1. Total Joint Efficiency Program Total Joint Efficiency Team Headed by Dr Melvyn Harrington 2006

2. Problem Statement  Objective to increase the Total Joint Program efficiency and quality of care  Background: Dr Harrington proposed to improve total joint efficiency through improving quality of care and increasing OR volume of cases. He communicated with fellow surgeons around the country to find out more about programs that have successfully organized efficiency programs.

3. Action  Dr Harrington and Paul Gorski initiated a Loyola Team trip to visit Dr Nimomiya’s benchmark joint efficiency program at Froedtert Memorial Lutheran Hospital in Milwaukee, Wisconsin, to learn about their program..  The LUMC team consisted of Dr Harrington, Dr Jellish, hospital administrators, surgical nurses, OR processing staff, clinic nurse, orthopaedic unit manager, social work, therapy department, and nurse practitioner.

4.  The Froedert Team was welcoming and had prepared presentations for a conference that reviewed issues that they had encountered on their journey to a joint efficiency program, and ways they solved their issues. Team members from both sides met and discussed their programs. The following day, the LUMC team went to the hospital and followed their respective counterparts to learn how they functioned. Tours were given and questions answered.

5.  Following this trip to Froedert, the Loyola team met monthly to discuss program actions and changes.  General Goals: Improve pain management, reduce length of stay, increase OR efficiency, and restructure the total joint class  Operational Goals: reduce length of stay, tray consolidation, complete 3 cases by 3 pm, and 4 cases by 4 pm.

6.  Dr Harrington gathered data on OR timing for room cleaning, wheels in/wheels out, preparation time, and skin to skin time. This data was used to assess for areas for improvement.  Central Processing worked to consolidate OR trays to reduce costs and time to turn around trays. 14 trays were reduced to 4 trays  Dr Candido and the anesthesia team worked to provide a new pain protocol to enhance pain control, reduce side effects, and help patients mobilize faster.

7.  Total Joint class was restructured to provide the same amount of information but in a shorter time, allowing patients to go to resident clinic for their history and physicals earlier in the afternoon.  Homecare and social work communicate patient needs earlier in the hospitalization which allows the homecare nurse and therapist to see the patient the day after discharge.  Therapy is seeing patients at their first visit on the day of surgery.

8. Successful Improvement  Prior to our Total Joint Efficiency Program (TJEP), the average LOS was 3.94 for both primary and revisions.  During the work of the TJEP Committee the LOS was initially reduced to 3.75.  Prior to the week of 8 ‑ 13, a new pain management protocol was developed by the TJEP Committee (special thanks to Dr. Candido). As a result of better pain management, the patient is able to participate with nursing and therapy more effectively on POD# 0. As a result, the LOS has dropped to 2.86. A LOS reduction of 1.1 days.  The 2.84 includes all primary replacements, revisions and bilateral replacements. All outliers are included in this total.

10. Joint Efficiency Success with a Little Help form our Friends  Goals achieved: Tray consolidation from 14 to 4 saves money and time  LOS reduced through better pain management.  OR turnover time reduced to achieve 3 cases done by 3pm each day  Next Goal: 4 joint surgery cases done by 4 pm! Increase the number of cases done each day