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3 117 21 11 Source: NewYork-Presbyterian 2016 Data: Reects orthopedic volume at NewYork-Presbyterian 3,509 3,475 2,441 Orthopedic Oncology Hand and Microvascular Surgery Foot and Ankle Shoulder and Elbow Hip and Trauma Knee Spine 544 Inpatient Volume Adult and Pediatrics 2016 n=10,118 CLINICAL CARE Orthopedic Surgeons 57 Orthopedic Procedures 10,900 Dedicated Orthopedic Beds 44 Physical Therapy Treatments >1,000/month RECOGNITION NewYork-Presbyterian is the Official Hospital and our orthopedic surgeons are head team physicians for the New York Yankees and New York City Football Club (MLS) The Hospital has 2 State-Designated Trauma Centers and is verified as a Level 1 Adult Advanced Trauma Center RESEARCH Columbia Orthopedics received over $3.3 million from the National Institutes of Health and other organizations 15 Columbia researchers conducted over 60clinical trials in specialties that include spine deformities, bone graft modifications, irreparable rotator cuff repairs, tissue reconstruction for trauma, imaging, and hip and knee arthroplasty GRADUATE MEDICAL EDUCATION At NewYork-Presbyterian/Columbia University Medical Center: 30 residents make up the orthopedic surgery residency program 9 fellows participate in fellowship programs in • Advanced Spinal Deformity • Comprehensive Spine • Hand, Elbow, and Microvascular Surgery • Hip and Knee Reconstruction • Pediatric Orthopedics • Shoulder and Elbow • Sports Medicine Volume includes orthopedic cases at NewYork-Presbyterian/Columbia, NewYork-Presbyterian Allen Hospital, NewYork-Presbyterian/Weill Cornell, and NewYork-Presbyterian Lower Manhattan Hospital 91% n=9,232 Adult Pediatrics n=10,118 Inpatient Volume 2016 Source: NewYork-Presbyterian 2016 Data: Reects orthopedic volume at NewYork-Presbyterian 9% n=886 Quality and Patient Safety Initiatives Systems-Based Approach to Quality and Safety in Orthopedic Care Three years ago, the Department of Orthopedics at NewYork-Presbyterian/Columbia incorporated a quality and safety focus as a mainstay of the department’s overall vision and strategy with the appointment of Michael G. Vitale, MD, MPH, as Chief Quality Officer and now Vice Chief of Quality and Strategy. Under the leadership of William N. Levine, MD, Orthopedic Surgeon-in-Chief, and Dr. Vitale, the department has developed an organizational infrastructure that is transforming orthopedic healthcare delivery. The improvements are driven by a multidisciplinary approach to improving quality, safety, value, satisfaction, and the overall patient experience across adult and pediatric orthopedic subspecialties. The initiatives focus on a number of universal concerns in orthopedic care, as well as on challenges that are relevant to specific procedures. Their work is based on a number of precepts: Variability Unexplained variability reflects suboptimal care Infrastructure A chaotic work environment benefits from infrastructure Group Better decisions are usually made in groups Data Using data can move the bell curve Culture Pivot the culture in order to sustain and scale change “Our processes always involve using best available evidence, harnessing the power of the group, setting goals, working toward those goals, and making the work visible,” says Dr. Vitale. “This five-step process is the foundation of what’s called lean management, which we have incorporated not only as a quality improvement tool, but also as a management tool for our department.” QUALITY AND SAFETY PRACTICES Risk stratification tools and risk severity scores better identify patients at highest risk for surgical complications Surgeon specific dashboards detail performance for select quality, safety, value, and satisfaction metrics drilled down to the origin of the safety issue to define actionable data Comprehensive Unit-Based Safety Program (CUSP) AHRQ-funded multicenter program improves patient safety and staff satisfaction through team building and leadership engagement 4 | NewYork-Presbyterian Orthopedics Delivering Precision Medicine to Orthopedic Care Self-Reported Risk Stratification Tool Potential Risk Factors Identified Guided Patient Services (GPS) Consider Nonoperative Treatment Progress to Surgical Scheduling In-House Referral Matrix Activated Fail Nonoperative Treatment Nurse Practitioner and Care Coordinator Outreach No Comorbidities Initial Consult Comprehensive Unit-Based Safety Program (CUSP): A Case in Point The Department of Orthopedics uses the CUSP model to build a culture of teamwork across disciplines and inclusive of physicians, nurses, and other clinical team members with a goal of improving processes in a number of areas. Following is one example of CUSP in action. CUSP Goal Perform two spine cases in one day The spine team set a goal of performing two spine surgeries in patients with adolescent idiopathic scoliosis in one day by 5 pm. The objective was to reduce the total time from the first-case scheduled start to the time the second case wheels out by 20%. A complementary goal was set to increase staff satisfaction by 25%. Action Plan After conducting staff interviews and observations, the CUSP team identified and implemented the following opportunities for improvement: Quick Wins Installed whiteboards in the OR
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