Hip and knee replacement is the most common major joint replacement—or resurfacing procedure—in America. There are currently approximately 300,000 total hips done and 600,000 total knees done in America each year. These numbers will increase dramatically in the next five to ten years; it’s estimated that they could go up 200 to 300 percent. We have an aging population, which is a primary driver of arthritis of the hip and knee, and [high] obesity, which greatly accelerates arthritis.
The Joint Commission is an arm of the federal government that certifies centers of excellence in healthcare. The Gold Seal of Approval is granted to an institution that can show that they are able to achieve certain standards [of care] and that they have verifiable processes that can reduce adverse events and improve quality and safety. This is the first year we’ve received this award and we’re the first hospital in Cincinnati to get it.
The Joint Commission asks you to pick some clinical quality, like preventing urinary tract infections. Then they survey everyone involved with patient care, from the janitors to the president, so that they know your methods and best practices permeate the whole institution. They’re very interested in how you recognize and solve problems. That’s what led me, in cooperation with the other doctors in the hospital, to invent this new initiative called “Zero in on Zero”—an initiative looking at the 10 most crippling and costly adverse events that surround total hip and total knee. We looked at the rate of these across the country, and we said: “Let’s have a zero rate at Good Sam.”
The doctors and staff at Good Sam agreed to create what are called “best practice bundles” around these problems. And we built a total joint registry, a database that captures key clinical information about a patient’s experiences, their implant names, serial numbers, all of that. We’re the only ones with a registry in total joint replacement in Cincinnati.
We can tell in six months: What really is the rate of transfusion? What really is the rate of infection? Our current blood transfusion rate is about 2 percent—nationally it’s 30 percent. The Medicare published literature rate for infection in total knee [replacement] is 1.55 percent; ours is zero percent for the last nine months.
So some of these things are really producing concrete results—they’re really exciting. The adverse event rates in Good Sam’s Total Hip and Knee Replacement Program are just as good or better than those at the Mayo Clinic or the Cleveland Clinic. We’ve had more success.
Illustration By Jing WeiOriginally published in the January 2012 issue.
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