Lessons Learned

With over a year in operation as the pacific northwest’s first surgery center dedicated specifically to total joint replacement (TJR) and other complex orthopedic procedures, the surgeon-owners at Oregon Surgical Institute (OSI) have honed many new processes. These practices are related to patient experience and patient selection, accompanied by a common core of protocols across the board. Undoubtedly, these systems establish the center as a respected destination for high quality outpatient treatment.

Below is part 2 of a three-part series of our Q&A series between two of OSI’s partner surgeons, Dr. Jim Ballard and Dr. Chris Nanson. In part 1, we learned about their experiences opening OSI and today we will learn the differences between ASCs and hospitals when it comes to patient selection, experience and outcomes.

Question: What patient selection/education process is in use at OSI?

Answer: “Because we’re not operating within the hospital, we have a fairly comprehensive list of disqualifying factors,” says Dr. Nanson, “They need to be healthy, any chronic conditions need to be controlled, and if there are any questions about medical fitness for surgery, we involve our anesthesiologists to help determine if the patient is appropriate for the ambulatory setting.”

In addition, beyond medical requirements, Dr. Nanson says there is a social piece to patient selection. “We require patients to assign a support system – a family member who will sign a coach contract. Also, we need assurance they have a safe environment at home. With outpatient, it’s very important to ensure they have support, transportation, and a good setting where they can safely recover.”

Medically, Dr. Ballard explains there is a surprisingly large segment of people that can undergo TJR in the ASC environment. “More than you would think; it’s not just for the super fit,” he added.

Question: How is the TJR patient experience different in an ASC vs a hospital?

Answer: A big part of the experience difference is the physical space.

“When you can bring them to an environment that’s beautiful, that’s obviously not a hospital, all the cues are different,” Dr. Ballard says “They feel so much better, they don’t feel like a sick person, they’re just here for the day. They get a whole different vibe. And that translates directly into how well they recover.”

Click here to read our white paper “The Case For Continual Innovation In Ambulatory Strategy” to learn more about the benefits and innovative practices occurring in ambulatory settings.

Another difference is the way patients interact with staff at OSI. “We get them involved in our GetWell Loop patient engagement software system,” says Dr. Nanson.  “It’s an app that pings them when they need to share information or take action pre-op, and serves as a portal for post-op communications, too. It’s a great way to involve the patients, and to serve them well even in a high-volume, outpatient center.”

OSI is the first ambulatory center in the nation to use the whole GetWell Loop program, which is a product from Zimmer BioMet. Dr. Nanson believes it helps patients gain confidence, engages them, and effectively triggers coordinators to reach out when a patient needs help. “It’s a great way to help make sure everything goes as smooth as possible, and to maintain control of the episode of care.”

Finally, since OSI surgeons are also owners, they can add personal touches to further differentiate the ASC experience. Dr. Ballard offers this example: when in recovery at OSI, every patient and their family is served food from a restaurant of their choice. In addition to a great meal, they have a chance to meet one-on-one with a physical therapist and interact with the total joint coordinators. “The OSI experience has been universally applauded by every patient we’ve had so far,” Dr. Ballard says.

Question: What advice would you offer to other doctors considering making the move to the ASC setting for total joint procedures?

Answer: Dr. Nanson: “I think the toughest thing is getting everyone to agree on a care pathway. And then, everybody on the team has to consistently help the patient know what to expect, what’s going to happen … everyone has to be on board.”

“Building a center like we have, from scratch, is a lot like building the next moon colony. I mean, it is complicated. Like any new business enterprise, it’s full of ups and downs, failures, and hiccups. You’ve got to be ready for that,” Dr. Ballard says. “If you can commit to that, welcome to the next frontier! We’re at an inflection point, and this is a paradigm shift. As a total joint surgeon, I know it’s going this way. It is just a matter of whether people will pioneer it in their area, or if somebody else will do it for them.”

To learn more about the trends shaping ambulatory success in 2020, click here.