A Note from the Chair
Growth despite a pandemic:
Convenient care and outpatient surgeries
The COVID-19 pandemic made clear something health care, including orthopaedic surgical care, had perhaps only given token attention to in the years prior: Convenience is a factor in patients’ decisions about where and how to receive care.
The pandemic and the public health emphasis on social distancing to avoid the virus made many patients concerned about coming to large comprehensive medical centers for lower acuity orthopaedic conditions. Prior to the pandemic, Rick Wright, MD, the Dan Spengler MD Professor and Chair of Orthopaedic Surgery, was already preparing VUMC for an increasing number of outpatient total joint replacement surgeries. In the initial weeks of the pandemic, VUMC, like other organizations, postponed non-emergent surgeries to avoid bringing large numbers of patients, their families and medical staff in close contact with each other.
But as the pandemic wore on and health care organizations cautiously resumed non-emergent surgeries under COVID-19 protocols, Vanderbilt’s orthopaedic surgery leadership recognized that staffing constraints—combined with patients’ desire to obtain care in more convenient settings – meant that the ability to provide total joint replacements on an outpatient basis would lessen the travel burden on patients. It would also be key to providing the best possible care and maintaining clinical volumes.“It became clear that patients, despite recognizing Vanderbilt as one of the leaders [in TJR],” and knowing COVID-preventive protocols were in place -- “that didn’t mean the average person wanted to come down to campus,” Wright said. Competing orthopaedic services have multiple locations throughout Middle Tennessee. Patients “could go see very qualified physicians more easily than coming to our campus,” he acknowledged.
Prior to the pandemic, Vanderbilt Orthopaedics, based in Nashville, already had a busy surgical center in the suburb of Franklin. In January 2021, it opened a new outpatient surgery center in Belle Meade, six miles west of the main Vanderbilt campus, in a less congested part of Nashville. Since 2020, Orthopaedics has also added clinics outside the city of Nashville: a comprehensive orthopaedic clinic and a walk-in (no appointment necessary) Injury Clinic in Hendersonville, 22 miles northeast of the main campus; and an Orthopaedics clinic in Murfreesboro, 32 miles to the southeast.
The ability to provide TJR surgeries on an outpatient volume has also been crucial to maintaining and growing volumes despite the pandemic – and for positive patient outcomes.
Thorough, evidence-based preoperative assessment of surgical patients allows the team to determine which patients are likely to have positive outcomes without a hospital stay. Aggressive pain management strategies mean they are able to function well enough to go home the same day as surgery. Thanks to these efforts and the growth of outpatient surgical centers, by 2022, 73% of Vanderbilt’s TJR surgeries were being done on an outpatient basis, with no apparent detrimental effect on outcomes.
“Patients recognize it’s safe, you don’t have to be in the hospital, you can go home, you can be more comfortable,” Wright said of the outpatient TJR experience. “It’s not a lower level of care. It’s actually a higher level of care.”
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Rick W. Wright, MD |
