Clinical practice Issue in the Organization’s Systematic Agenda
In today’s technology-driven health care environment, the emphasis on safety and efficiency is becoming increasingly important. The emergence of the outpatient total joint arthroplasty program (TJA) is a measure to lower the cost of health care by converting the patient category from inpatient to outpatient Mariorenzi et al., 2020). However, a 2015 report by the Centers for Medicare and Medicaid Services summed the cost of joint replacement surgery at over $6.5 billion for beneficiaries under Medicare, making it the most expensive procedure covered by Medicare in 2013 (Mariorenzi et al., 2020). Additionally, outpatient TJA in health care will continue to increase. Lovald et al. (2014) attribute this expansion to myriad factors such as the aging population, the growing obesity epidemic, and increased public awareness of the successful outcomes following joint replacement surgery. This paper aims to discuss the clinical practice issue of implementing a standardized pathway of identifying patients suitable for outpatient TJA. Furthermore, this paper intends to illustrate considerations for effectively getting the buy-in of stakeholders.
One of the recent hallmarks of change in the practice organization is initiating the outpatient TJA program after the team’s redeployment during the COVID-19 pandemic. As the volume of elective surgeries increased, the practice gap of identifying the right patient for same-day discharge TJA highlighted many safety and quality care issues. The lack of a standardized process or tools to identify these patients caused the increased length of stay, poor care coordination, space capacity issues, readmission, and patient and staff dissatisfaction. Outpatient Arthroplasty Risk Assessment (OARA) score is an effective tool to determine patient optimization for same- and next-day discharge after surgery ( Ziemba-Davis, 2019). In addition, leveraging OARA requires physicians and other stakeholders to establish and implement clear clinical guidelines such as providing the following in advance: home medication prescriptions, assisted devices, or web-based educational materials during preoperative preparations ( Ziemba-Davis et al., 2020). In addition, the success of this modality is a combination of strategies that include comprehensive patient instruction by physicians, nurses, and other stakeholders ( Bodrogi et al., 2020). While many factors are essential in determining the patient’s eligibility for outpatient TJA, such as medical history, physical function, and social determinants, patient safety is vital ( Bodrogi et al., 2020).
Strategies to inform and persuade stakeholders and persuade them of identified clinical practice issue
The role of DNP-prepared nurses is paramount in getting on the agenda at any level, in shaping clinical pathways, guidelines, and policies that impact patient care delivery ( Executive Producer, 2011). Using data on those outcomes such as length of stay, pain management, space capacity, and others using the outcomes of care due to lack of standardization of patient classification based on the risk factors can provide knowledge to the stakeholders to pilot the Outpatient ORA. It will require a lot of data and communication to share the information at different venues such as the patient safety medical committee, unit practice council, senior leadership meeting, case management, social workers, Rehab professionals, Pharmacy, and the nurses. Currently, I lead the High-Reliability Organization (HRO ) Safety Huddles to talk about safety issues, and we share our findings with the team; it takes a while but the goal of patient safety is worth pursuing
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