The amount of time patients spend in a hospital after a total hip or total knee-replacement procedure continues to plummet at hospitals across the country – including at Indian River Medical Center.
Just ask Colleen King, manager of the IRMC rehabilitation department, and Maria Puras, joint program coordinator. They are key players in the Vero hospital’s continuously evolving rehabilitation program known as “Joint Camp.”
Back in 1991, according to the National Institutes of Health, patients spent an average of 9.1 days hospitalized after a hip replacement. By 2008 that was down to 3.7 days, and today “the typical hospital stay after hip replacement is one night,” according to the University of California.
Some knee-replacement patients spend less than 24 hours in the hospital.
King and Puras employ an infectious sense of humor and an undeniable rapport with each other and their patients to encourage people to get up from their post-operative beds as soon as possible after surgery to start rehabilitating those hips and knees.
As Puras points out, “we do get them up out of bed within four hours [after surgery],” though she admits some patients can be a little “grumpy” about that – which is where a sense of humor helps.
“We’re making sure that they’re mobile, getting the range of motion and decreasing the edema at the surgical site, regardless of whether if it’s a hip or a knee,” King adds.
That said, the Joint Camp’s work begins long before a patient is wheeled into or out of the operating room.
According to King, Joint Camp actually begins with a meeting that lasts an hour or an hour and a half.
“We do [the meeting] once a week,” she explains; it includes a tour of the hospital to show patients where to park the day of surgery, where to check in and what to expect.
“Patients and families can come as many times as they want leading up to their surgery,” King continues.
They also “have patients come in [for the class] who are not even scheduled for surgery, but they’ve heard about the class so they come just for future knowledge,” Puras says. “I think that’s great, too.”
Participants are provided a checklist for what to bring with them to the hospital – and what not to bring – along with some clear and concise tips for making their homes safer during their recovery. They receive information on pain management and medications, durable medical equipment such as walkers and canes, occupational therapy and even sex after joint replacement surgery, along with exercise tips and advice.
For most patients, post-op pain management is a main concern and the good news on that front is IRMC, like many hospitals, has moved away from relying on opioids for pain control.
As King explains, “we’re doing what’s known as the ERAS [or enhanced recovery after surgery] protocol right now.” That, she says, reduces narcotic intake but still successfully manages patients’ post-operative pain.
“What we’re doing now is a ‘cocktail’ [of drugs] where we use less narcotics,” King says. “It actually improves the outcome because patients don’t have all the side-effects [of narcotics], yet their pain is very well under control.”
Puras jumps in to add, “that’s our main focus. Managing their pain. Because if they don’t have their pain managed, they can’t do anything with their exercises.”
Another element of IRMC’s Joint Camp is making use of folks who have “been there and done that.”
“We have what we call Joint Camp ambassadors who are prior patients,” King explains. “One is a knee patient. One is a hip patient. Together they can give the patient perspective on what to expect.”
Since the Mayo Clinic reports that “hip and knee-replacement operations are now among the most commonly performed operations in the U.S., with around 1 million procedures performed each year,” both Puras and King are looking forward to helping more patients resolve their hip and knee problems by “camping out” with them.
For more information on Indian River Medical Center’s Joint Camp call 772-794-2556.