An Innovative Patient-Centered Total Joint Replacement Program

JAMES RICKERT |

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Total joint replacement surgery is among the most commonly performed inpatient procedures in the United States. More than 1,000,000 hip and knee replacements are performed each year, and, with the aging of our population, that number is expected to grow quickly. Despite the general success of such replacements, approximately 20 percent of recipients of well-done replacements are unsatisfied with their surgery, and unmet patient expectations for the procedure are typically an important cause of such dissatisfaction. In fact, one study found that the most important contributing factor to dissatisfaction following total knee arthroplasty was not meeting patients’ expectations. Furthermore, rates of replacement surgery continue to vary across geographic regions and by race, and these differences cannot be explained solely by differences in the prevalence of hip and knee disease. Research suggests the decision to proceed with joint replacement surgery may at times be more reliant on provider preferences than on objective criteria and patient preferences. A large 2014 study showed that when validated appropriateness criteria were applied to actual cases of knee replacement surgery, over one third of those procedures done in the U.S. were inappropriate.

Spotlight

Central Texas Medical Center

Central Texas Medical Center is a 178-bed hospital providing a wide range of healthcare services in San Marcos, Texas and neighboring communities. The hospital was established in 1960, and the present facility opened in 1983. In late 2009, CTMC completed a $35 million expansion and renovation on a 64,000 sq ft Women's Center that includes all private rooms, a Level II nursery and a new cardiac inpatient nursing unit with all private rooms. It also includes an on-site, high-risk delivery suite and a customized cesarean section suite.

OTHER ARTICLES

Health IT coalition to use data analytics in battle against COVID-19

Article | April 2, 2020

Healthcare organizations, technology firms, nonprofits, and academia are banding together to use their collective expertise, data, and insights for rapid deployment of innovative, open-source solutions to the global pandemic. The COVID-19 Healthcare Coalition, a private-sector led response, aims to mitigate the worst effects of the coronavirus by flattening the curve. A key component of this effort will be the use of real-time data for analytics that will help preserve the healthcare delivery system. LUMEDX client partners HCA Healthcare, the Mayo Clinic, and Intermountain Healthcare have joined big tech companies such as Amazon, Google, Microsoft, and others. For a full list, visit the website here. All coalition work is voluntary, and members are asked to pledge open cooperation and sharing. In addition to combining the best sources of information from around the world to provide data, analytics and insights to all, the coalition’s priorities include

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Danny Cain discusses safety considerations for night-time transport projects

Article | April 2, 2020

© 2019 American Cranes & Transport Magazine. Night moves Moving over-sized, over-dimensional loads during the day is no easy task. Adding darkness and poor visibility to your trip adds numerous hazards that must be thoroughly identified and mitigated. When planning a specialized transportation project, there are three primary objectives: Ensure the safety of the transport crew and the general public. Protect the integrity of the cargo and transport equipment. Protection of Infrastructure – roads, bridges, traffic control devices, utilities and the like. For the most part, specialized carriers perform night transports to reduce the impact on day-time commuter traffic. Route challenges – construction, road closures, lane crossovers, bridges and other obstacles – are often better solved at night. Police and utility support are often more readily available at night. Night transport hazards include employee fatigue, slowed reaction time and poor visibility for both the transport crew and motorists. Decreased visibility increases potential for trips, falls, runovers, back overs and equipment strikes. It can’t be emphasized enough how critically important it is to ensure that all transport crew members have had adequate rest for these projects. Workers need complete rest before the transport takes place. A fatigued worker is a danger to himself as well as his fellow crew members. And while impaired drivers can be out on the streets during the day, there is often an increased number of these drivers on roadways at night. Limited visibility is a given when it comes to night-time transports. Limited visibility increases the chance of going off route and striking objects, and the transport driver’s maneuverability and reaction time maybe be reduced. Road conditions can abruptly change during a night-time transport. Therefore, it is critically important to know the route and to have drivers run it in advance. Statistically speaking, accident frequency increases when the transporter goes off route and attempts to correct itself. While providing the necessary lighting to make night transport is important, artificial lighting can pose visibility hazards, especially to the drivers. Other hazards may include bright work lighting that produces glare. OSHA has identified the “Focus Four” accident events that make up the most serious injuries and fatalities in the construction business. They are also known as the “Fatal Four.” Many carriers have had employees injured in the past as a result of one of these four incidents. Caught-in-between hazards are injuries resulting from a person being squeezed, caught, crushed, pinched or compressed between two or more objects or between parts of an object. This is also referred to as “pinch points or entrapment.” As the transporter navigates its designated route the landscape is continuously changing. It is imperative that all ground crew members maintain situational awareness and not place themselves between the moving transporter and fixed objects such as guardrails, parked vehicles, buildings, etc. Struck-by hazards are injuries produced by forcible contact or impact between the injured person and an object or piece of equipment. There are many potential struck-by hazards. Guide wires that must be raised can snap and strike workers on the ground. Tag lines should be used to control loads. The primary purpose of using tag lines is to control the load but more importantly give the worker a safe buffer distance away from suspended and the uncontrolled movement of these loads. Fall hazards are anything that could cause an unintended loss of balance or bodily support and result in a fall. To prevent fall hazards all workers should have either fall prevention or a means of fall protection in place. As a rule, 100 percent tie off is required when using a fall arrest system (FAS). FAS’s should be thoroughly inspected before each use. Electrocution hazards result when a person is exposed to a lethal amount of electrical energy. Maintaining minimum approach distances (MAD) is a critical safety practice. As everyone knows, equipment does not have to physically make contact with energized equipment or lines to cause serious injuries and even death. Electrical energy can “jump” from lines into equipment that has encroached the Minimum Approach Distance based on its voltage. As noted above, it is critically important to ensure that crew members have had adequate rest and are not fatigued. Night transports are difficult enough, and the last thing you want to introduce are tired and fatigued workers. Being fatigued creates a risk for anyone who undertakes an activity that requires concentration and a quick response. All companies should have an “Hours Worked Policy” that clearly spells out the number of hours allowed to work before a mandatory rest period. This policy should ensure that the transport crew has had adequate rest during day, that a fatigue assessment is conducted on all team members, that crews are never allowed to work double shifts and that employees are prohibited from driving long distances to return home. Dealing with darkness Visibility and slowed reaction times should be a part of the project planning. A limited amount of ambient light that only projects upward and outward impedes vision and increases blind spots for drivers. Lights cast shadows, increasing the potential for slips, trips and falls. All transport moves should establish pre-planned Emergency Action Plans. When an emergency occurs, time is of the essence and can mean the difference between life and death. If it is a long-distance move the emergency numbers and first responder information can change. Crews should know when it’s time to seek emergency “safe harbor.” When approaching overhead obstructions such as guide wires, electrical lines, communication lines and overpasses, travel speed is of utmost importance. Again, pre-route surveys provide advance knowledge of obstructions. At night, visual identification of roadway obstructions is reduced and delayed and last second reactions to oncoming hazards can lead to accidents. Support personnel in bucket trucks also have the challenge of reduced visibility. In darkness, overhead hazards often require more utility support for height clearances, which means the need for raising energized lines, lifting traffic control devices, trimming tree limbs, releasing tension on guide wires, removing highway signs, repositioning street lights and raising railroad crossing arms. Traffic control can also create hazards. The general public may ignore pilot car lights at night, so it’s often advisable to also use police escorts. All support vehicles and trucks should be properly marked and equipped with strobe lights. The configuration of the transport system can also be a hazard. Navigating sharp turns or crossovers is greatly reduced based on the length of transporter. Snake-like maneuvers of trailers pose an increased risk. It’s important to never allow personnel to take shortcuts by walking through or under transporter while it’s in motion. Stop or have the worker go around. Situational awareness The transport crew must always maintain “situational awareness” to prevent being in line of fire or entrapped between moving and fixed objects. All the equipment used in the transport must be deemed safe. You should have procedures to conduct thorough assessment of all new equipment. Ensure machine guard devices are in place especially around moving components. Provide secured areas using catwalks/railing system. All steps should be designed with slip resistant material. Ensure that all deck openings are properly protected and covered. Components that hydraulically extend and retract should be clearly posted with DANGER signs. Roadway conditions are always a bigger concern at night. Assess weather conditions prior to start of the project and don’t take chances. A “Go – No Go” criteria should be developed for each project. Once the decision is made to transport the load there is no turning back. Changing weather can cause the transporter to lose traction. Underpasses that are shaded during the day will likely freeze up more quickly. If the temperatures drop significantly during the move, equipment performance may be affected – especially those with hydraulics. Because the reaction time of the transport crew is reduced, speeds are often reduced, causing potential for curfew violations. Boarding and deboarding the transporter increases risk for slips and falls. Other potential road condition hazards include grade of road, width of road, shoulder surfaces, railroad crossing clearances and bottoming out, overpasses, tight and narrow turning lanes, parked vehicles and frequent grade changes. Crew prep is essential and should be a part of the job plan and job training. The team should be briefed each day to identify the responsibilities of all crew members. The crew should know it is empowered; everyone has the authority to stop the transport if something looks unsafe or when someone is unsure. In the event of a complication, crews should be informed of how to regroup and formulata mitigation plan. There should be an established means of communication that is limited only to transport issues. Most importantly, crew should embrace these words: When in doubt, call time out! A Task Hazard Analysis (THA) should address all scope of work activities, identify hazards and have a mitigation plan for each, clear channels of communication, the traffic control plan and an “Emergency Preparedness Plan.” And finally: Know the route; ride the route and expect the unexpected. Edwards-Moving_Faktor-5 (2).jpg Edwards Moving performs a night move using it’s Goldhofer Faktor-5 transport system. Keys to a successful night transport Early planning and attention to detail. Anticipate roadway hazards such as guardrails, poles & hydrants that pose obstruction with travel path or turning radius. Preparing a detailed traffic control plan. Thorough due diligence throughout scope of work. Established contingency plan for equipment.

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The innovations bridging health sciences and business in 2020

Article | April 2, 2020

The decade’s first global health crisis has placed the spotlight on the need for healthcare technology that can prevent and solve the world’s critical health challenges. This last week, Microsoft shared progress on innovations helping to meet these objectives. Today, we’re spotlighting intelligent health and business solutions from Microsoft Business Applications that empower health providers to help transform operations and deliver better patient experiences, better insights, and better care. Healthcare organizations are leveraging Dynamics 365 and Microsoft Power Platform to improve both provider operations and patient outcomes. These customers are prime examples of our focus to enable tech intensity across healthcare, empowering organizations to develop their own digital capabilities that use data and AI to address challenges and tackle new opportunities. Across healthcare, quality of care is increasingly dependent on synchronizing operations across staff to gain greater efficiencies and accelerate decision-making.

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The Data Behind: Helping Healthcare Get Better

Article | April 2, 2020

Healthcare is experiencing a digital transformation, shifting how the medical ecosystem operates and the way that care is delivered. And all of this change comes down to one little word: data. In 2013, the healthcare industry produced 153 exabytes of data; in 2020, that volume is estimated to increase over 15-fold to 2,314 exabytes. It’s projected that healthcare data is expanding faster than in manufacturing, financial services, and media. That’s right — we produce more data at the doctor’s office annually than we do swiping our credit cards or surfing Netflix. It follows that unlocking the power of all that data is the key to transforming the future of healthcare with quality and precision in mind, across clinical, financial, and operational processes. As Big Data continues to expand, what are some of the major trends that data leaders in the healthcare industry are addressing in 2020 and beyond? In this piece, we explore the data that impacts decision-making within the healthcare industry, and how this data helps practices tackle the challenges facing the communities that they serve.

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Spotlight

Central Texas Medical Center

Central Texas Medical Center is a 178-bed hospital providing a wide range of healthcare services in San Marcos, Texas and neighboring communities. The hospital was established in 1960, and the present facility opened in 1983. In late 2009, CTMC completed a $35 million expansion and renovation on a 64,000 sq ft Women's Center that includes all private rooms, a Level II nursery and a new cardiac inpatient nursing unit with all private rooms. It also includes an on-site, high-risk delivery suite and a customized cesarean section suite.

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