Knee replacement surgeries at Dartmouth-Hitchcock Medical Center and other hospitals across the country, including the University of Iowa Hospitals and Clinics in Iowa City, soon could be handled by a specialized operating room team as the result of a data-sharing project among health systems throughout the U.S. aimed at improving health care and lowering costs.
The Lebanon, N.H. hospital is among the founding members of a collaborative created in 2010 to analyze a range of high-volume, high-cost medical procedures and conditions and quickly spreading the word about which approaches result in the best outcomes and the lowest costs. Its findings on knee replacements were published last week, but several of the health systems already have made changes based on the results, said Dr. Ivan Tomek, a surgeon at Dartmouth-Hitchcock.
Dartmouth-Hitchcock has been considering a team-based approach for years, but the collaborative has finally given the idea a strong push forward, he said. While it's important that anesthesiologists, nurses and technicians be able to handle all kinds of surgeries, the data-sharing project showed that there are significant benefits to consistently matching knee surgeons with the same specialized team, he said.
Among the five health systems, the average time spent in surgery ranged from 80 minutes to 105 minutes, with the one health system that has a dedicated team having the shortest time. That is significant because longer time in surgery is associated with higher complication rates for patients. And shorter operating times may mean there's time to squeeze in one more surgery per day, Tomek said.
Tomek said he was surprised there was so much variation among the hospitals, given that they are all leading institutions. For example, the average length of time patients spent in the hospital ranged from three days at one hospital to just over four days at another.
The collaborative's report, published by the journal Health Affairs, does not identify which health system had which results, but Tomek said Dartmouth-Hitchcock was among those with longer hospital stays. But it already has reduced its length of stay by about half a day simply by spending a bit more time explaining to patients what to expect before, during and after surgery, he said.
"We've started conditioning patients to this timeline a little better, saying 'This is going to happen on day one, this is going to happen on day two,'" he said.
That's cut down on patients who spend extra time in the hospital because their family members didn't realize when they'd be discharged and thus weren't available to pick them up, he said.
Dartmouth-Hitchcock also will be implementing a model before surgery that's known as co-management, based on the approach taken by the health system with the lowest complication rate. That involves identifying patients with additional medical problems that could affect the surgery early on, and getting other departments involved from the start rather than waiting and saying, "Oops, something's gone wrong, let's get internal medicine in here," later, Tomek said.
The other founding members of the collaborative are: Cleveland Clinic in Ohio, Denver Health in Colorado, Intermountain Healthcare in Utah, the Mayo Clinic in Minnesota and The Dartmouth Institute for Health Policy and Clinical Practice.
Eleven other health systems also have joined and will participate in the upcoming projects. They are: Baylor Health Care System in Texas, Beaumont Health System in Michigan, Beth Israel Deaconess Medical Center in Massachusetts, North Shore-LIJ Health System in New York, MaineHealth, Providence Health and Services on the West Coast, Scott and White Healthcare in Texas, Sutter Health and UCLA Health System in California, University of Iowa Health Care, and Virginia Mason Medical Center in Washington.Next up will be an analysis of how the health systems treat diabetes, followed by heart failure, asthma, weight loss surgery, labor and delivery, spine surgery and depression.