data and outcomes. Perform a program quality review every 6
months, says Excelsior.
• Patient selection criteria. There's no specific age criteria, but
Excelsior has a long list of guidelines for accepting patients, starting
with BMI <40, minimal past medical history with few if any comor-
bidities, well-controlled sleep apnea and being opioid naïve. There
should be no history of cardio-thoracic or diabetic problems, pul-
monary embolism or deep vein thrombosis, blood thinners, rheuma-
toid arthritis, MRSA or gastric bypass. Then there are the invariables
to consider, including patient motivation, family support and the
resiliency of the patient.
• Patient education. All patients and caregivers must attend an
Excelsior patient education class taught by therapists, nurses and
DME staff.
• Surgical techniques and pain management. An anterior
approach for hips offers patients less pain, fewer restrictions, quicker
S E P T E M B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 1 1 1
patient ambulate with a physical therapist.
4. Is your staff up for the challenge? Find out if your nurses,
anesthesia providers and physical therapists have the knowledge
and motivation to offer an outpatient TJR program. Determine if
you'll need to offer extended hours, hire new staff and incorpo-
rate training into the development plan. You'll also want to desig-
nate a point person who coordinates getting the proper equip-
ment and supplies in for each case and also deals with inventory
management and billing.
— Greg DeConciliis, PA-C, CASA
Mr. DeConciliis (gregd@bostonoutpatient.com) is the administrator at
Boston Out-Patient Surgical Suites in Waltham, Mass.
