WALLINGFORD, Connecticut — At its 101st Annual Meeting on Thursday, June 20, 2019, the Connecticut Hospital Association (CHA) recognized Norwalk Hospital with the 2019 John D. Thompson Award for Excellence in the Delivery of Healthcare Through the Use of Data for improving the integration of care for patients receiving joint replacement surgery by implementing a Total Joint Replacement Destination Center of Excellence. The goal was to improve key program metrics: length of stay, discharge home, and patient satisfaction.
Watch this short video about the Norwalk Hospital Joint Replacement Center.
“Norwalk Hospital demonstrated that its patient- and family-centered multidisciplinary approach, along with applying best practices and reducing variation, led to better outcomes and greater patient satisfaction,” said Jennifer Jackson, CEO, CHA. “Norwalk uses data to both measure and drive the program’s success. We are proud to honor Norwalk Hospital with the John D. Thompson Award.”
Prior to developing and implementing the Destination Center in 2012, Norwalk Hospital’s patient satisfaction scores were not optimal. The vast majority of patients were discharged to extended care facilities, length of stay was higher than the national average, and surgeons followed varying protocols.
The hospital’s overarching operational goal was to create a cohesive patient experience. This required establishing a dedicated, multidisciplinary care team whose members were the architects of the new program. Surgeons set aside personal preference to formulate standardized care pathways, which required consensus on surgical dressings, medications, precautions, and equipment. The team developed robust protocols for surgical site infection (SSI) prevention, pre-operative medications, and blood utilization.
A framework of program messaging was established, beginning with the simple expectation that patients should return home after surgery. Patients and caregivers were educated on what to expect; this is a highlight of the program, and the hospital identified a direct correlation between patients and caregivers who attended pre-op class and those who returned home, had good clinical outcomes, and reported high satisfaction.
A cohorted care unit was created, staffed exclusively by specialized team members, enabling Norwalk to offer a consistent, reproducible, high-quality experience. The hospital also advocated for non-opioid pain management options and agents to minimize nausea and intraoperative bleeding. Over time, these interventions decreased complications, transfusions, and days in the hospital. The hospital also executed a culture change of nurse-driven early and frequent mobility, and integrated the assistance of a patient navigator.
Multiple measures of patient care are monitored. Each quarter, data are extracted and validated. Outliers are investigated by the Orthopedic Program Coordinator through individual chart audit to identify trends. Press Ganey patient satisfaction survey scores are uploaded into the dashboard. ChimeData is reported during quarterly dashboard data reviews conducted with the surgeons, the Performance Improvement Team (PIT), leadership, and key stakeholders. The data dashboard and ChimeData provides transparency and validity in reporting that drives key performance improvements.
In 2017, five years after the Total Joint Replacement Destination Center of Excellence was implemented, the program achieved 75th percentile ranking among a database of 300 top-performing hospitals in six key performance metrics: discharge home, length of stay, readmissions, blood transfusions, distance walked, and overall satisfaction. The program has sustained this high performance level through data transparency and team engagement.