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The folks doing knee and hip replacement surgery at Bryn Mawr (PA) Hospital must be doing something right. For the second year in a row, the 330-bed hospital has been named "Best Performer" for operating room effectiveness and efficiency by OR Benchmarks, a Santa Fe, NM-based benchmarking company. The hospital was one of a dozen studied that provided data to OR Benchmarks on 51 cases of total knee replacements. Thus far, the company has collected data on 880 cases over the past five years. Data collected ranged from cost of supplies to use of clinical pathways.
Among the findings for the current year:
For total hip replacements, 19 facilities submitted 75 cases, bringing OR Benchmarks’ total number of cases over the last five years to 697. The findings in that study showed that the prostheses represented 81% of the total costs. Cemented implants most often are used in older patients where there might be fears of low bone density. Younger patients are more likely to get the more expensive noncemented models, in part, because they are more likely to need a new replacement later in life, and the noncemented versions are easier to remove.
Other findings include:
Robert Good, MD, chief of the division of orthopedic surgery at Bryn Mawr Hospital says his facility consistently fell at the low end in all of the key categories. But while the good performance at Bryn Mawr is a pat on the back, Good says he and his team need to look carefully at the data "to see what we can do better."
Good was particularly pleased with his facility’s turnover time and the low costs for implants that he had negotiated with vendors. "We have a real team effort here with administration, surgeons, and social workers," he says. "But I think we can do better in our turnover time. And there is a big problem with pain control, particularly in the total knee replacement." Another area he says could be improved is setting up better in-home and outpatient rehabilitation programs.
The whole report will be disseminated to key hospital administrators, orthopedists, and OR nurses. "You never really know how you are doing until you look at the data," he explains. "We used to do an operation for recurrent shoulder dislocation and thought patients did really well. But after five years, we decided to review the cases and found out that wasn’t true. You have to look at the data and reevaluate it. Just thinking you have an acceptable infection rate isn’t enough. You have to see how you compare to others."
[For more information, contact:
• OR Benchmarks, P.O. Box 5303, Santa Fe, NM 87502-5303. Telephone: (877) 877-4031.
• Robert Good, MD, Chief of Division of Orthopedic Surgery, Bryn Mawr Hospital, 130 S. Bryn Mawr Ave., Bryn Mawr, PA 19010. Telephone: (610) 527-2727.]