We also adjusted some of the more conservative candidate criteria
as we got more accustomed to the program. Initially we capped the
program at age 65, but then we realized our older patients were doing
really well, so we asked, "Should age really be a limitation if a can-
didate met all the other criteria?" So we slowly pushed the envelope
with patient age and, as of right now, our oldest same-day patient was
80 years young.
Finally, we used our same-day initiative as a pilot program of sorts
for other organization-wide initiatives. And it happened completely by
accident. We noticed our same-day medication regimen was very opi-
oid-heavy — with both the primary and the secondary meds being
hydrocodone and oxycodone. So we decided to test an opioid-sparing
protocol for our same-day patients where they started with only non-
opioid pain meds — such as acetaminophen — combined with non-
pharmacological treatments like ice therapy and moved up to opioids
based on pain level. The protocol was so successful that we soon
rolled it out to our non-same-day patients, too. We've now implement-
ed our opioid-sparing protocol across our entire total joints population.
First of its kind
In the end, our move to a same-day total joints program was all about
quality, about providing our patients with better outcomes. And by
taking a pre-emptive approach, we created and fine-tuned a program
that was the first of its kind in our city.
OSM
F E B R U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 1 3
Ms. Jean-Louis (kimberly.jean-louis@
nyulangone.org) is a nurse leader of the Total Joint Replacement Same Day
Discharge Program at New York University Langone Orthopedic Hospital in New
York, N.Y. Ms. Moynihan (annmarie.moynihan@nyulangone.org) is the direc-
tor of nursing for the pre-admission testing unit and ambulatory care units at
New York University Langone Medical Center's Langone Orthopedic Hospital.
