John Muir Health Reduces Post-Surgical Complications By 32 Percent In Total Hip And Knee Replacement Patients

Walnut Creek, Calif. (May 28, 2013) – A study conducted as part of a John Muir Health care improvement project showed a reduction in postoperative complications by an average of 32 percent for nearly 700 total knee replacement and total hip replacement patients. The findings were presented recently at the 8th Annual Society for Perioperative Assessment and Quality Improvement Conference in Florida.

“Nationally, more than one million patients annually suffer from serious post-surgical complications,” said Doug Lange, M.D., orthopedic surgeon at John Muir Health. “These complications range from simple urinary tract infections to heart attacks, serious infections and death. The toll in patient suffering is staggering as is the unnecessary cost to the health care system.”

The pre-operation project improves the surgical process for patients by implementing a new standardized patient evaluation to identify potential risk factors for surgery and evidence-based best practices to reduce those risks. As part of the study, a group of patients were seen and evaluated using a standardized, medical evaluation process, much like a physical. The evaluation was administered by a nurse practitioner in a new, dedicated pre-operation clinic. Results were compared to a control group of patients who underwent the same types of surgery in the year immediately prior to the new clinic opening. No other quality improvement interventions were implemented between the two study periods.

“The process produces a standardized medical history and current physical condition and, if appropriate, the process can generate pre- and post-operative order set changes, such as medications and dosages, to minimize the chance of post-surgical complications,” said Dr. Lange.

Among patients in the control group, the perioperative (time of hospitalization for surgery through discharge) complication rate was 12.40. Patients going through the new pre-operation clinic process had a 32% reduction in perioperative complications (from 12.40% to 8.45%).

“The new process reduces complications and improves surgical outcomes,” said Dawn Knight, senior vice president of quality at John Muir Health. “Our work is supported by national trends in the emerging science of perioperative medicine, where there has been a tremendous surge in new information on how to better evaluate and enhance quality of care for patients.”

John Muir Health is one of the only community health systems nationally doing this type of perioperative work and is looking to expand the program to include other types of elective surgeries as well. The integrated health system is establishing a perioperative medicine service, which includes multidisciplinary rounding to check on all surgery patients, and expanded data monitoring of surgery patients to provide actionable clinical information back to physicians and staff.

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