(Holly) Hello everyone, and welcome to today's webinar
on Achieving Advanced Orthopedic Certification.
Before we get started, I would like to go over a few items
so you know how to participate in today's event.
You will see the webinar Control Panel on your own computer desktop.
When you joined today's webinar,
you selected to join either by phone call or computer audio.
If for any reason you would like to change your selection,
you can do so by accessing the audio pane in your Control Panel.
You will have the opportunity to submit questions to today's presenters
by typing your questions
into the questions pane of the Control Panel.
You may send in your questions at any time,
and we will collect these and address them
during the Q and A Session at the end of the presentation.
The slides are available in the handouts section
of the Control Panel,
and the recording of this webinar and a copy of the slides
will be sent to you via email.
I will now turn it over to Loren Salter,
Associate Director Hospital Certification at The Joint Commission.
(Loren) Great! Thank you, Holly, and welcome, everyone.
Thank you for taking some time out of your day to join us.
My name is Loren Salter, and I'm one of the Associate Directors
of Hospital Certification here at The Joint Commission.
Today, we will be discussing
the Advanced Total Hip and Knee Replacement Certification,
as well as the Advanced Certification in Spine Surgery.
You're also going to have the opportunity to hear from an organization
who has achieved both of these certifications,
and they were the first in the nation
to achieve the new Advanced Certification in Spine Surgery.
I am really looking forward to hearing all about their certification journey.
When it comes to accreditation, The Joint Commission is at the center
of exceptional patient care.
And these same standards of care
are applied to our Orthopedic Certifications.
These certifications are more than a badge of honor.
They symbolize the quality of orthopedic care
that you provide to your community,
and the passion your program has for its patients.
Evidence-based practices along with Certification Standards
help your organization improve its orthopedic services.
For more than 60 years, The Joint Commission has been the leader
in helping organizations with quality, safety, and performance improvement.
Our surveyors and reviewers
are among the most knowledgeable in their fields,
and our accredited and certified organizations
are among the top in their marketplace.
We currently have a number of organizations
who are certified with our Advanced Total Hip and Knee Replacement Certification
and the Advanced Certification in Spine Surgery.
To view a full list of these organizations,
you can visit our website www.qualitycheck.org
to see the organizations who are currently accredited
and certified by The Joint Commission.
We currently have 150 certified
with the Advanced Total Hip and Total Knee Replacement Certification,
and seven with the Advanced Certification in Spine Surgery.
The Advanced Certification Programs will assist healthcare organizations
in providing consistent communication and collaboration
of all healthcare providers involved in the care of the patient,
starting with the orthopedic consultation
through the follow-up visit to the orthopedic surgeon.
A few key pieces to certification are listed below:
Patient-centered care from the consultation
through the follow-up;
Staff proficiency in all patient settings and transitions of care;
Shared decision-making with the patient throughout the continuum of care;
Collaboration among the clinical team;
and Ongoing improvement processes.
Ongoing improvement processes are a big piece to certification.
The Orthopedic Certification process guides your path to better patient care
by helping you identify and measure areas for performance improvement.
There are volume eligibility criteria for each certification program,
and they're listed below.
For ACSS or the Advanced Certification and Spine Surgery,
the program must have served a minimum of 200 patients annually,
and for the Advanced Total Hip and Knee Replacement Certification,
the program must have served a minimum of ten patients,
and that's ten hip replacements and ten knee replacements.
And the volume eligibility criteria must be met
before you can apply for the certification.
Certification is your organization's commitment
to continuous performance improvement,
providing high-quality patient care, and reducing risks.
Our Advanced Orthopedic Certifications
are evaluated under the disease-specific Care Certification manual,
and they have three main components.
Our first component is the Standards,
and these are something that The Joint Commission publishes,
and they lay the framework for how your program will be structured.
Each certification has its own set of standards
with verbiage specific to requirements
for Total Hip and Total Knee Replacement Certification,
or requirements for the Advanced Certification in Spine Surgery.
The next component is Clinical Practice Guidelines,
and providing clinical care consistent with evidence-based medicine
is at the heart of our Joint Commission certifications.
A reviewer will be looking to see
that your chosen clinical practice guidelines are integrated
into your program and are consistently being utilized.
The last component to certification is Performance Measurement.
And the performance measures for each of these certifications
are standardized.
There are four Standardized Measures for ACSS,
and five Standardized Measures for THKR,
and you'll collect data on those.
The structure of utilizing these three components
provides a framework for consistency of care to improve patient outcomes.
I want to dig into each of these components individually,
and give you a brief explanation of each,
as well as some resources that we have available for you.
With certification, an organization is asked to demonstrate
elements of six categories of standards.
The first category of standards is DSPR or Program Management,
the business aspect of your program, focusing on operations
and the qualifications of clinical staff.
Then, there's DSDF, which is delivering and facilitating clinical care,
so focusing on who's delivering the clinical care,
using clinical practice guidelines to develop a plan of care
based on the patient's need.
DSSE is supporting self-management.
Your program involves the patient in making decisions
about managing their disease or condition.
How are you teaching that patient?
Is the Treatment Plan individualized based on the patient?
DSCT is Clinical Information Management.
How is the information gathered and shared across the continuum?
Is the information confidential, secure,
and extensible with relevant practitioners?
Next is DSPM, which is Performance Measurement.
And it helps identify metrics where improvement is needed
within your program
in evaluating patients' perception of the quality of care.
And CPR is the Certification Participation Requirements.
So requirements that apply to the certification process
and are required to maintain the certification.
The Advanced Certification Standards include verbiage showing requirements
specific to the Advanced Total Hip and Total Knee Replacement Certification,
or the Advanced Certification in Spine Surgery.
These advanced standards build off
of the core disease-specific care certification standards,
and on my next slide, I'll show you an example of this.
The Standards provide the framework for self-assessment,
and I always recommend that an organization
who's interested in pursuing the Advanced Certification,
get a copy of the Standards and perform what we call a Gap Analysis:
going through the standards to see, “Are you meeting this one? Yes or No?”
And if you're not, what are you going to put in place
in order to be in compliance with these standards?
Essentially, looking at the gaps in your program versus the Standards.
Here is a snapshot from the Standards manual.
As you can see, the standard is found in the Program Management chapter,
which is notated by the acronym DSPR.
This standard reads that the program defines its leadership roles,
and there is an element of performance listed underneath that.
There's verbiage under the first element of performance that states:
"Requirements specific to Total Hip and Total Knee Replacement Certification."
This is an example of how the Advanced Program
builds off of the core certification.
Your organization must identify a Medical Director
for the Total Hip and Total Knee Replacement Program.
Under the element of performance number two,
you will see there is a symbol of the letter D,
like dog with a circle around it.
And this symbol means that the organization must have
some sort of documentation to support compliance of that standard.
The Gap Analysis will allow an organization
to see where they currently stand, versus the Standards,
and also ensure they have the documentation
that's required for each Standard.
As far as how to get a copy of these Standards,
you have a few options.
We have an online Standards manual available, known as E-dition,
that will allow you access the most recent and up-to-date standards.
And in a later slide, I'll show you how to gain access to these Standards.
You can also purchase a hard copy manual from our publications team
through The Joint Commission resources.
Clinical care is provided based on industry guidelines
and evidence-based practice.
Organizations will be expected to demonstrate their application of
and compliance with clinical practice guidelines,
which may include the guidelines and recommendations
published by the American Academy of Orthopedic Surgeons,
relevant to that patient being treated.
You will want to ensure your guidelines cover the entire continuum of care.
So formally adopt published guidelines that cover the key components
of your program.
All of the guidelines should be current and relevant,
and you should have guidelines for all of the consistent steps
that you do for every patient.
You may need to use multiple sources, such as AAOS or NAON.
For the advance certification,
organizations will be required to collect and submit data
for a specified measure set.
This means that any organization who decides to pursue certification
will collect data on the same measures.
The Standardized Measures for THKR are:
regional anesthesia;
post-operative ambulation on the day of surgery;
discharge to home;
pre-operative functional health status assessment;
and the post-operative functional health status assessment.
For ACSS:
their surgical site infection rates;
new neurological deficits;
unplanned return visit to the OR;
and the pre-operative and post-operative patient-reported outcomes.
The expectation with data
is that at the time of the initial onsite review,
you will present the reviewer
with the most recent four months' worth of data.
Once you are certified, you will collect the data
on a monthly basis and report the data on a quarterly basis
through The Joint Commission Connect extranet site.
It is a mandatory requirement
that organizations are actively participating
in the registries below:
the American Joint Replacement Registry
for the Advanced Hip and Knee Replacement Certification,
and the American Spine Registry for ACSS.
For measure specifications or questions that are related
to AJRR or ASR,
please contact the Registryinfo@aaos.org.
Certification from The Joint Commission offers your organization
many opportunities and benefits,
from gaining a competitive advantage, to coming together across functions
and departments.
Just to name a few, here are some of the benefits your program may see:
Provide organizations with a pathway to excellence.
Our Orthopedic Certifications were designed to recognize
the specific capabilities and expertise of those delivering
the highest quality of care.
And we talked about this in detail before,
but Providing a framework to improve patient outcomes;
Reduce variation in care delivery;
and Establish a consistent approach to care,
reducing the risk of error.
Certification organizes the team on a common mission
and helps them take ownership in the direction of their program.
Because everyone is on the same page
and following the same guidelines or policies,
there's less chance for error.
And Demonstrate commitment to a higher standard of clinical service.
When an organization displays that Gold Seal
from The Joint Commission,
patients know they are getting the highest quality of patient care.
Now, I'd like to go through the steps you'll take
if you'd like to pursue certification.
If you're sitting there thinking that you'd like to start
the certification journey, but you're just not sure where to begin,
that's where I come in.
We have a team of individuals like myself,
who are there to help you through the certification process.
It's our job to provide you with the necessary resources
that you need during the certification process,
and serve as a point of contact, if you have questions along the way.
You can reach out to the email address provided on the screen,
which is: certification@jointcommission.org
to be connected with your local Associate Director.
You'll then want to get a copy of our standards,
and our Business Development team can set you up with a free 90-day trial
to the online standards known as E-dition.
You can then perform your gap analysis
to see how your program currently compares to those standards.
If you need assistance walking through the standards,
you can ask your Associate Director for help.
And should you need help interpreting a standard,
you can also reach out to our Standards Interpretation Group.
They can provide you with a written response
on your compliance with the standards,
or just offer concrete clarification on the standard in question.
This resource can be found on the Standards tab of our website.
In order to prepare for your application process,
you will want to identify your clinical practice guidelines.
Like I mentioned earlier on,
providing clinical care consistent with evidence-based medicine
is at the heart of our Joint Commission Certifications.
A reviewer will be looking to see
that your chosen clinical practice guidelines
are integrated into your program and consistently being utilized.
The Performance Measures for the Advanced Certification
are standardized.
And these are the measures that were shown earlier
that you will collect data on.
You will share four months' worth of data
from those defined measures when the reviewers are on site.
After becoming certified,
you will monitor this data on a monthly basis
and report the data through The Joint Commission Connect portal
on a quarterly basis.
The final step to preparing for the application
is to complete the Performance Improvement Plan.
And this is a series of five questions that are related
to your Performance Improvement Initiatives in your program.
And our Business Development staff
can provide you with a template for these questions,
so that you can complete this before even getting into the application.
And the application is done online
through The Joint Commission Connect portal,
and your Business Development staff can assist you through this process.
We do ask that your organization submit your online application
about four to six months before you'd like the onsite review to occur.
Since this would be an initial review, you would get a 30-day advance notice
of when that onsite review would occur.
And for each of these certifications,
it would be a two-day review with one reviewer.
Now, should you be learning or interested in learning
what the onsite review will entail,
you can reach out to your Business Development team
who can provide you with the review process guide.
This outlines the day of the onsite review,
goes through a typical agenda and materials you should have prepared.
I highly recommend utilizing this resource.
If you are interested in pursuing either certification,
the Advanced Total Hip and Knee Replacement Certification
or the Advanced Certification in Spine Surgery,
please reach out to your Business Development team
at certification@jointcommission.org
and we can connect you with your local Associate Director.
So, that's all for me.
I'm going to hand it over to Dianne Vye, the Regional Orthopedic Program Manager
at Connecticut Orthopedic Institute.
Dianne, I'll hand it over to you.
(Dianne) Great. Thank you, Loren and Joint Commission
for this opportunity to share Connecticut Orthopedic Institute's journey
to advance certification.
My name is Dianne Vye,
I'm the Regional Orthopedic Program manager
with over 20 years experience in Orthopedic Spine Care
and Program Development.
Also, with me, today presenting is Andrew Turczak,
our Vice President of Connecticut Orthopedic Institute.
He has extensive history as a PA, as well as in Business Management.
And also joining us is Dr. McCallum, our Orthopedic Surgeon,
as well as our Medical Director for Connecticut Orthopedic Institute.
We have developed an Orthopedic Institute
that encompasses Hartford Healthcare's vision
to be nationally respected for excellence in patient care
and most trusted for personalized coordinated care.
Our goal is to provide an exceptional patient experience,
while providing world-class quality and safe care driven by data
and research-based orthopedic spine best practices.
With the collaboration and support of our physician leaders,
we have developed an Orthopedic Destination Center,
which opened in April of 2017.
The Institute operates as a hospital within a hospital,
providing patients with convenient access to high-quality, comprehensive care,
outstanding physicians, and the latest technology--
all in their community.
Next slide, please.
MidState Medical Center is part of Hartford Healthcare,
and Harford Healthcare represents
the next generation of Integrated Healthcare Systems,
which is Connecticut's largest healthcare system
with a focus on strong patient care, quality performance,
and collaborative sharing of best practices.
A hallmark of Hartford Healthcare's vision
is to strengthen access to care close to home for our patients.
Harford Healthcare Partners include seven acute care hospitals,
behavioral health centers, cancer centers with a charter member
of the Memorial Sloan Kettering Cancer Alliance,
a large PCP Practice group, a Regional Home Care System,
and a Physical Therapy and Rehabilitation network.
Hartford Health Care Senior Services is committed to helping seniors
remain healthy and independent as possible through every stage of their lives.
This model gives us the first ever natural opportunity to show the totality
of Hartford Healthcare,
our broad continuum of care at many touch points,
and interconnectedness that our patients can experience.
Next slide, please.
Hartford HealthCare is dedicated to providing patients
with an exceptional coordinated experience and a single high standard of service.
Our mission is to improve the health and healing
of the people and communities we serve
with the vision to be most trusted for personalized coordinated care.
Our goal is to enhance everyone's experience
and improve the safety and clinical quality of care
that we provide to our patients.
Visions of excellence is driven by five core values
of caring, equity, excellence, integrity, and safety.
Next slide.
Harford HealthCare is further regionalized into five regions within the state.
A Connecticut Orthopedic Institute at MidState Medical Center
is in the central region
with the second location at St. Vincent's Medical Center,
and that opened in 2019, and it duplicated the model of care
that was developed at MidState Medical Center.
Hartford HealthCare is a high-reliability organization,
and it aims to create a culture and organizational structure
where clinical care, education, and research are supported
to bring the latest technology and discoveries
in clinical excellence innovation to the patient and the community.
Next slide.
Next slide, please.
MidState Medical Center is a 156-bed acute care hospital
serving the communities of Central Connecticut since 1998.
MidState Medical Center offers a complete range of services,
general and minimally invasive surgery, emergency medicine, urgent care,
weight management, oncology, family birthing, digestive health,
pain management, neurosciences, and cardiac care.
Next slide, please.
I'm going to turn it over to Dr. McCallum right now,
and he can speak to the development of the Connecticut Orthopedic Institute,
and how we got here today.
Dr. McCallum?
(Dr. McCallum) Absolutely. Thank you. Thank you, guys. Thanks, Dianne.
Just a quick summary of how we sort of approach this concept.
We had a vision as a mechanism to deliver high-quality care,
that we just weren't achieving in our experience to date.
Through our participation with Harford HealthCare,
they gave us the opportunity to create the Connecticut Orthopedic Institute,
and our goal being to really, be the definitive
and the highest quality care delivery system in the state.
That dovetailed nicely
with The Joint Commission's Advanced Certification,
as this gave us the opportunity to really scrutinize
this program and deliver end-to-end high-quality experience,
have it reviewed and critiqued,
and ultimately ensuring
that it really did meet the expectations for us and our patients.
And I think that element really was absolutely essential
in our development process
and achieving the high quality that we're seeing right now.
One of my patients just came in today and couldn't be more emotional
about the whole quality from start to finish.
And I think that's a testimonial
to what this integrated approach can really deliver for our patients.
And it's something that is missing in big systems,
as I see across the country.
And I encourage people to really take the opportunity to try to utilize
the resources out here to really up their game,
and deliver the best that they can do.
So, at this point, I'll turn it over to Andy,
but I do thank you, guys.
(Andrew ) Thank you, Dr. McCallum. Thanks, Dianne. I appreciate it.
We'll go to the next slide, please.
You know, as Dr. McCallum was beginning to explain,
a key component of the success COI has had here
has been truly the partnership with our surgeons and Hartford HealthCare.
This truly has been an institute that has been developed by the physicians
with support from administration and not the other way around.
Surgeons have every single part of the pie from the entire continuum of care,
to really be able to provide that input,
to ensure that best clinical practices are being delivered,
and to ensure that we're delivering that high-quality care,
continuously improving and delivering an exceptional patient experience.
And we've been really successful and very fortunate to see
when we opened in 2017,
of our overall total volume around 1,500 cases.
And in a matter of five years,
this year we'll be closing in on nearly 5,000 cases.
A big component of that is our Total Joint Program
and our Spine Program.
The Institute started initially with less than ten physicians.
It has now grown to over 65 physicians
because they want to be part of this model of care that we're delivering.
Next slide, please.
It is a true continuum of care.
And I think that is the ultimate thing that when we had our surveys here,
and when we were planning.
This doesn't start when the patient enters the door,
and when the patient exits the hospital.
It is a full spectrum continuum of care
that takes the entire multi-disciplinary team.
Before a patient is even a patient,
we really focus on delivering and giving back to our community--
community education.
We have physicians who have bought in to the importance
of educating our community around disease processes
and surgical techniques,
for at times, trying to avoid surgery, initially trying to avoid surgery,
and really being able to get that across to our patients,
where we find a lot of value.
Patients then will enter the primary care provider,
or already have a referral to an orthopedic surgeon,
and they will begin that process of conservative therapy,
which we understand and appreciate.
It has to be well documented.
We ensure that all components of care, before they hit the hospital,
is documented appropriately.
Once a decision has been made between surgeon and the patient,
the patient is scheduled for surgery, and the hospital really then takes over
and ensuring that we are shoulder-to-shoulder with the patient
through the entire episode of care.
We have Nurse Navigator Program.
We have guidebooks; we do classes.
During COVID, we pivoted from in-person classes to online classes.
We have a third-party platform that helps with our patient-reported outcomes,
helps to really guide the patient through the entire episode of care.
We now have a Pre-Admission Center.
It is critical for our patients to be optimized for surgery.
We have stringent guidelines to ensure
that patients will be set up for the highest success.
But with that, if a patient has a high BMI or high hemoglobin A1C,
we also have avenues to refer them out to other specialists or other programs,
so we can help optimize them to get them to a point
that we can safely do surgery on.
We have the buy-in from the surgeons.
It is critical to have the buy-in from the surgeons to support that
in order to be successful.
Within the hospital itself, we have a full multi-disciplinary team.
Anesthesiologists that are wanting to be cutting-edge,
doing the newest and latest technology of medicine of blocks in spinals.
We have a huge initiative to help reduce narcotics.
We have specialized nurses,
specialized PA's that are critical
to everyday care of the patients.
We have our dedicated OR nurses and techs who also have specialized
or have many years of experience in orthopedics.
And then, we have a phenomenal unit
with just the absolute, most caring nursing
and tech staff with a rehab team
really working together while in the hospital
to ensure that the patient is navigated correctly.
During that timeframe, we understand that ambulating,
being out of bed is critical.
We have a focus around that.
How we do that is we will measure our outcomes.
We have dashboards that are required by The Joint Commission,
but we don't stop there.
We really ensure that every step of this pathway,
we're measuring ourselves against best practices across the nation,
and then measuring ourselves against ourselves
to ensure that we're continuously improving.
We have dedicated teams, including the medical advisory board,
a multi-disciplinary team that comes and meets every other week
to discuss quality, operational, and efficiency issues and/or concerns
within the program.
That is including the surgeons at the table,
as well as all, the entire multi-disciplinary team.
We stringently review what we need to work on,
and we will then set ourselves up for success.
That is our framework of how we self-prepared to go
for the advanced certifications.
And another key piece of it,
and I want to give a big shout out to Dianne Vye, our program manager,
to have a point person to really help manage, and run,
and be an expert in this area who's working directly
with The Joint Commission has been critical.
And we couldn't have done without Dianne.
So I want to give her a public acknowledgment for that.
So I'll turn it to Dianne to discuss a little bit more
about the actual Joint Commission process.
(Dianne) Thank you, Andrew, for that recognition,
and thank you for explaining that continuum of care model.
Next slide, please.
Our journeys to certification started with education.
As Andy mentioned, as being the point person for the program,
as well with Joint Commission,
I immersed myself in educating understanding what those standards were.
I brought a team together with the different disciplines
to review those standards and understand what the requirements are.
I utilized The Joint Commission resources that are available on the website,
as well as webinars that were provided to us
as leaders in the community,
and tried to understand the interpretation of those standards.
If there were any questions that our team had,
we reached out to Joint Commission.
They are a wealth of knowledge who are able to interpret
some of those standards for us, if we needed some clarification.
Once we reviewed the standards and requirements,
we developed a Gap Analysis.
During that Gap Analysis, we had listed all the standards
and all the requirements, just as Loren had shown us.
And we decided whether we were meeting those standards or not,
and how we were meeting them.
If we were not meeting them, we developed action items
and a timeline to achieve those standards.
And that took a multi-disciplinary team approach.
We educated the team and the staff with the expectations,
and what is required.
Program development is key for this certain type of certification.
We took the phase of care approach, as Andy mentioned,
the continuum of care starting in the physician's office
from pre-op to post-transition home.
We identified leaders from the multi-disciplinary teams
and had Physician Champions to support those teams to look at best practices.
And we achieved standardization by developing program guidelines.
We had broken up those committees into the different phases of care.
From pre-op, we had a team working on pre-op,
and what best practices were
for preparing our patients for the surgery, having them optimized.
The inter-op team looked at best practices regarding antibiotic usage
and OR best practices.
And then, post-operatively, we had the team and the unit
who took care of our patients involved in that committee,
and what is best practice for these patients,
as well as developing our order sets.
In addition of tracking our metrics that are required for Joint Commission,
we also are looking at compliance with our standards.
For example, documentation of implant choice discussion
is needed for the Advanced Certification.
So, we track that monthly report, that out monthly on our dashboards.
And that also gives us insight if our providers are following
our program guidelines.
We have to ensure that our guidelines are being followed.
As we prepared for surveys, we did a mock survey with our staff,
we did patient tracers, we identified certain patient charts
and reviewed those charts,
as well as tracked those patients and interviewed the staff members
to prepare them for the survey.
We use the review guide that is offered for Joint Commission as a checklist.
That was very important for us,
as we prepared for our certification and our survey.
It provided us a list of documents that were needed.
And the agenda helped guide us through our survey.
And most importantly, the team approach was imperative for this.
We needed our team to be available for the survey,
and to be able to speak, depending on the disciplines.
Next slide, please.
Why pursue a Joint Commission disease-specific certification?
It defines our program as a center of excellence.
The care continuum is built around the evidence-based standards
and our clinical care guidelines.
It validates that we're providing high-quality care to our patients,
and it's used as a catalyst to bring multi-disciplinary teams together,
and commitment of them improving our performance.
It gives us a Gold Seal approval from Joint Commission.
It also differentiates us in the orthopedic market
to our patients, as well as our surgeons,
and demonstrates a value-based care model,
a trending necessity that we're seeing with our payers.
Next slide, please.
In conclusion, Connecticut Orthopedic Institute
provides safe and high-quality care,
and is recognized nationally by these accomplishments.
As mentioned, we are the first in the country
to receive the Advanced Certification Spine Surgery
from Joint Commission in September of 2021.
In addition, Advanced Certification for a Hip and Knee Replacement Program,
initially received in 2019 and then re-certified in 2021.
Currently, three of the hospitals within Harford HealthCare
have Advanced Spine Surgery in Joint Commission.
So we're very proud of that.
We're currently in the process of pursuing our shoulder certification.
We received the OR Go Clear Award, the Gold Recognition Level,
as well as distinctions from our Anthem Blue Cross Blue Shield,
as well as Aetna Institute of Quality
for both Joint Replacement and Spine Surgery.
We also were voted America's Best Hospital for Orthopedics
by the Women's Choice Award
and received Healthgrades Award for Five-Star Recipient
for total knee replacement and spinal fusion surgery.
In addition, MidState Medical Center is mandated by CMS to be part
of the CJR Bundled Payment Model,
and we're very proud of the work we've done with that bundle.
We received an excellent rating for the past two years
of 19.4 quality score out of 20.
In addition, most recently, received
the 2022 Greater New Haven Chamber of Commerce Healthcare
and Life Science Award winner.
And just recently recognized nationally
by Healthgrades for Outstanding Patient Experience Award.
We're very proud of our accomplishments,
and it's a true reflection of the dedication and talent
of teams of colleagues at Connecticut Orthopedic Institute.
I'd like to thank you for this opportunity to share our journey
at our Connecticut Orthopedic Institute.
Thank you.
(Loren) Great. Thank you so much.
I hope everyone enjoyed the presentations and hearing about their journey
through certification and becoming the first organization
to achievet he Advanced Certification in Spine Surgery
as well as being certified
with the Advanced Total Hip and Knee Replacement Certification.
Now, we're going to open it up for questions.
If you guys have any questions for myself,
or any questions for the team at MidState Medical Center,
please type them into the Questions box,
and we have some time that we can go ahead and answer those.
So I'm going to start pulling up some questions.
Alright. If you are not familiar with the go-to Webinar tools,
if you guys have questions,
there is a Questions tab in the side dashboard,
and you guys can type them in there.
Alright. This question is one that I will answer.
The question says, "Do you have to have the basic certification in order to apply
for advanced certification, or can you apply directly
for the Advanced Certification in Spine Surgery?"
Great question.
You do not have to have the core certification first.
You can jump right into the Advanced Certification for Spine Surgery.
I just recommend getting in touch with your local Associate Director
from your Business Development team to kind of an intro meeting with them,
and make sure that you get a hold of the Standards
and go through your Gap Assessment,
and they'll be able to guide you through that journey.
But you do not have to start out with the core certification.
Some organizations do choose that path.
if they haven't had certification in the past.
That's up to your organization.
But, again, the best step is usually to connect with your Associate Director.
And to piggyback off of that, Dianne, did you guys have a core certification
for either hip, or knee, or spine
before going for the advanced certification,
or did you guys dive into the advanced certification?
(Dianne) So, I can tell a funny story regarding the spine certification.
We originally had a date, ready to go for the core spine,
which was of March of 2020, and then COVID hit.
So, our survey was canceled.
We had a date ready to go.
And during that time is when the advanced certification
came out for spine.
So we felt that that was an opportunity for us to pursue that.
We looked at the requirements and started working on that.
So for the spine, it was straight for the advanced certification.
And for the advanced knee and hip, we had the core,
and then went for the spine, excuse me, for the advanced knee and hip.
(Loren) Great.
There's another question here, Dianne.
Someone asked if they wanted to get in touch with anyone
at your organization to connect with you about your experience
and ask you some questions.
Is there contact information that you'd be able to provide,
or would they be able to contact you?
(Dianne) Sure, I can be reached via email
at: dianne.vye@hhchealth.org.
(Loren) All right. Thank you, Dianne.
(Dianne) Thank you.
And this question is for you, as well.
It said, "How long did it take you guys to achieve the certification?"
(Dianne) It took us less than a year to achieve that certification.
As I mentioned, we were all set for a core certification.
Once we found out
what the advanced certification requirements were,
we worked with our team to be able to achieve those.
So it is capable of being done within a year.
You just have to have a stringent timeline support
from your leaders, and from your physicians,
and the multi-disciplinary team to stick to that timeline.
This question is for me.
It says, "Is this program specific to in-patients only?"
Both of the certifications,
both the Advance Certification for Spine Surgery
and the Advanced Total Hip and Knee Replacement Certification,
are open to both hospitals, as well as ambulatory surgery centers.
Let's see, what else is in here.
Oh, and another question.
It says, "Will we have access to the recording?"
Yes, the slides, as well as the webinar recording,
will be sent out to anyone who has been registered for the event
in the coming days.
You can keep an eye out on your email for that.
Someone asked here. Dianne, this is for you.
"What did your mock survey look like?
Is there a tool that was used that you can share?
Can you talk about that experience?"
(Dianne) I partnered with my quality team,
and we as a system, have a survey tool that we use.
And we used that as our mock survey tool,
and went around and asked certain questions
that the surveyor may ask the staff members.
We do have a tool that our hospital quality department uses,
as we prepare for our Joint Commission certifications,
as well as accreditations.
I would make a recommendation to reach out to your quality team
and see if they have one available.
(Loren) Great. Thanks, Dianne.
Now, this question is for me.
It says, "What is the transition period or timing
if you're already core certified,
and you want to move to the advanced certification?"
So it's really up to you.
You can actually apply for any certification at any time.
Sometimes organizations like to see through that two-year certification cycle,
and about six months ahead of time before recertification,
they will apply for the new advanced certification
just to meet that timeline.
However, if you guys are ready to go, and you're already meeting the standards,
you can absolutely apply at any time and have the certification review
for the new program whenever your organization is ready.
Keep the questions coming.
This is great. We've got a lot of questions coming in.
I'm just trying to sort through them here. (laughing)
So this question. Dianne, maybe you could shed a little bit of light on this.
Someone asked about your Aetna IOQ distinction
for the Advanced Hip and Knee as well as for Spine Surgery.
Can you talk a little bit about your experience with that?
(Dianne) Sure. It is through Aetna, and it's by invitation only.
The hospital receives an invitation to be able to participate in that.
And the newest requirements now do require that you are advanced certified
in knee and hip as well as spine through Joint Commission.
So, that was something newly announced not too long ago.
And when you receive that certification, there is a list of questions
that need to be filled out by your team,
either the program manager along with your quality team member
that needs to fill out some quality questions
regarding some of your data.
(Loren) Great. Thank you. Dianne, another question for you.
This question says, "What data tracking tools
did Connecticut Orthopedic/Dianne use or recommend?
There was a large volume change annually.
How did you manage that as far as tracking?"
(Dianne) We use a dashboard, as Andrew had mentioned,
to be able to collect our data and report that out monthly.
What we do is we track every patient having knee and hip and spinal surgery,
and we track their outcomes.
We partner with our data analyst team
to use our tools that we currently have in our EMR,
which is Epic, to be able to run reports for us.
In addition, we do have manual--
We do have to do some manual audits to make sure that information is in place.
And I have a team of members that help assist with that, as well,
to validate and verify the data is accurate as well.
(Loren) Great. Thank you.
And then this is also for your team.
Someone asked, "What were some of the challenges that you guys faced
through the certification process?"
(Dianne) I think some of the challenges, in the beginning, was understanding
that when we were going for advanced certification,
that requirement was standardization from continuum of care,
and getting the approval, and the buy-in from our physicians.
That we need to standardize.
And that's when we developed our standardization guidelines
from pre-op to post-discharge.
When we developed that,
we did have our committee members put together,
where we had Physician Champions, which was very helpful.
What we thought would be challenging really helped us get through that
by having the Physician Champions for each committee
review the evidence-based practice that is out there
to determine what our standardization in our program guidelines should be.
Once we've implemented that, the physicians all agree to use that.
And then post-implementation,
we were tracking some of those elements from our program guidelines
to ensure that we were compliant.
I'm sorry, I just want to add one more thing.
And to Loren's point, Joint Commission is all about process improvement.
You want to show to Joint Commission where some of your challenges are,
where some of your metrics were
or perhaps you weren't doing so well in
and then what action items you put in place,
and process improvements you put in place to improve that.
A great example would be
if you're looking at collection of patient-reported outcomes.
If you have a low compliance rate in the beginning,
what action items you put in place to improve that.
Here at Connecticut Orthopedic Institute we've partnered with a third-party vendor
to be able to capture that preoperatively,
as well as post-operatively.
We have our Nurse Navigators that are in contact with our patients
preoperatively, as well as post-operatively
within the continuum of care of 90 days.
And they're able to confirm whether a patient filled out those surveys,
and if they didn't, to reach out to those patients,
to make sure they filled them out.
That was one example of process improvement
that we worked on in one of our metrics.
(Loren) Great. Thank you.
Someone asked if your facility is Magnet certified as well?
(Dianne) No, we're not Magnet certified.
I believe there's only one hospital
within Harford HealthCare and that's St. Vincent Medical Center
that has that certification,
but we have not done that yet as a hospital.
(Loren) These next couple of questions are for you, Dianne, and for your team.
Someone asked about your standardized clinical practice guidelines.
Can you give some examples of the clinical practice guidelines
that you guys utilized?
And would you be willing to share some of those?
(Dianne) Sure. Some of the guidelines that we obviously use
are through the American Academy of Orthopedic Surgeons, as well as NAON.
They do have them specifically to knee and hip, and then for the spine.
The Spine Society has them associated too with caring for patients.
I had reached out to our providers
to be able to look at those guidelines for us
and to make sure that was up to date.
And what we were using was best practice.
Those guidelines are available on AAOS website.
If you look under orthoguidelines.com, you'll be able to find them as well.
As also in NAON, for the Orthopedic Nursing Association,
you can reach out onto their website and find guidelines as well.
And you have to find the guidelines
that are best appropriate for your programs.
There are many out there, and you decide as a program
what guidelines are appropriate for your program.
And approval must be by the team annually,
and if any changes need to be done on that or changed--
Or we can do that bi-annually if needed, but for our program,
we review those guidelines annually.
(Loren) Another question for you guys.
Someone asked, what product do you use to track patient-reported outcome scores?
(Dianne) We use Force Therapeutics as our third-party vendor
to be able to track our patient-reported outcomes.
That was a new vendor that we initiated with
and we've been quite successful with using them,
as well as providing that continuum of care from pre-op to post-discharge
and follow-up with our patients.
(Loren) This question is for me.
It says, "What is the cost of these certifications?"
I recommend, actually, reaching out to your Associate Director.
You can reach out to certification@jointcommission.org
to be connected with your local Associate Director,
and they can go through the pricing, the pricing structure, and all of that.
Again, just reach out to certification@jointcommission.org
and they can go through all the pricing with you then.
Oh, another question for your team.
Dianne, it says:
"Are all of the ortho surgeons at Connecticut employed?
Or do you also have private surgeons?"
They are actually-- all our orthopedics for our Joint Program,
are all private physicians.
For some of our spine surgeons,
we do have a handful that are hospital employed.
What helped us keep track of making sure that the staff at those offices
were informed of the changes, as well as the physicians,
is we do have a physician liaison manager
who's in touch with our providers and the staff offices
with any updates to our programs.
Bi-weekly updates are sent to them; as well she visits those offices
to provide any updates, as well.
And we do have monthly and quarterly meetings as needed,
to update the staff, as well as the offices,
of any changes to our program.
(Loren) How many orthopedic certified nurses does your facility have?
(Dianne) For percentage-wise, currently, at this time,
we're about 50% that are qualified and certified.
There are specific criteria, number of hours
that are needed for those nurses to be able to take that exam.
Our Education Department does support our nurses
in achieving that certification.
And it is the expectation upon hire within one year
that our staff and nurses apply for that exam
and take on that certification.
We've partnered with our Education Department
to be able to provide the support for our nurses
who are achieving that certification.
(Loren) And, Dianne, who does your core team consist of?
(Dianne) Our core team consists of myself, Andrew, Dr. McCallum.
We have another PA who's operational manager.
We have our team leads for different departments:
our Director of Anesthesia, our Director of Rehabilitation,
Case Management, and Nursing, as a Team Group that meets bi-weekly
to review any changes to our program, or any concerns,
or any issues that may be coming up.
(Loren) Then another question for you, Dianne.
Someone asked if you can share an example of the policy
that was developed for your program related to the use of clinical guidelines.
(Dianne) To share... I'm sorry, the policy or the guidelines,
the standardized guidelines?
(Loren) Mm-hmm.
(Andrew) Dianne, I could take that one, if you want.
(Dianne) Go ahead.
(Andrew) To be a participant of the Connecticut Orthopedic Institute,
you actually have to sign a participation agreement,
and that is a contract that you will abide by the clinical practice guidelines,
be in good standing with medical staff.
There's a whole slew of additional entities as part of that.
Because it's a privilege to be able to participate in a high-quality program
with the resources that are provided and to help.
And in return, for both the surgeons and the patients,
we do expect there to be a commitment to continuous improvement,
as well as compliance to the clinical best practice guidelines.
I think the important piece of that is that's not just thrown at the surgeons.
The surgeons are part of developing those and annually reviewing those,
so that it really is collaborative, so that there's buy-in from the beginning.
(Loren) Great. Thank you so much for that.
All right. A couple of other questions coming in.
Again, for Dianne and your team: "What benefits did your organization see
in becoming certified with both of those certifications?"
(Dianne) The benefits were that the community recognized
that we are providing high-quality care to our patients, as well as the surgeons.
As Andy had mentioned, we onboarded many more surgeons to our program
knowing that we had these certifications.
And the expectation for our providers, as well as our team members,
is to provide that high quality of care.
So, the certification really validated the care
that we're providing to our patients, and to our communities.
(Dr. McCallum) Dianne, if I could just add-- This is John, again.
I think one of the true benefits
was that this hospital within the hospital system
originated in a hospital that was essentially a great community hospital,
but not known, necessarily, for a large orthopedic delivery system.
And this allowed us to differentiate
this program within the state,
and gave objective evidence
that we really achieved a milestone
with the development and the origination of this program.
So, I think this was moving forward,
it was actually trying to elevate our visibility.
And I think it was really critical
to be able to sell the program throughout the state.
I think it was invaluable as part of this development process.
Plus, it also gave us a direction, as I alluded to before,
gave us a direction how to integrate it from start to finish.
Since we had a clean slate, we needed that kind of roadmap.
But, all in all, I think that was the best possible scenario.
It raised the visibility and gave objective evidence of success.
(Loren) Was there anything specific that your organization did
to promote to the community that you achieved the certifications?
(Dr. McCallum) Andy can attest to this and Dianne, as well.
It was marketed.
We did put it on the usual social media,
billboards, those kinds of things.
It was the face-to-face with your patients and talking about it.
I think that...
Although, the average patient may not know
what The Joint Commission truly means
to the nth degree.
To have an objective reviewer come in
and identify us
as meeting that level of quality
really plays a role.
We would put report cards, basically,
of our clinical outcomes, including our awards.
That, I think, really also gave them the ability to take that home
and review that card, and recognize the quality
that was potentially going to be part of their health care delivery.
(Loren) Great. Thank you all for sharing those.
Now, I think we have time for one last question here.
Dianne, someone asked, "To deliver the high level of care,
what are your nurse-to-patient ratios on the post-op unit?"
(Dianne) On the unit itself, it's five patients to one nurse.
(Loren) Great. And then, okay.
I think actually, we can fit in one more question.
One more just popped in.
It says, "Did the recent pandemic put stressors on compliance
with best clinical practice guidelines for you guys?"
(Dianne) Actually, we have a strong leadership team
with Andy leading the team and Dr. McCallum.
With the pandemic, we were the first in our healthcare system
to resume orthopedic surgery.
It did put a stressor, but we brought our team together
to make sure that our community knew it was safe to resume surgeries.
We did a lot of education with our patients,
and the physicians, and the offices.
And we still followed the guidelines.
We had to pivot a little bit, like Andy mentioned,
making sure our patients were still educated.
We offered the webinar classes, online classes,
as well as live Zoom classes
until we were able to resume in-person education.
But we still were able to provide that high quality of care.
We had support from our leaders in the hospital too,
to be able to showcase that to our communities as well.
(Loren) Great. Thank you so much, Dianne.
We are out of time today.
I want to give a big thank you to Dianne, Andy, and Dr. McCallum
for sharing their experience
on achieving certification with The Joint Commission.
So thank you so much for your participation today.
There were a couple of questions that we did not get to.
If we did not get a chance to answer your question,
please reach out to certification@jointcommission.org
and we can get those answered for you.
As another reminder, we will be sending out
a recording of the webinar along with the slides in the coming days,
so be on the lookout for that.
With that, thank you guys so much
for your participation today and for your attendance.
We look forward to working with you.
Have a great day!
(Dianne) Thank you.
(Dr. McCallum) Thank you. Take care.