Collaborating to Improve Patient Access
What happens when one system member has more patient demand than it can accommodate, and another member can meet that demand?
D-H has been monitoring access to inpatient beds and operating room availability for some time. Last year, APD had an excess of both, so the two system members formed a combined D-H and APD Steering Committee to seek out a common solution.
Upon approval to move forward, Daniel Herrick, vice president of Perioperative Services at D-H and Gretchen Rutherford, associate vice president of Perioperative, Cardiopulmonary and Sleep Services at APD, considered how to leverage APD’s strength to address D-H’s access issues. Enter orthopaedic surgeons Michael Sparks, MD, and Wayne Moschetti, MD, MS, who see clinic patients at DHMC.
“Doctors Sparks and Moschetti would meet in my office on Thursdays at 7 am, and we’d toss ideas around with Heidi Boutilier and Heather Bonneau, our OR and Same Day/PACU managers,” says Rutherford. “We knew we were going to do total hips and total knees. What instruments would we use, given that D-H and APD use different types? Would we buy or borrow needed equipment? Now that APD has adopted eD-H (the electronic health record system), how will we schedule the patients? Who will conduct pre-admissions testing? I was impressed that the surgeons wanted to ensure their standards of care were being met, yet were sensitive to encroaching upon the culture at APD and especially our existing Orthopaedics practice.”
APD’s already robust Orthopaedics Department includes John Houde, MD, Diane Riley, MD, Leonard Rudolf, MD, and Ivan Tomek, MD. The department has recently added Tim Lin, MD, who performs surgeries at both APD and D-H. All five spend time in APD’s Orthopaedic Clinic, together with three physician assistants providing high-quality, personalized care for diseases and injuries that affect the body’s musculoskeletal system. Due to the high volume of orthopaedic surgeries already done at APD—including 400 hip and knee replacements a year—the perioperative staff was well equipped to handle the volume and acuity of the D-H orthopaedic patients.
Rutherford and her colleagues assembled a team made up of representatives from each area needed for the project. In addition to the surgeons from D-H, members included administrative, clinical, quality and scheduling; and from APD, physical and occupational therapy, care management, inpatient, perioperative services, radiology and orthopaedic services. D-H’s Joel Preminger from the Value Institute provides ongoing expertise supporting LEAN and quality initiatives.
“We knew we needed to thoroughly examine every aspect of the partnership,” says Moschetti. “We looked at everything from cements used, to drug timing, to what time patients need to prepare in order to come in on the day of surgery. D-H’s instructions to patients are different than APD’s. Their care on the recovery floor might be different than what APD’s staff were used to. We made sure everyone was aligned.”
After two months of preparation meetings every Friday, surgeries began on Tuesday, July 16, 2019. It was the first step in what everyone involved hopes will be a long, harmonious partnership. D-H's Department of Orthopaedics now has a block of time in APD’s OR every Tuesday, increasing patient access to these surgeons and filling up previously unused time. The project team continues to meet every Friday, reviewing what went well, what needs improvement and what issues may become concerns. “There have been a few minor hiccups, but the weekly meetings have been an extremely productive way to work through them,” says Sparks. He adds that “from this collaboration, we’ve seen tremendous opportunity for process change like expedited recovery that will ultimately benefit all parties, most of all, our patients.”
And what is the team most proud of now that the partnership is underway? “This is a great example of collaboration in the system,” says Herrick. “It shows how receptive the system is to member initiatives and how successful it can be for everyone.”
Thus far, patient reports are glowing. “It was a great experience,” says Greg Jackmauh, a recent patient of Sparks who received a total knee replacement in August. “Because of the small scale of APD, it felt very personal, like a private clinic. Everyone on the team knew everyone else, so there was a real sense of cohesion. Even my wife, who tends to be a worrier, felt cared for in the process.”