By Michelle Price
UCBJ Managing Editor
COOKEVILLE – Getting patients prepared for total knee surgery is reaching new heights with the addition of CRMC’s new orthopedic nurse navigator. Cookeville Regional’s orthopedic surgeons, surgery department and the nursing floors have collaborated together to create a newer total joint program that has the patient completely in mind.
Melissa Thompson, RN BSN, joined the CRMC staff recently as an orthopedic nurse navigator. Her role is to launch the new Joint Venture Camp, a program designed to provide patients with the tools necessary to have a successful surgery and to have the best possible results in their recovery.
“Our goal is to improve the patient experience and part of that I think is decreasing their anxiety level and making sure they are prepared,” said Thompson.
Thompson is doing just that by working with patients well before their surgery. Her first in-person contact with a patient is at their pre-admission testing appointment where she reviews medications and evaluates patients based on any other conditions that the patient might have. Patients are then advised what medications to put on hold until after the procedure.
Patients are then scheduled for Joint Venture Camp where they receive information about surgery as well as nutritional instruction and physical therapy in a group setting. Thompson even goes over anatomy. She shows them pictures of what a normal healthy knee looks like versus theirs and tries to explain to them what’s going on in their body and why they’re having the pain that they’re having or the decreased mobility.
“I think the most critical thing in this program outside of the technology and how we do things is the education of the patients,” said David Phillips, director of surgical services. “I think that by far, by giving them the knowledge base of what the expectations are sets them up for success because the more knowledge that they have prior to surgery, the better prepared you’re going to be after surgery.”
Part of that education is one pre-hab visit with the physical therapist that they choose for their post-op treatment. The patient learns the exercises that they will be doing in rehab and is encouraged to be doing them as part of their preparation for their surgery. This preparation has been very successful.
“I had one patient that actually was a retired nurse and had a knee replaced eight years ago,” said Thompson. “She was having one replaced this time and she had got herself completely off of her cane by doing the exercises that we gave her and her booklet before the surgery.”
Thompson’s role as a coordinator between the orthopedist, the operating room and the recovery floor is designed to help the patient navigate the process more efficiently and with better outcomes.
“Basically, this program allows us to do total joints in a way where we could safely deliver exceptional care to these patients and get them out of the hospital faster,” said Phillips. “To do that it’s almost like you’ve got three wheels turning at the same time and they all have to be in sync…with orthopedists, the operating room and the floor. Orders have to be streamlined, our processes have to be streamlined and how we do things had to be streamlined in order to accomplish these goals.”
The process is working. In the past patients would be taken from recovery to the orthopedic floor to have a meal and rest for the evening before beginning to walk on the new joint. Now, patients are prepared for their recovery and know that they will begin walking within two to four hours. Some will even be able to leave the hospital within 24 hours of the surgery.
“We have seen presentations of other programs, that are doing the same thing we are doing, , that within two hours postoperatively the patients are walking down the hall with a walker, four hours after they’re walking down the hall without a walker and they’re walking up stairs,” said Phillips. “Ten years ago, you would be lucky if they did that on the first postop day., Now, we’re talking four hours after surgery they’re doing this.”
With the aging of the baby boomers who were much more active in sports and other activities than the previous generations, the number of total knee replacements is growing at an increasingly rapid pace. Between 2012 and 2015 data shows a 47 percent increase in the number of total joint replacements. That number is projected to explode with total knee replacements projected to increase by 457 percent over the next 10 years.
CRMC currently does between 15 to 20 total knee replacements each week. The orthopedic nurse navigator was a next step in allowing CRMC to meet the projected increasing numbers.
Outpatient total knee replacement surgery sounds like something that might be possible in 2030, but with the addition of the orthopedic nurse navigator, it could happen here within the next year or two, and it is projected nationally that by 2027, 50 percent of all joint replacements will be in an outpatient setting.
“We had a quasi-joint camp for a period of time to get patients out of the hospital in a few days after surgery, but now what we’re talking about is total knee replacements and them being done as an outpatient procedure, which is being done across the country,” said Phillips.
Not everyone is going to be able to go home the same day that they have total joint replacement surgery but the staff at CRMC is standardizing the treatment so that all patients go through the exact same process regardless of their health.
“Everybody gets treated the same,” said Phillips. “Everybody gets the same message about nutrition, about physical therapy. Everybody gets the same across the board, the labs were drawn the same and all of the joints that are replaced are the same.
“A lot of it is up to the patient,” added Phillips. “We just want to be there to support them and make sure that they have a successful joint replacement, that they’re in the appropriate rehab therapy program and they go home feeling prepared. How fast they get out, that’s up to them.”
CRMC and Tier One continuously strive to provide the community with an orthopedic program in the Upper Cumberland that is as good as one you would find in any large city.
“There’s so many things that we do here that are on the cutting edge, as far as the robotic surgery and the tourniquet less surgery,” said Thompson. “We’re doing so many different things in order to do better at managing pain, blood management and the patients are just really showing exceeding results afterwards. I mean they’re just they’re doing excellent.”
The advancements, such as the Stryker navigation, the Navio robot and the tourniquet less surgery technique, enable CRMC to provide a better surgical experience by lessening the amount of blood loss reducing the need for transfusions and reducing postop infections. The changes in techniques are another reason that patients are going home faster with better outcomes.
“The services we offer at Cookeville Regional are some of the current trends that are happening throughout the country,” said Paul Korth, CEO at Cookeville Regional Medical Center. “For us to stay on the cutting edge, conversations will continue to take place about the latest technology, procedures and processes to continue serving the community with the very best. The orthopedic nurse navigator program is a great asset to the joint program at the medical center, because it allows for clear communication and support throughout the whole process right here close to home. Traveling far away is hard on caregivers and the patient, so we work to ensure that they can receive the same services here that they can get in Nashville or Knoxville.”
After surgery is over, the navigator will continue to follow the patient to provide support, answer any questions, and provide a continuum of care to avoid preventable readmissions. Thompson stays in touch with each patient for 90 days post op to assist and encourage in the recovery.
“It’s so important for me to have that relationship with them and to be accessible, so they always have my phone number,” added Thompson. “They can call me anytime. I have my phone next to my bed, it’s always on and I let them know that. I always check up on them. I really want to them to know that I am here for them and that they can reach me at any point and I’m here for anything.”