Movement has always been associated with health, whether it happens on a dance floor, a basketball court, or even with the stroke of a paint brush over canvas. Movement represents vitality, strength, well-being.
At Memorial Hospital Central’s ortho/neuro/spine unit, where patients recover from total knee or hip replacement surgeries, movement is a top priority to ensure faster, better healing. Patients who have surgery in the morning, for instance, are up and out of bed by the afternoon. Memorial Central’s new approach to after-surgery care has enabled people to go home from the hospital sooner than ever before after total joint replacement surgery.
“We do our darndest to get people up,” said Jae Sanders, care manager of the ortho/spine unit. “These were people who were at the grocery store the day before and there’s no reason they should be tied to a bed. These not sick people, they are people who have had surgery.”
In March 2009, a physical therapist and nurses on the ortho/spine unit, with the blessing of orthopedic surgeons, challenged their co-workers to get patients out of bed on the day of surgery instead of allowing them to stay in bed. That seemingly simple act paid off in shorter overall hospital stays for patients.
In the past, patients spent an average of 3.1 days in the hospital. Those age 65 and older spent five days in the hospital. Now, people with knee replacements spend an average of 2.7 days in the hospital and those who have hip replacements spend 2.6 days. The national average according to the Agency for Healthcare Research and Quality is 3.6 days for knee replacements and 4.6 days for hip.
In addition, fewer people are sent to nursing homes after surgery; only 7% now compared with 30% a year ago. The early mobility process gained popularity with spine and neuro surgeons and within eight months, Memorial applied the early mobility philosophy to people who had back surgeries, netting similar results. “If it was my mom, I would want her out of here,” Sanders said. “This (the hospital) is a place to get better, not a place to stay. We want people to go home, and that’s where they want to go.”
The improvement is part of an overall effort by Dr. Larry McEvoy, chief executive officer, to grow a culture at Memorial that focuses on building highest quality health care through team work. On the ortho/spine unit, a team works toward getting people up and out of bed starting immediately after surgery. When patients arrive in their room, they’re given a protein drink or broth and crackers to mitigate weakness and dizziness—important for patients who have been fasting for hours before surgery.
Nurses remove urinary catheters, allowing patients to go to the bathroom on their own and reducing risk of infection, which can lengthen a person’s stay in the hospital. With a doctor’s blessing, nurses use more ice to dull pain and fewer pain killers, reducing that “loopy’’ feeling that may cause people to loose their balance when getting up for the first time after surgery. Each patient, no matter what time of day their surgery occurs, is asked to sit up in bed and brush their teeth. Even that movement is helpful, because it promotes respiratory health.
Group therapy is next. Patients dressed in their regular clothes work with physical therapists to get in and out of a mock bathtub and negotiate a mock set of stairs. “When they go to group therapy, they’re getting out of their room and seeing other people who are doing well,” Sanders said. “It provides a little bit of peer pressure. If you’ve got an 80-year-old woman climbing stairs on the day of surgery and a 40-year-old man who is not moving as well, it puts a little pressure on him.” Memorial’s ortho/spine unit also strives to involve families in physical therapy since that helps with the patient’s confidence according to Sanders who adds that seeing patients get up and out of the hospital and back to their homes is extremely fulfilling.
On the unit, it has helped build morale, team work and a sense of accomplishment. “Some patients stand and take a few steps on the day of surgery and others are able to climb the stairs. It’s all patient specific,” said Sarah Sacks, a physical therapist who helped initiate change on the unit. “Most patients want to get out of bed as soon as possible. They chose to have surgery because they wanted to get back to doing something they couldn’t do. It’s wonderful to see their motivation.”