In late April 2014, Diane Desantis went out into her yard and raked mulch. In early May, she wore a pair of high-heeled shoes to a baby shower. Later in the month, she played a round of golf. These seemingly simple activities had been out of the question for the past two years.
With advanced osteoarthritis in both knees, Diane had been in excruciating pain and unable to live the active lifestyle she loved. Getting up and down the stairs at work became an unbearable challenge. A breast cancer survivor who had been through successful treatment at Massachusetts General Hospital, Diane turned to Andrew Freiberg, MD, vice-chair of the Mass General Department of Orthopaedic Surgery and chief of the Hip & Knee Replacement Service, for treatment of her knee pain.
Creating a Seamless, Coordinated Experience
Working with a team that included Dr. Freiberg, Kristin Wood, NP, and others, Diane had two total knee replacements: her right in February 2013 and her left 14 months later. During both procedures, Diane was part of the EXCELerated Recovery Joint Replacement Program at Mass General.
For Diane, being a part of this program meant that she was an active member of her care team. She was given information about what to expect every step along the way, from preparation to procedure to recovery, and the team had her engaged in physical therapy the day after her surgery.
“A physical therapist comes in the next day,” says Diane, describing her experience after surgery. “They say, ‘come on, we’re going down the hall,’ so we did. Later that day, we did it again, and the next morning, we did the stairs with crutches. It was a little scary for me, but the physical therapists are great. So I did it.”
Just one day later, Diane was discharged home to continue the healing process outlined in her recovery plan, which for her included working with nurses and physical therapists in her home three times a week for four weeks. The team helped her regain the ability and confidence to go up and down stairs, and they worked with her to increase the range of motion in her knee with each visit.
Rethinking Care Delivery
Diane’s experience reflects a larger effort at Mass General and the Massachusetts General Physicians Organization called Care Redesign. As a team leader of the EXCELerated Recovery Joint Replacement Program within this initiative, Dr. Freiberg is one of dozens of leaders throughout the hospital who are rethinking the way medical care is provided to our patients. They are bringing together teams of clinicians, administrators and support staff to closely examine the entire process of a procedure and identify ways to make it better—with measurable results.
“To me, Care Redesign means we’re improving how treatment is coordinated and how expectations are communicated to the whole care team, including the patient. This allows us to deliver the highest quality care,” Dr. Freiberg says. “Through the initiative, my team and I looked at the whole process a patient goes through—from being seen preoperatively to their anesthesia, surgical procedure, early recovery, hospitalization and follow-up—and made it more efficient for the patient, which improves both the timeliness and the effectiveness of their care.”
The EXCELerated Recovery team created new educational materials to better communicate what patients can expect. They modified care protocols to start physical therapy earlier for some patients and discharge them sooner, among other efforts to improve the entire experience.
Through these and other improvements, the EXCELerated program led to concrete and substantial improvements for patients receiving a total knee or hip replacement. Since its launch in 2011, the program has resulted in:
- More than 25% reduction in the average length of time patients stayed in the hospital
- A 6% increase in satisfaction, based on patient surveys
- An increase in the number of patients the program was able to treat each year
“The principles of Care Redesign can apply to any medical or surgical specialty,” Dr. Freiberg says. “You take a group of organized, dedicated people who are determined to improve every step and coordination of a process for patients, and you can see measurable results.”
Getting Patients Back on Their Feet Quickly
Like other patients in the EXCELerated program, Diane returned to Mass General for a follow-up appointment with members of her original care team four weeks after surgery. She proudly demonstrated the range of motion in her knee and expected to complete physical therapy within a few days.
She also wanted to make sure the team noticed she was wearing her high heels again.