Improvements in operating room efficiency expected with Biomet Rapid Recovery Program

Eugene S. Krauss, MD, who developed and was first to use the program’s protocols said each surgical step was designed to be logical and enhance safety.

When the Rapid Recovery Program from Biomet Orthopedics was originally launched overseas it consisted solely of protocols for improving preoperative, as well as post-anesthesia care unit or postoperative practices. While international surgeons told Orthopedics Today those practices have helped their patients recover from total joint replacement and led to more rapid discharge, Biomet officials recently added an intraoperative element to round out the program.

Being introduced in the U.S. market now, Biomet expects this new piece of its program will increase operating room efficiencies to the extent that patients, the surgical team and hospital will quickly see benefits in terms of satisfaction, cost savings, better resource utilization and other improvements, according to Vice President, Marketing & Development, Knees and HCI at Biomet, U.S. Orthopedics, Todd O. Davis.

Rapid Recovery is Biomet’s brand name for its product that promotes using fast-track surgical principles during total hip arthroplasty (THA) and total knee arthroplasty (TKA) to better prepare patients for surgery, maximize efficiencies at all stages of THA and TKA, standardize pain management and promote early mobilization, he said.

Two installations

Davis told Orthopedics Today that orthopedist Eugene S. Krauss, MD, and Biomet collaborated to develop the intraoperative component of Rapid Recovery, the module that is now in use at Peconic Bay Medical Center in New York, where Krauss works. In January, 3 months after Biomet introduced the program in the United States, installation began at a second site — the Orthopedic Hospital at Parkview North in Fort Wayne, Ind., Davis said.

“These will be our premier sites where hospital administrators and surgeons can visit and spend the day, watching what Rapid Recovery has been able to do within those two institutions,” he said.

Biomet delved into this area because it had extensive experience on the patient education and other front-end aspects of THA and TKA surgery, as well as its back-end aspects that furthered the patient’s joint replacement experience. “The component missing in all of that was the operative piece,” Davis noted.

Based on aerospace principles

Krauss’ work came to the company’s attention in 2010, after he was selected to work with the United Kingdom’s National Health Service to reduce orthopedic wait-lists there by implementing a system to optimize operating room efficiencies.

Prior to his collaboration with Biomet on the Rapid Recovery Program’s operative module, Krauss tapped into his aerospace engineering background to develop a methodology involving the usual surgical steps of an orthopedic procedure. Essentially, he broke them down into quality-assured steps and then delegated their execution to specific surgical team members.

“Everyone on the team knows exactly what their role is and how they’re going to advance that surgery with each one of those steps,” Davis explained.

Reproducible, teachable

“When you have a reproducible program, quality goes up and costs go down,” said Krauss, who currently completes about 12 total joint arthroplasties 3 days per week.

Having used the principles behind the methodology for several years at three different hospitals, Krauss, and the hospitals with which he is affiliated, have experienced many key benefits of employing the intraoperative philosophies incorporated into Rapid Recovery, he said.

“The hospital administration has seen tremendous improvement in all the things they are looking for — better patient satisfaction, Press Ganey scores, decreased costs.

“Professional satisfaction also goes up. The doctors are happier. The nurses are happier. The PAs are happier,” Krauss said

Professional support

Concerning the impact of these operating room procedures on orthopedic surgeons, Davis said, “The typical operating room has a rotating team of people coming in and out. Maybe they did a spine case in the morning and now they are in the hip case that afternoon. Part of the Rapid Recovery philosophy is to have a dedicated team. What I think it means to the surgeon is they can invest the time and energy in training these people, which it is ultimately going to make their day better.”

Before implementing the program, Biomet’s Rapid Recovery team assesses each facility to understand its procedures and goals and then proposes changes that will work at each hospital. “This is not one size fits all,” Davis pointed out.

There are program models for sites with up to four operating rooms dedicated to orthopedics, which Biomet estimates will suit the needs of about 98% of U.S. hospitals, he added.

Implementing new processes

According to Krauss, the steps in the operative module have been shown to work in various settings. “Biomet has seen me do this for a decade and has seen it reproduced at other hospitals,” he said.

As a result, the company developed extensive educational and support materials for Rapid Recovery, including educators, nurses and technicians that work with the staff to implement the program, Krauss said.

Surgeons who want to spend a day observing the operating room efficiency portion of Rapid Recovery at Krauss’ hospital can do that, as hundreds of orthopedists, including President of the British Orthopaedic Association Peter K. Kay, FRCS, of Wrightington Hospital, have already done.

Making these changes and taking steps toward a more efficient and orderly operating room involves a three-way partnership between the manufacturer, the hospital and the surgeon. “It is a process, but it is not something you do alone,” Krauss said.

As of press time, dozens of U.S. hospitals had heard Biomet’s Rapid Recovery plan and some were at the contract stage, according to Davis. Eventually, Biomet may expand the program into other areas where it has a solid presence, such as shoulder arthroplasty, spine and sports medicine, he said. – by Susan M. Rapp

• Todd O. Davis can be reached at Biomet Orthopedics, 56 E Bell Drive, Warsaw, IN 46582; 574-371-3020; e-mail: todd.davis@biomet.com.
• Eugene S. Krauss, MD, can be reached at NY Orthopaedic and Spine Services, 833 Northern Blvd., Suite 220, Great Neck, NY 11021; 516-622-7990; e-mail: annboiallis@aol.com.
  Disclosures: Davis is a Biomet employee. Krauss is a paid consultant for and receives royalties for Rapid Recovery from Biomet.