Program meets needs of orthopedic surgeons

Physicians learn benefits of rehab

Before designing its Progressive Orthopedic Program (POP), staff at Columbia St. David’s Rehabilitation Center in Austin, TX, spent a lot of time finding out physicians’ needs and perceptions about rehabilitation. They designed the program based on physician input and feedback.

"We made them our partners, and that’s why they have bought into the program," says Laura Halliday, LMSW/ACP supervisor of the orthopedic program in rehabilitation.

Until the POP was developed, there were no set criteria for where patients were being discharged after joint replacement surgery. Different physicians had different philosophies about how patients should be rehabilitated, she says.

Some wanted their patients to receive rehab services in the acute care hospital and go directly home, but payers were not willing to keep patients there for as long as they used to, she adds.

Many physicians expressed concern about the cost of rehab, and many had a false perception about how much rehab costs, Halliday says. In the past, some orthopedic surgeons would attempt to save money by sending patients to the hospital’s skilled nursing unit, where they might stay two weeks or more.

Others were keeping patients in the acute care hospital seven to nine days, then sending them home with outpatient services. However, the acute care hospital costs twice as much as rehab because of staffing ratios, she points out.

A team of clinicians, nurses, program managers, and surgeons designed the critical pathways that include the POP. "We have looked at variances and revised it several times in the past two years. We took everybody’s feelings and philosophies into account," she says.

About 25 to 30 patients went through the POP during the first four months of operation.

The program runs between seven and nine days, including the acute hospital stay. Patients begin the rehab regime by getting out of bed and walking on the day of surgery. They exercise, practice ambulation, and have pool therapy while in the acute hospital. On day four, when they transfer to the rehab center, they begin working on activities of daily living, such as preparing meals and negotiating architectural barriers. They are discharged when they can function independently at home.

"Orthopedic surgeons have all been educated in the benefits of this program, and they are starting to use it. The numbers are increasing," Halliday says.

The marketing department calls on orthopedic surgeons in the area to promote the program’s benefits, and Halliday never misses a chance to sell the POP when she follows up with surgeons on a daily basis in the acute care hospital. "We discuss who is appropriate and who might be more appropriate for a longer stay in rehab."