The process for handling total joint patients used to be fairly simple at San Francisco's Presidio Surgery Center: Get them into the center, get their surgery done and get them home safely. Then one day, the Joint Commission called and everything changed. "They were trying to figure out standards [for their new total joint certification program] and wanted input from an ASC," says administrator Jessie Scott, MBA.
What followed was eye-opening, as Presidio began a journey that would lead to its becoming Joint Commission-certified for total joints, the second of only 3 such U.S. surgery centers to achieve this new designation meant to validate a surgical facility's ability to deliver excellent outcomes to every patient. The Joint Commission launched its "Advanced Certification for Total Hip and Total Knee Replacement" program in early 2016 for accredited hospitals, critical access hospitals and ASCs that perform both total hip and knee replacements.
"How you think about your responsibility toward patients changes as a result of the process," says Ms. Scott. "It's not just getting them into surgery. It's managing all these other things that go along with it."
That evolution began when a surgeon and a nurse, sent by the Joint Commission, arrived and began doing mock surveys and asking tough questions. How, for example, would the center handle an overnight patient who developed hyperglycemia or hypertension? (California patients can stay in ASCs for 23 hours and 59 minutes.)
"We said, well, we'd call the surgeon," Ms. Scott recalls with a laugh. "He pulled down his glasses and looked at me and said, 'I'm an orthopedic surgeon. I know we don't know what to do.' I knew he was right."
In September 2016, Ohio Specialty Surgical Suites in North Canton became the first surgery center to be certified. In so doing, they, too, had learned to expand their focus and immerse themselves in the entire episode of care. For example, the Joint Commission advised them to improve their collaboration with doctors' offices and everyone else involved in the process.