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Using 32 new quality indicators can help TJR surgeons have more consistent results
OREF/CCJR Clinical Practice Award-winning paper offers guideline-like processes to improve results.
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A recent study has identified evidence-based preoperative, intraoperative and postoperative practices can help total joint replacement surgeons reduce complications and consistently deliver high-quality medical care to patients.
Nelson F. SooHoo, MD, and colleagues identified 32 total joint replacement (TJR) high quality-of-care practices including documentation of preoperative indications, adhering to intraoperative recommendations for surgical time-out protocols and routine use of postoperative clinical care pathways.
“This can help with the goal we all have of improving the quality of care by applying the best scientific evidence in daily practice,” SooHoo said at the 2009 Current Concepts in Joint Replacement (CCJR) Spring Meeting.
TJR guidelines
SooHoo received the first Orthopaedic Research and Education Foundation /CCJR Clinical Practice Award for the research seeking to develop a set of evidence-based TJR quality indicators.
He and a panel of nine experts used the RAND/UCLA appropriateness method to determine the 32 evidence-based processes for delivering TJR care. These are easy to perform and many resemble guidelines from the American Academy of Orthopaedic Surgeons (AAOS) and other organizations, SooHoo said.
Pre- intra- and postoperative
Preoperative practices identified for reducing TJR error rates were documenting appropriate indications for surgery, ordering appropriate lab studies and imaging, and complying with American College of Cardiology-American Heart Association risk stratification guidelines.
Intraoperative practices that panelists recommended were the use of surgical time-outs, the use of antibiotics consistent with AAOS guidelines and discussion of appropriate anesthesia options.
Based on SooHoo’s findings, standardized postoperative processes that promote quality care include having a written clinical care pathway, evaluation by physical therapy, multimodal pain management and adequate discharge planning and follow-up.
For more information:
- Nelson F. SooHoo, MD, can be reached at the University of California at Los Angeles, Department of Orthopaedic Surgery, 10945 Le Conte Ave., PVUB Suite 3355, Los Angeles, CA 90095; 310-267-5299; e-mail: NSooHoo@mednet.ucla.edu. His study was funded by an OREF grant.
Reference:
- SooHoo NF. Quality care indicators for patients undergoing total joint replacement. #72. Presented at the 10th Annual Current Concepts in Joint Replacement Spring Meeting. May 17-20, 2009. Las Vegas.