New Step Joint Replacement Program, Concepts and Features Concepts: The Joint Replacement Unit at CMC is a Three Phase Rapid Recovery Program, which utilizes a combination of new surgical techniques, advanced education and therapy procedures that can potentially lessen traditional rehabilitation and shorten hospital LOS substantially. Features: The surgical techniques called Microplasty or minimally invasive joint replacement utilizes a shorter incision, which can reduce postoperative pain, blood loss, muscle disruption, hospital stay and rehabilitation. For the patient, this can also mean a quicker return to work and everyday activities. Dr. Schmaltz performs Microplasty joint replacement procedures and his typical hip patient has surgery on Monday and is discharged to home on Wednesday-Knee patient, surgery Monday discharge Thursday. The program uses preoperative education classes and materials (informational ”Guide Books”) to condition the patient before surgery. Adequate education and stated goals helps set the entire psychological aspect of the patient’s recovery. An educated patient has a better understanding of his or her roll before, during and after joint replacement. We schedule our preoperative educational sessions about 10 days to 2 weeks prior to surgery typically on Wednesdays in conjunction with the patient’s preadmission testing. This is done for the convenience of the patient in order to avoid an additional trip to the facility. Comprehensive Patient Guide Books. Informational guidebooks are made available to the patients. These are distributed though the physician’s office usually at one of the pre op visits. The guides are specific to hips and knees and have detailed information covering all of the 3 rapid recovery phases, 1. Preoperative, 6 weeks before, up to the day of surgery. 2. Hospital stay and 3. Post discharge. The Program Calls for a “Dedicated” Occupational and Physical Therapy Team. We enjoy having the same occupational and physical therapists assigned to the unit. They provide bedside therapy and they also develop a therapy plan for the patients based on their individual needs. The patient’s therapy continues after discharge at home. The home therapist supervisor reports to the physician on a daily basis. This combination of in house and home therapy affords a continuity of care that is extremely beneficial for the patient and is certainly one of the key components in achieving a rapid recovery. Dedicated Hospital Unit. New Steps is 14-bed joint replacement/spine unit located on the 5th floor. This unit has recently been expanded physically, from 9 to 14 beds and with the addition of staff (from D-5) we are open 24-7. This change has allowed us to accommodate more physicians and increase our census. At this point in time Dr. Alan Gillick has agreed to admit his spine and joint patients to New Steps, and we are actively working on an educational program to meet his patients’ needs. Dr. Edwin Malloy has also been scheduling his elective patients with us. Dedicated Nursing Staff. Most of our nursing personnel have been working on the joint unit since its inception. The staff who are new to us are all experienced orthopedic nurses with an interest and understanding of the New Steps program and its goals. Physician Leadership. Dr. Harry Schmaltz is our Medical Director and takes an active roll in the day-to-day workings of New Steps. He was certainly the driving force behind the development and implementation of the existing program. He is always available to the community for advancement of the program through education sessions as well as assisting CMC with marketing endeavors. Efficient Operating Rooms and Staff. On Mondays the OR has 2 rooms scheduled for Dr. Schmaltz along with 2 surgical teams. This accommodation allows for an efficient use of time and permits the physician to schedule additional cases. Pain Management. The unit places a very strong emphasis on pain management. The physician and staff work closely with the anesthesia department to develop methods that are both safe and effective for our patients. Most patients are scheduled for spinal anesthesia. This modality allows for early ambulation of the patient, an important component of the program. PCA pumps, nerve blocks, oral and IM medications are also utilized. Pre operative use of a Cox 2 inhibitor has also been found to be effective in reducing postoperative pain. Therapeutic gel packs are an excellent source of cold therapy. Daily Newsletters. Each patient is provided with a personalized newsletter. They contain helpful information the patient can use during his or her hospital stay. Standardized Physicians Orders. Preprinted physician orders are available. Joint Care Coordinator. Works closely with physicians and staff members to develop, implement and organize the joint unit. Make daily rounds with the physicians. Assist the patient and act as their advocate, before, during and after their hospital stay. Responsible for pre operative education programs. Liaison between the patient, the patient’s PCP, the patient’s surgeon and the hospital. Patient satisfaction tracking. Outcome studies. Assists with discharge planning. Quality improvement plan. Organize biannual reunion luncheons. Provide and distribute an elective surgical schedule to assist in bed management. Work with other disciplines, unit nurses and therapists, operating room and post anesthesia staff, anesthesia personnel, etc. Assist family members the day of surgery with questions and concerns. Social / Amenities The unit tries to have an ice cream social weekly and provides a Joint Replacement Identification Card and a New Steps logo T-shirt on discharge. Marketing CMC actively markets New Steps through the local and regional media, WNEP TV and others.