Wednesday, January 11, 2012

Spotlight on Care Redesign Teams

Massgeneral Magazine Winter 2012

Trailblazing the Future of Care

In an era of economic challenge, Mass General sets the pace on redesigning patient care without compromising quality. Read more

Over the next decade, as a result of aging, obesity and an increasingly active senior population, it is likely that a million total joint replacements will be needed every year. The problem is that there are not enough orthopaedic surgeons to go around. Out of 500 orthopaedic residents annually, only 30 to 40 specialize in joint replacement. In the last two years, just one of 24 Mass General residents chose joint replacement as a specialty. The total joint replacement team led by Andrew Freiberg, MD, vice chair, Orthopaedic Surgery, and chief, Hip & Knee Replacement Service, is looking at strategies to reduce costs and improve access. One approach is to begin physical therapy within hours following surgery to help accelerate total joint replacement rehabilitation by one day.

The obstetrics care redesign team, led by Laura Riley, MD, MGH medical director of Labor and Delivery, is focused on reducing the cost of vaginal deliveries. With nearly 60 members, the team is analyzing ways to improve the efficiency and the quality of the care from the first prenatal visit to postpartum care and discharge. In the project’s second phase, the team will turn to patient education. The aim is to standardize information and deliver it in new ways (using the web instead of paper) to set clearer expectations about pregnancy and delivery. As with diabetes, group visits may provide obstetric patients with opportunities to learn from other women or develop a new skill such as relaxation techniques to reduce stress.

Improving the patient’s experience and decreasing costs from diagnosis to post colectomy are the goals of the colon cancer redesign team co-led by David Rattner, MD, chief, Gastrointestinal and General Surgery, and David Ryan, MD, clinical director, MGH Cancer Center. Communication is an important component of the team’s work. Colon cancer is especially complex, because patients enter the system in different ways, though gastroenterology, primary care and surgery. New checklists and guidelines help standardize the process regardless of how the patient came to the Cancer Center. To ensure that patients obtain the information and tests they need, a dedicated access nurse serves as a single point of contact. In addition, in collaboration with patients and families, the team developed educational materials and a patient compact outlining the responsibilities of the patient and the team.

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