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mize opioids, employ multimodal pain proto- cols, and help total- joint patients heal as quickly and comfort- ably as possible. "We're really proud of what we've done in the last year," says Ms. Ford. The hospital, she says, had been doing joint replacements for 12 years, "but last year we decided to take a closer look at some best practices and try to standardize what we were doing. All of our sur- geons were doing things a little differently, so we decided to set up some meetings and compare notes." The result was a program in which patients set their own expecta- tions, begin physical therapy on the day of surgery and circle back for "reunion lunches," to provide a continuous feedback loop for the care and handling of future patients. It all hinges on careful collection of data, says Ms. Ford. "Because that's what tells the story about the effectiveness of our care." Shortly after implementing the program, the hospital was able to document that patients were getting up sooner, walking farther, decreasing their lengths of stay, and, yes, improving their flexion. "We attribute it all to better pain control," she says. Making sure patients have realistic expectations is another key. "In the pre-operative holding area, we ask patients what they'd like their target pain score to be after surgery," says Ms. Ford. "If they say zero, we say, well, we're probably not going to get you to zero, but what will be tolerable for you? Maybe a 4?" A nurse documents the target and hands off the info to PACU. And 4 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • S E P T E M B E R 2 0 1 7 As the procedure is completed, surgeons deliver the RECK solution — a combination of ropivacaine, epinephrine, clonidine and ketorolac that's injected into the joint.