Dr. P. Brodie Wood, a board-certified surgeon at Olympia Orthopaedic Associates (OOA), is one of the busiest orthopedic surgeons in the country, performing over 1,000 total joint replacements every year. Previously, many patients opted for a longer stay in a hospital or skilled nursing facility after surgery, but COVID-19 has changed that preference. The clearest indicator is the number of outpatient surgeries Dr. Wood has performed in the past year. Before the pandemic, they comprised just 25% of his practice. In 2020, that number jumped to 75%.
“The pandemic has created an enormous tailwind for outpatient surgery,” says Wood. “It’s not unlike the transition to Zoom videos for conferencing. I don’t see this trend reversing.”
Even before statewide mandates, OOA had begun modifying surgical procedures and as the pandemic progressed, those modifications expanded. Aside from strictly adhering to PPE protocols, the staff have created a one-directional path from the pre-op station through the surgery ward to post-op. “That allows us to eliminate the risk of exposing other patients to family members,” says Wood. “I call the patient’s family immediately after surgery and we have a discussion and arrange for the patient to be picked up. It’s been a wonderful, streamlined process.”
The OlyOrtho team also adapted pre-operative and post-operative procedures to minimize risk to patients and staff. The biggest changes involve telehealth and how the medical team communicates with patients, according to Becki Taylor, RN, BSN, surgical services program manager at OOA’s Surgery Center.
“I do a Zoom class weekly to educate patients,” she explains. “That was a little challenging at first because not everybody was familiar with Zoom and some patients still don’t have internet access or know how to navigate the system. We also have a phone option for patients to call in and listen to the education piece. If they have any questions, I’m available to answer them.”
Before COVID-19, family members could accompany patients into pre-op and wait for them in post-op, but now all communication happens by phone unless the patient has a disability of some sort. “Patients are alone,” says Lynessa Sample, RN, preoperative/postanesthesia care unit lead. “I thought they would struggle with that a lot but they’ve been pretty understanding.”
Alisa Dietz, RN, postoperative/postanesthesia care unit nurse, agrees. “Everybody does well,” she says. “We try to communicate as much as we can to the family in the car, because we know they’re worried and patiently waiting. I interact face-to-face as much as possible. I’ll go out to the car to give the family instructions if I have time.”
Although the pandemic has been challenging for everyone, some benefits have come from it. Patients who previously traveled from outside the region or the state had to cram all their appointments in a short period. Now they can stay home, spread out their visits and achieve the same results through telehealth. “I think that access has increased for patients who normally had to travel long distances,” says Taylor. “They don’t have to leave the comfort of their living rooms to come in for a class because it’s all done virtually.”
The shift toward more outpatient surgeries has also been beneficial for patients, according to Wood, leading to lower costs, increased mobility in a shorter period and quicker recovery. “Outpatient surgery centers are markedly more efficient with care,” he says. “A patient comes in at 8 a.m. and by 1 p.m. they’re headed home. They’re walking independently, getting in and out of cars and navigating stairs. Those kinds of transitions to an ambulatory status might take 12 to 24 hours in the hospital.”
Being able to recover at home means more privacy for patients and the ability to medicate themselves when they need to. “They get better sleep,” says Wood. “They’re motivated to be active because they look around the house and see things that need doing, and they get up to do them.” Within two weeks of total knee replacements, most patients have nearly full motion, a result that would have been unheard of 10 years ago. Then, Wood notes, doctors were thrilled if full motion occurred within six weeks.
Outpatient orthopaedic procedures are also significantly less expensive. The Center for Medicare Management removed total knee replacements from the In-patient Only (IPO) list on January 1, 2020, at a 40% saving per surgical case for the federal government. Total hip replacements weren’t scheduled to be removed from the list until 2023 but with the advent of COVID-19, they were also allowed as outpatient procedures starting in January 2021.
Patients have responded positively to the shift toward outpatient surgery and the changes put in place to ensure their safety, says Caterlin. “After the year everyone has been through, they’re just so grateful to be here, getting their total joint replacement. It’s something they’ve been looking forward to and they’re thankful that we’ve stayed open and done everything we need to so we can be here for them.”