Orthopaedic Nursing最新文献

Orthopaedic outpatient surgery in the form of Ambulatory Surgical Centers (ASCs) continues to rise over the past several decades with enhancements for the patient and organization that includes ease of convenience, efficiency, and cost-effectiveness when examining the comparison to a traditional hospital with outpatient departments (Wang, K. Y., Puvanesarajah, V., Marrache, M., Ficke, J. R., Levy, J. F., & Jain, A. (2022). Ambulatory surgery centers versus hospital outpatient departments for orthopaedic surgeries. Journal of the American Academy of Orthopaedic Surgeons, 30(5), 207-214). Furthermore, the rise of ASCs also includes various ownership models such as a sole physician, ASC management company, or a health system, which also commonly results in a blend of all three elements based on the strategy of the group. The purpose of this brief is to examine the unique delivery role that durable medical equipment (DME) plays in the care for patients following an orthopaedic surgery at an ASC when providing DME by Certified Athletic Trainers. Optimizing Certified Athletic Trainers in the ASC space creates opportunities for improving patient satisfaction and surgical staff burden while adding revenue to the ASC.

Total joint arthroplasty (TJA) procedures are being performed at higher rates at ambulatory surgery centers (ASCs) and outpatient hospitals as surgeries continue to progress with minimally invasive approaches. Reducing surgical costs without compromising safety and clinical outcomes are a few driving factors for utilizing ASCs. Similarly, there may be avenues to reduce the rehabilitative costs of traditional home healthcare. Research continues to support the need for early therapeutic interventions after TJA. Historically, patients undergoing total joint replacements have been discharged to a skilled nursing facility or home healthcare. With the frequency of TJAs performed as outpatient procedures, there is an opportunity to change the dynamic of postoperative rehab. Advancements in surgery and anesthesia have led to optimization for TJA patients. As a result of advancements, implants are lasting longer so patients are considering replacements at younger ages. These factors present an opportunity to close a gap in the market, creating an outpatient home physical therapy program. During the initial phases of planning for total joint surgery, physical therapy in the home is initiated and scheduled prior to surgery. This mitigates variables that may affect delays in the rehabilitative process which can drive negative patient outcomes, dissatisfaction, and hospital readmittance.

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.