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Orthopedic Complication Rate Reduction – A Joint Effort

The NKCH total joint complication rate now averages at just 2.2%, thanks to the efforts of the orthopedic quality committee, a multidisciplinary collaboration between the hospital, the ortho-spine surgeons and collaborating physicians. “Our goal was 4.1% for the 2015 Medicare population,” said Charles Orth, DO, FAOAO, the group’s quality chairman and an orthopedic surgeon with Orthopedic Surgeons, Inc.

“Exceeding our goal is directly related to the collaborative work done in our committee. We use data and evidence-based medicine for everything we do,” he said, “but we also look at how even the smallest process can impact patient care.”

Additionally, an in-depth, interdisciplinary chart analysis is completed on every case in which a patient was readmitted within 30 days or experienced a complication after a total hip or knee arthroplasty procedure. With NKCH performing more joint replacement procedures than any other hospital in Kansas City, according to Sept. 2014 HIDI data, this committee reviews a large percentage of metro-wide patients and reflects NKCH’s dedication to providing patient-centered care.

Ortho Chart_Complications

Current Initiatives

Each year, the committee reviews opportunities to improve orthopedic care, and physicians actively engage in processes to achieve desired outcomes. Recent accomplishments and activities include:

  • Pain modality. Pharmacy conducts ongoing pain studies to analyze pain management modalities including anesthesia options, nerve blocks and oral medications. “Each physician takes a different approach to pain management,” Dr. Orth noted. “We talk about our individual preferences, listen to each other and work toward common ground, with our patients’ best interests always in mind.” These conversations have led to standardization of pain management for total knee arthroplasty patients.
  • Presurgery screening. Patients attend a presurgery appointment with their hospitalist who assesses them, identifies comorbidities and conditions and helps tailor treatment to each patient.
  • Patient education. Patient education classes were reinvented to make them more concise and more frequent. Detailed information and resources were also moved online. As a result, patient participation, previously at 30%, has more than doubled.
  • DVT prophylaxis. Using evidenced-based data, risk factors are identified and modifications to online order-sets approved.
  • Postoperative pneumonia reduction. With the assistance of multiple departments, a process was developed that includes patient incentive spirometry training prior to surgery, same-day ambulation, as well as post-operative rounding.

The committee has expanded collaboration to include anesthesiologists, ED physicians, hospitalists, nurses, pharmacy, PT and pulmonologists. The group’s efforts have decreased complication rates and hospital-acquired pneumonia.

Ortho Chart_pneumonia

Unique Cooperation

The ortho quality committee is part of The NKCH Ortho/Spine Co-Management Company, LLC, formed to improve quality and efficiency of the orthopedic service line. It is an innovative approach to orthopedic care that is accomplished through a physician-led partnership between North Kansas City Hospital and 19 spine and orthopedic surgeons from several independent practices.

The NKCH Ortho/Spine Co-Management Company analyzes hospital-related patient safety and quality issues that directly and indirectly affect patient care. The cross-practice collaboration allows physicians to directly impact the care their patients receive. Global initiatives include:

  • Improving timely and accurate documentation
  • Improving coordination and standardization of care between caregivers
  • Decreasing complication and readmission rates
  • Incorporating evidence-based practice and peer reviews

NKCH Ortho/Spine Co-Management Physician Officers

  • Leslie D. Thomas, MD - Board Chairman (Northland Bone & Joint)
  • Christopher L. Wise, MD - Medical Director of Trauma (Drisko, Fee & Parkins)
  • James P. Reardon, MD - Medical Director of Joint Replacement (Northland Bone & Joint)
  • Stephen L. Reintjes, MD - Medical Director of Spine (Meritas Health Neurosurgery)
  • Charles Satterlee , MD - Finance Chairman (Drisko, Fee & Parkins) 
  • Charles Orth , DO, FAOAO – Quality Chairman (Orthopedics Surgeons, Inc.)

Ortho/Spine Co-Management

Physician-led Effort

“Orthopedic specialists contribute to the patient experience, Dr. Orth said. Every ortho physician is committed to implementing measures that result in the best outcomes for our patients. Our goal is to tailor our care to our shared patients, educate patients to reduce their anxiety and return them to their primary care physicians."

Charles Orth, DO

Charles Orth, DODr. Orth earned his medical degree and completed residency at the University of Health Sciences College of Osteopathic Medicine. He completed his internship at Tulsa Regional Medical Center. He is Clinical Professor of Surgery at Kansas City University of Medicine & Biosciences. Dr. Orth’s medical interests include total joint arthroplasty and sports medicine injuries and treatment.