Q: What sparked your interest in launching a total joints initiative?
Dr. Stoeckl — My background is in sports medicine, and the knee replacements I performed were primary an inpatient procedure. I was curious if they could be done safely and effectively in our practice's surgery center. I met with the center's clinical and business leaders to put a plan in place to make it happen.
Ironing out the pain control plan and figuring out patient selection are the relatively easy steps. The hard part is managing all the behind-the-scenes details.
Q: What puts surgical facilities at risk of events like these?
Dr. Stoeckl — Absolutely. I focused on a select group of knee replacement patients who I operated on at the local hospital — the ones who were doing really well post-op day 1 — and envisioned what we'd have to do to ensure they could be cared for in the outpatient setting.
Q: What's the first building block of a successful program?
Dr. Stoeckl — It's essential to first identify patients who are good candidates for outpatient joint replacement. You must assess their comorbidities, the amount of support they'll have at home during the post-op recovery phase and whether or not they're narcotic naïve.
Q: What type of patients are prime candidates?
Dr. Stoeckl — NPatients receive anti-inflammatories and we place abductor canal blocks, which provide good analgesia and let patients retain good motor function. Injections of bupivacaine liposome at the joint have been a huge part of our pain control success. We also administer tranexamic acid to decease hemarthrosis, which in turn lessens post-op bruising and swelling at the joint.
Q: So how do you manage patients' pain?
Dr. Stoeckl — Great teams know you have to practice together as a team, because you have to learn how to anticipate each other, you have to understand each other's body language and you have to understand how people are thinking. Great athletes don't practice on their own. They practice as a team. And great musicians practice as a team. The whole point with great sports teams and great orchestras is they work together so they can function effectively as a team. We don't do that in health care.