2 August 2016

Better Pain Control Halves Length of Stay for Westside Regional’s Joint Replacement Surgery Patients

Jonathan Katz MD, a Sheridan Regional Medical Director and Chief of Anesthesiology at Westside Regional Medical Center in Broward County, Florida, and Eric Schiffman, MD, a board-certified orthopedic surgeon and fellowship-trained hip and knee replacement specialist, are the featured guests on a new episode of Dateline Health, a television show produced by Nova Southeastern University (NSU). Drs. Katz and Schiffman spoke with Fred Lippman, R.PH., Ed.D., NSU’s Chancellor of the Health Professions Division and the host of the show, about their extremely successful rapid recovery pathway at Westside Regional, which has significantly improved post-operative pain management and cut the average hospital stay for orthopedic surgery patients in half.

When Dr. Katz first arrived at Westside Regional about eight years ago, he identified opportunities to further improve the hospital’s already robust orthopedic joint replacement program. Back then, “total joint replacement was a tough operation. Patients would be in the hospital for five to seven days,” explains Dr. Katz. “Pain management was one of the major issues,” he says, because the pain medications used at the time had a number of side effects including nausea, vomiting and delirium that prevented patients from going home.

Dr. Schiffman made some recommendations that Dr. Katz discussed with the hospital’s team of orthopedic surgeons, whose collaboration was an important part of the new pathway’s success. Adaptations to the practice were made based on the best available evidence in the relevant medical literature. Then, they looked at ways to improve the experience of patients undergoing joint replacement surgery. Instead of looking at how patients were doing immediately following the operation, the doctors took a more comprehensive look at the entire patient experience and how it could be improved.

Together, they developed a start-to-finish pathway that begins three to four weeks prior to the scheduled surgery, when there is a discussion with the patient to set appropriate expectations and explain his or her role and responsibilities (with regard to pain management, physical therapy, rehab, etc.) in making their overall experience, recovery and outcome as positive as possible. The pathway includes the use of a multi-modal technique throughout the process, beginning with preemptive analgesia that includes medications given to patients in a preoperative holding area as well as nerve blocks administered by an anesthesiologist. At the time of surgery, Dr. Schiffman administers a non-narcotic, anesthetic “cocktail” around the surgical site that combines different medications to help control the pain, reduce blood loss and decrease inflammation.” Post-operative pain is managed effectively with minimal amounts of narcotics.

Dr. Schiffman, who hasn’t used a pain pump in five years, says improvements to the pain management process have dramatically enhanced recovery times and patient’s overall experiences with joint replacement surgery. Patients who had previous joint replacement surgeries are “shocked” by how little pain they have the next day and how quickly they are able to leave the hospital and return home.

Standardization and consistency are key aspects of the process at Westside Regional Medical Center, where joint replacement surgery patients now typically go home in three days or less. And bilateral hip surgeries are now an option, thanks to the hospital’s approach that makes it easier for patients to get around independently immediately after the surgery.

To learn more about these and other innovations in joint replacement surgery at Westside Regional, watch the entire interview with Drs. Katz and Schiffman.