who do not meet these criteria follow the standard surgical process and spend one night in the hospital.”
HOI’s patient outcomes have supported these efforts. Nearly 2,000 patients have experienced this unique program, with approximately 90% meeting the criteria for safe discharge on the same day of surgery.
“Patients did well after going home and experienced minimal complications,” stated Dr. Nassif.
HOI’s complication rate is also one of the lowest in the nation at 1.4% and significantly better than the national average of 2.4%. This complication rate is similar to or better than HOI’s outcomes for traditional joint replacement surgeries.
Specific pre and post-surgery guidelines were developed by the HOI team to facilitate an enhanced patient experience. The modifications include improved preoperative hydration to reduce nausea, improved pain protocols, and elimination of catheters and drains. These changes have helped to decrease pain and complications after surgery. In addition, at-home physical therapy begins the day after discharge, and patients have multiple follow up appointments at their surgeon’s office to ensure they are healing appropriately.
It’s important to note that although same-day discharges have been described for nearly a decade, the move to increase joint replacement procedures in the outpatient setting has been accelerated by the Center for Medicare Services (CMS), which moved to allow total knee replacements to be performed as an outpatient starting in 2019, and total hip replacements in 2020.
Recognized Excellence through Outcomes and Patient Experience
In addition to leading in outcomes, volume and lowest complication rate, HOI continues to be recognized for orthopedic excellence and patient experience. HOI recently ranked in the Top 2% of orthopedic hospitals across the country and #1 in Orange County by U.S. News & World Report’s Best Hospitals List 2020-2021.
HOI also received three Press Ganey awards for patient experience including, the Guardian of Excellence® for Patient Experience for the seventh consecutive year, the Pinnacle of Excellence® for Patient Experience in HCAHPS for maintaining consistently high levels of excellence over multiple years, and the Pinnacle of Excellence® for Patient Experience in “Inpatient” for maintaining consistently high levels of excellence over multiple years.
Additionally, HOI is the only hospital in Southern California to receive a five-star rating for patient experience from the Centers for Medicare & Medicaid Services (CMS) after a nationwide assessment through its recent Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star ratings.
“We are honored that our patients recognize our staff for their exemplary work and dedication to creating a patient-centered, healing environment at Hoag Orthopedic Institute,” said Jennifer Mitzner, CEO of Hoag Orthopedic Institute. “We pride ourselves in fostering a culture of empowerment and excellence to ensure each patient has the best outcome.”
For more information, call 888-813-2659.
