About 40 years ago, surgery’s place was in the hospital, and it was common for patients to stay for days in recovery. In the 1970s, the concept of outpatient surgery was developed, and, since then, the Ambulatory Surgery Center Association reports they offer higher patient satisfaction scores, increased convenience and more efficient care.
This is not where outpatient surgery opportunities end for low risk patients, clarifies Dr. Vladimir Alexander, founder of Alexander Orthopaedics Associates. About five years ago, his orthopedic practice turned to an outpatient surgery model, but what makes it unique is the continuum of care it includes. In addition to the surgery team, physical therapy and other departments are on site. “When we control everything and keep it within our own entity, it allows the patient to feel like they have already signed on with where they are going to be with their care. It makes them a lot more comfortable,” he says.
Alexander said, in the last five years, he has seen his patients’ outcomes improve, infection rates decrease to zero and reduced procedure costs. He considers the reduced cost an aside to the benefits the program offers its patients. “The focus should be about great patient care and improving the patient care experience,” he said. “(This program) is really aimed at early recovery and focusing on patient care and what is best for the patient – not what is best for a third-party institution who is really interested in making money off facility fees.”
“We know what we are doing is right; we know what we are doing is safe, and our outcomes are phenomenal.”
Patient Experience and Processes
The program started with components from the Early Recovery After Surgery (ERAS) Program. “Once we figure out the criteria for making that process safe, we took all of that in house,” Alexander said.
Patients are referred to the facility by a primary caregiver, which is when they meet with one of the three orthopedic surgeons, like Alexander. The surgeon with work with the patient to discuss procedure options and realistic outcomes. After a procedure is scheduled, the patient will work with one of the four physician assistants on site to prepare for surgery.
The day of surgery, the patient will meet with the physician assistant and surgical team. After the surgery, the patient will return home with a capable caregiver, who can help administer oral pain medication and tend to their needs. A day after surgery, a surgeon or physician assistant they have worked with will make a house call to see how manageable their pain is, change wound dressings and look for any signs of infection. The same will be done a day later.
A week later, the patient will visit the facility for a follow up appointment. Physical therapy also begins at the facility with one of the four physical therapists.
What is missing from this picture is the hospital stay, reliance on overworked nursing staff to care for patients, high patient discomfort and increasing infection rates associated with hospital procedures and stay, Alexander said.
Since this program, along with other outpatient surgery programs, is still relatively new, data has yet to prove its effectiveness, but Alexander says in the next year or so, substantial data will have been collected and released. Until then, he says the larger facilities and reimbursement programs will be watching how patients are affected. “That’s okay, because we know what we are doing is right; we know what we are doing is safe, and our outcomes are phenomenal,” he said.
