Probably the overriding biggest question was why would you NOT want to go to the hospital, which to me clearly is to avoid unnecessary tests and procedures.
At my hospital they require a Foley catheter for any male that has had a history for anything that has to do with his prostate, urine, kidney, bladder, etc. So, the patient has to have an unnecessary Foley. Unnecessary lab work. To have a machine that beeps. To have the nurse to wake you up to make sure you’re asleep. You have to hit the call button to go to the toilet. Patients don’t want that. We don’t subject patients with any other operation that’s considered an outpatient—your ACL, your gall bladder, your thyroid…we just don’t do that anymore. And that’s where total hip replacement is in 2017.
Moderator Thornhill: I asked one of the speakers here at another meeting…he’s a great educator, great teacher, great everything and good institution…and I asked him the question about education and he basically talked about the lack of support he got from his hospital. Sort of what Keith was saying…You get wakened up to see if you’re asleep and all the stuff. Is this a problem? What can you do as chairman of the department to make everything work perfectly for you and the patients at your institution?
Dr. Lieberman: Some of those are JCAHO laws that they must have. We checked into this because most of my joints go home the first day. So, we wanted to eliminate some of these blood pressure checks, but they’re JCAHO rules so maybe they should look at that. I think that is an issue. But I’m not sure that everybody wants to take their patient home. I’ve had a lot of patients say after the first night that they’re ready to go. I think that it’s fine if you’re going to do it, but you just need to set up a system as Keith has.
There’s one thing that Keith said that I think is the slippery slope here. He said if you don’t have any organs failing it’s okay to do it. I think we must be careful about that kind of stuff because the first thing you know it’ll be “Well, you only have one organ failing.” Or “it’s only two organs failing.” Or, “the organ is close to failing, but we’re going to be doing it.” I think need to watch that or we’re going to have trouble with some of these patients.
Moderator Thornhill: I’d just soon get off the subject of failing organs, so let me just go back. When you moved to the outpatient, were you pushed or were your pulled?
Dr. Berend: I was doing the pushing and doing most of the pulling. As I showed, the multiple stakeholders in this situation, and as Jay mentioned, with full disclosure there’s a significant benefit to me personally and there’s a significant benefit to the system to do this as an outpatient, so I was doing all the pushing and most of the pulling.
Moderator Thornhill: Thank you both for a great debate.
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Senior Editor: Jay D. Mabrey, M.D., whose 35 year career in orthopedics included residency at Duke University Medical Center, service in the United States Army Medical Corps, Fellowship at the Hospital for Special Surgery and a long, distinguished career at Baylor University Medical Center where, in addition to his overall leadership at that institution, developed the Joint Wellness Program that helped patients get up after surgery more quickly, developed the first virtual reality surgical simulator for knee arthroscopy and chaired the FDA Orthopaedic Device Panel, is Orthopedics This Week’s contributing writer and editor.
