To get a sense of Sibley Memorial Hospital’s dedication to high value care, look no further than the orthopaedics unit. There, a two-hour joint replacement education class for patients considering or scheduled for hip or knee replacement surgery has helped streamline operations and improve patient expectations and satisfaction.

“We know from nursing literature that patients do better if they know what to expect, and you teach them,” says nurse practitioner Cathy Pulford, clinical manager of Sibley’s Institute of Bone and Joint Health. “If you can prepare them for their surgery, you eliminate a lot of anxiety.”

Pulford oversees three nurse navigators, who handle everything from soup to nuts to help get joint replacement and spine surgery patients safely to surgery and back home again. The nurse navigators reach out to each patient to conduct a detailed pre-surgery interview. Who is their primary care physician? Are they taking any medications for pain? How many stairs do they have to take to reach their front door or their bedroom? They ask patients what caregiver support they have available after surgery and inquire about their expectations. They also share the hospital’s expectations of patients.

“As partners in care with the patient, we really need to make sure that we’re all working together. It’s not just what a patient can get from us, it’s also what we expect from the patient,” Pulford notes. The information gathered is shared with nurses, the operating room and rehabilitation staff and others during weekly planning rounds so the whole team is alerted to potential needs during the person’s acute stay and discharge home.

Patients and their caregivers also are invited to the class, where nurse navigators go over what to expect in the hospital, how long patients will stay, what it will feel like after surgery, what type of pain medications they can take in the hospital, the side effects of those medications, and what to expect when they return home.

“Patients love having someone they can call and talk to, and some will call two to three times a day until their day of surgery just because they’re nervous, or they can’t remember what the last answer was,” says Pulford. Nurse navigators meet patients in the preoperative area as well. Patient satisfaction scores are in the 90s.

Since March 2017, the orthopaedics group also has participated in an Enhanced Recovery After Surgery (ERAS) plan, adapted from the gastrointestinal surgery group. The protocol includes medications given preoperatively and during surgery. In addition, patients are asked to drink 20 ounces of Gatorade two to three hours before surgery to enhance hydration and provide some carbohydrates, potentially reducing the need for pain medications and reducing gastrointestinal complications after surgery. The work has led to a statistically significant reduction in opioid use and improvement in functional outcomes, particularly for hip and spine patients, Pulford says.

While the hospital doesn’t get reimbursed for services like the nurse navigators or education classes, “we decided the investment is worth it because of the outcomes they bring,” says Caroline Shafa, Sibley’s vice president of operations. “We are uber-focused on our metrics, making sure that all of our outcomes are what they should be, and we’re providing care in the most efficient way we can.”