Orthopaedic Nursing最新文献

This paper will review special considerations for orthopaedic ambulatory surgery specialties in sports medicine, hand, foot and ankle, and spine procedures. Orthopaedic ambulatory surgery has seen a rapid increase in the number of cases that are being migrated from the hospital to the outpatient surgical setting. This rapid increase warrants a heightened awareness for special considerations for outpatient surgical procedures that include both patient and procedure alike. As patients become more complicated, so do the procedures that are being performed in the ambulatory surgery setting. Without recognition of special considerations for ambulatory surgery center (ASC) patients, especially in sports medicine, hand, foot and ankle, and spine procedures specialties, there lies an inherent risk that has the potential to be mitigated. Patient selection needs to be carefully considered when procedures are selected for the ambulatory surgical setting, in addition to considerations that include a multidisciplinary approach to care. Orthopaedic nurses play a vital role in the treatment and care delivery in the ASC setting and for sports medicine, hand, foot and ankle, and spine procedures. Each aspect of the care continuum needs to be considered to avoid adverse outcomes and patient safety-related issues.

Advances in minimally invasive surgical techniques, robotics, anesthesia techniques, and recovery protocols have been instrumental in shifting orthopaedic surgical care from the hospital-based operating room to ambulatory surgical centers. Outpatient surgical services are thought to offer a lower-cost model of care, reduced out-of-pocket expenses, more predictable scheduling, faster recovery times, convenience, and lower risk of nosocomial infections. With these known advantages, it is critical to examine whether this safer environment is accessible to all. Racial/ethnic and gender disparities have been well-documented in the inpatient orthopaedic environment and concern has been raised that the shift toward outpatient surgery could widen disparities and access to care. This article describes ongoing disparities in ambulatory orthopaedic surgery for racialized minorities, women, and people with obesity. Having experienced these disparities, many lack trust in health care providers and the health system. Approaches for addressing this mistrust to create meaningful patient-centered care are described.

Background: Over the past several years, there has been a focus on decreasing hospital length of stay after primary total joint arthroplasty (TJA). With the removal of total knee and total hip arthroplasties from the Centers for Medicare and Medicaid Services inpatient-only list in 2018 and 2020, respectively, the number of arthroplasties performed on an outpatient basis has dramatically increased.

Methods: A gap in quality was identified, as only 19% of primary TJA patients were discharging postoperative day 0 (POD 0) at our institution. Using the DMAIC quality improvement format (define, measure, analyze, improve, and control), we aimed to increase the number of TJA patients that discharge on POD 0 by 51% from 19% to 70% without adversely impacting 30-day hospital readmissions.

Results: Interventions were tested and refined based on learning curves and continuous process improvement. After 90 days, the improvement measure was remeasured. At this point, the rate of POD 0 discharge for TJA patients increased to 41%. At the second remeasurement (1-year post intervention), this increased to 71%. The balancing measure of 30-day hospital readmissions was unchanged.

Conclusion: Many factors must be considered when selecting patients for same-day discharge (SDD) after TJA. Regardless of SDD or overnight stay, patient safety should always be the number one priority. Our institution demonstrated that a post-anesthesia care unit-based TJA SDD program could be safely implemented without negatively impacting 30-day hospital readmissions. Defining clear objectives, having a multidisciplinary team structure, and engaging stakeholders regularly are all necessary to ensure project success.

Outpatient orthopaedic surgery necessitates unique requirements from anesthesia to optimize institutional operations, patient safety, and outcomes. Anesthesia involvement spans the entirety of the patient's perioperative experience, which is split into three phases: preoperative, intraoperative, and postoperative. A thorough anesthesia-specific workup is crucial to patient selection and creation of an anesthetic plan. The anesthetic interventions intraoperatively are varied and selected specifically for each patient. Recovery from anesthesia is guided by evidence-based criteria, followed by discharge education and a final assessment from an anesthesia provider. The future of orthopaedic surgery continues to trend toward ambulatory surgery, and anesthesia is adapting appropriately.

Nurses caring for pediatric orthopaedic patients in the ambulatory surgical setting must employ a comprehensive approach to care, integrating both clinical expertise and principles of growth and development. Therefore, this article offers a synopsis of the core considerations for providing holistic care to the orthopaedic pediatric surgical patient. It discusses strategies for addressing developmental and emotional needs, emphasizing the importance of age-appropriate care. Additionally, it explores essential evidence-based elements such as safety protocols and the critical role of family involvement. Recognizing the unique developmental, psychological, and physiological needs of pediatric orthopaedic surgical patients, this article aims to equip orthopaedic nurses with the essential knowledge and skills to provide holistic, patient-centered care. By ensuring age-appropriate care, orthopaedic nurses can foster a nurturing and compassionate environment that enhances outcomes for pediatric patients.

In this paper, we will describe a team-based care model using registered nurses (RNs) co-located in orthopaedic offices providing care management using billing elements of principal care management (PCM). RN-led PCM can be used to optimize the pre- and postoperative condition of our patients and support them and their families in ambulatory surgery centers and orthopaedic offices by providing care management (continuous monitoring, assessment, coordination, and engagement). Orthopaedic nurses can enhance our patient's ability to return to fully functioning lives after their orthopaedic procedures. Using a case, we will also describe the RN actions within PCM and methods of coding and billing to produce revenue to cover the costs of an RN in an orthopaedic office practice or other ambulatory settings.