The ASC model is highly suited for joint replacement procedures because it efficiently manages the entire patient experience, from admission to discharge. Utilizing this model, Restore Orthopaedic Surgical Institute (ROSI) in Chadds Ford, Pa. ensures consistent, high-quality results and greater patient satisfaction by focusing on one area of orthopedics – total joint replacement procedures.
Becker's Healthcare recently spoke with two leaders from ROSI, Steven Dellose, MD, and James Rubano, MD, to learn more about how this hyperspecialized approach to orthopedics sets them apart from outpatient centers that offer a broader range of services.
Specialization brings increased consistency and efficiency
By focusing on one aspect of orthopedic surgery, ROSI has been able to invest in highly experienced and dedicated staff, clinically proven protocols and processes, and specialized equipment. This, Dr. Dellose explained, contributes to greater clinical outcomes.
"Performing the same cases over and over ensures consistency," Dr. Dellose said. "Studies show that higher volume is usually correlated with better results."
In a traditional hospital setting, physical and non-physical silos can make it difficult for staff to understand their roles and responsibilities. As a small, hyperspecialized ASC with two or three surgeons, ROSI's team multitasks while "staying on the same page," which supports optimal efficiency.
In addition to having a highly specialized team, all aspects of ROSI's operating model are designed specifically for total joint replacements. This includes care coordination, admission, sterile processing, nursing, anesthesia, and discharge planning. By creating a focused approach, teams across all of ROSI's operations can streamline care and create a more efficient experience for patients.
"Our detailed pre-operative assessment and optimization process is managed by a nurse and physician assistant who are directly involved in patient care," Dr. Rubano said. "This helps us avoid surgical cancellations and improves our awareness of patient-specific issues that could delay care either prior to or on the day of surgery. The same team follows the patient postoperatively and tracks outcomes with a tech tool used to provide education, information, and exercises. This all helps avoid day-of or post-operative complications, resulting in an overall positive patient experience."
Success is measured through patient satisfaction
Dedication to patients is a guiding principle for staff at ROSI. The surgeons closely examined the process and outcomes of their first 250 ASC cases to ensure their previous success in the hospital setting was reproducible in the ASC environment.
According to ROSI's data, all 250 patients went home the same day with only a 0.79% admission rate to the hospital and a 0.79% 90-day surgical complication rate. The average length of stay at the ASC was 4.82 hours and there were no deep vein thromboses/pulmonary embolisms. The team has now performed over 1,500 cases and ongoing data collection continues to reflect these early successes.
"Patient satisfaction is an outcome we're particularly proud of and being associated with Surgery Partners allows us to compare our performance with other centers nationwide," Dr. Dellose said.
ROSI innovates to support continued growth and top-tier outcomes for patients
ROSI evolves with changing times by leveraging new technology and embracing innovation for future development. That means continually adjusting the outpatient total joint replacement experience to improve results.
"We understand the importance of optimizing operating room utilization, attracting and retaining highly qualified and motivated staff, and identifying and improving inefficiencies," Dr. Rubano said.
One key for ROSI's leadership to sustain growth is their continued focus on fostering relationships with payers through value-based models.
Dr. Dellose also underscored openness to learning and change while adopting solid principles and protocols as critical to success.
For ASC administrators interested in specialized joint replacements, Dr. Rubano encouraged careful consideration of three key factors. "Successful same-day discharge in the hospital setting should be accomplished before venturing into the ASC setting," states Dr. Rubano. "Although it can be difficult, hiring staff with experience is also essential — especially for leadership positions. And lastly, the importance of a highly- talented anesthesia team can't be underestimated."
Outpatient total joint replacements are safe and effective, with lower complication rates and improved patient satisfaction. ROSI's hyperspecialized approach to these procedures provides a unique experience for patients as they become part of ROSI's team in delivering high-quality outcomes — and it's equally satisfying for physicians.
"It's rewarding taking care of patients with joint pain," Dr. Dellose said. "Most patients are thankful to get back to doing what they love and most times the procedure is life-changing for them. This is why I chose to specialize in total joint replacements."