Re­cov­er­ing at home

Modern Healthcare - - NEWS - —Shelby Liv­ingston

To im­prove sur­gi­cal out­comes, save costs and en­hance pa­tient sat­is­fac­tion, Atrius Health nurses launched a pro­gram to en­sure most joint re­place­ment pa­tients re­cov­ered from surgery in their own homes rather than in costly skilled-nurs­ing fa­cil­i­ties.

Col­lab­o­rat­ing with nurses in Atrius’ home health unit VNA Care and with hospi­tal case man­agers, the nurses ini­ti­ated a team-based ap­proach that puts the pa­tient’s needs at the cen­ter of care from the start of pre-op vis­its to well af­ter the pa­tient is dis­charged from the hospi­tal.

“It’s very co­or­di­nated from the time of the surgery right down to the post-op visit, and it’s very con­cise and timed for these pa­tients,” said Michael Costa, the pro­gram’s nurse team leader.

Once a pa­tient is iden­ti­fied as a joint re­place­ment can­di­date, nurses work with the pa­tient to dis­cuss post­op­er­a­tive is­sues, al­le­vi­ate fears or con­cerns, and set ex­pec­ta­tions to re­cover at home af­ter the surgery. The nurse also pin­points any bar­ri­ers that could make re­cov­er­ing at home dif­fi­cult and would dis­qual­ify the pa­tient from the pro­gram, and re­lates those is­sues to the home health team.

Next, VNA Care nurses and phys­i­cal ther­a­pists ar­range a pre-op­er­a­tive home visit a cou­ple of weeks ahead of surgery to trou­bleshoot any bar­ri­ers to safe re­cov­ery and coach the pa­tient about self-man­ag­ing their care.

Once the surgery is com­plete and the pa­tient is sent home, a phys­i­cal ther­a­pist pays a home visit to start ther­apy and dis­cuss post-op care within 24 hours. Atrius uti­liza­tion man­age­ment nurses are on the phone with pa­tients soon af­ter.

Be­fore launch­ing the pro­gram, nearly 67% of Atrius’ joint re­place­ment pa­tients were dis­charged to a nurs­ing home af­ter surgery in 2013. In 2015, just 29% of pa­tients went di­rectly to a nurs­ing home.

For those pa­tients who were nec­es­sar­ily dis­charged to a skilled-nurs­ing fa­cil­ity, the hands-on care helped shorten their stay by an av­er­age of two days. As a re­sult, cost sav­ings from the pro­gram to­taled about $665,700 in 2016.

Just as im­por­tant: pa­tients are hap­pier. The pro­gram “pro­motes a higher qual­ity and lower cost of care for the pa­tients, and bet­ter pa­tient ex­pe­ri­ence over­all,” Costa said.

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