Integrating Virtual Care Across the Continuum for Total Joint Replacement: A Q&A with AdventHealth

Over the past year, AdventHealth launched a coordinated virtual pre-op and post-op comprehensive joint program across the care continuum and all facilities within the region—from the physician’s office to acute care and the outpatient team. This innovative program not only allowed them to continue to provide the highest quality care throughout the COVID-19 pandemic, but is also helping to improve standardization of care, boost operational efficiency, and drive significant improvements to clinical outcomes. It’s allowing them to execute on research demonstrating that low-risk patients can expect to see better outcomes going from acute care to outpatient, ultimately saving costs throughout the episode of care.

We sat down with J Coomes, PT, MBA, Executive Director for Acute Care Rehab Services and Rehabilitation Hospitals at AdventHealth, and Leigh Harris, PT, DPT, Director of Operations and Clinical Quality at AdventHealth Sports Med and Rehab, to talk about the goals behind their innovative virtual care program, how it’s generating measurable outcomes, and specific strategies for achieving alignment, participation, and consistency across the continuum.

Q. Can you share some detail on the structure of the total joint program and navigate us through that process?

J Coomes: With our revamped total joint program and pre-op class, our patients are first introduced to it at their surgeon’s office, where they are scheduled for their pre-op class. Today we live in a digital world, so these classes are an opportunity for our therapists to meet with their patients virtually to begin the educational process and discuss what to expect both during the surgery and post-surgery. We begin with our MedBridge templates and introduce them to their Home Exercise Program, and then they’re able to begin their program immediately or wait until after surgery.

Q: You had previously done pre-op classes and made the case to reimplement them in a more standard and consistent way throughout the full continuum. How did you decide to actually focus here and build this type of program?

Leigh Harris: Recent literature shows that we can achieve improved outcomes and patient satisfaction by accomplishing these preoperative classes for total joint replacements, and that it lowers hospital length of stay, decreases readmissions, and improves costs. Due to COVID-19, we took the opportunity to do it virtually and decided that we can use this to improve operations and standardize the program. We looked to MedBridge for our initial templates, and for establishing the connection with the patient by having their physical therapist present during their virtual pre-op class. Holding the class virtually also improved operational efficiency, as clinicians didn’t have to spend time away from the clinic as they previously did when offering the classes in person.

Q: Can you explain how you got that alignment and consistency across the continuum?

J: First, we started with the inpatient team and looked at what the evidence said about pre-op classes, the exercises patients need to be doing for different orthopedic surgeries, etc. The research showed that we need to keep patients from being overwhelmed with the number of exercises that they get right at surgery, so we’ve tried to keep the number of exercises down under five.

We took that evidence and brought it to our physician champions, then asked them to help us with the rest of the division. In our Central Florida division, we have over 15 hospitals, many outpatient centers, and many surgeons, so we knew that our physician champions were going to be essential to achieving that buy-in across that many people.

Leigh: This division-wide virtual opportunity allowed our teams to come together to collaborate on the materials and highlight outpatient rehab as well as inpatient, because the research shows that total joint patients coming directly to outpatient rehab from inpatient have better outcomes.

Q: Besides the buy-in from the physicians and different departments, what about the clinicians themselves? How did you get that consistency from the rehab team to be able to generate the results that you’re hoping to see as you build this program?

Leigh: It’s a three-step process on a continual loop, and step one is educating our clinicians on why it’s important. If clinicians understand the evidence, they will understand that patient participation in the pre-op class is going to improve their outcomes. Step two is focusing on the evidence and the care that we should be providing, and to make sure all of our staff are adhering to that plan when they connect with patients. Step three is sharing the feedback and the data that we are going to be able to pull from these classes to close that loop and show them that they’re making a difference.

One unique way that we utilize MedBridge is in developing knowledge tracks to ensure that our inpatient teams, our home health teams, and their outpatient teams are all on the same platform. We standardized the training and the education, and then we have breakout sessions with our teams to make sure they have the skills they need. We want to involve the team in actively learning about and participating in the launch of this program, and prepare them to connect with the patients in the virtual class.

To find out more about AdventHealth’s coordinated virtual pre-op and post-op total joint program, specific tips for success, and plans for the future, watch the full presentation here.