After surgeries ranging from a kidney transplant to cataract removal, James Warren thought he knew surgery. But when he needed a total knee replacement, his perceptions changed. To alleviate his uncertainty before going under the knife, he had orientation. Smiling, kind nurses catered to him like a king. He paid no extra fee for his large, private room with hardwood floors, and to top it off, he and the dozen other patients in his unit had knee and hip replacements on the same day. Despite their pain, by the next day they laughed and played games in group therapy. Together, they chatted and compared notes while enjoying gourmet fare, such as filet mignon, tilapia and shrimp Alfredo. On his way home from the hospital one day last summer, Warren realized he had made new friends. “This is the way to do it,” says Warren, 67, with his wife, by his side as a support coach. Warren's experience is not some strange medical fairy tale; it's reflective of a new patient-centered care model sweeping the United States. Tired of wham-bam hospital care, patients have rallied for more humane treatment, and hospitals are taking notice as they realize patients who heal together, heal faster. “It just makes you feel good,” Warren says. “The nurses here are very compassionate, and they're handpicked for this unit. They'll bring you a cup of coffee at 3 a.m. I've had some nurses get mad at you if you ask them for something. The doctors come in here, and you can ask them whatever you want to ask. Our therapists - everybody - they seem to really care.” Change may be coming to the whole industry, but drastic change is slow, of course, In many segments of patient care, this idea manifests itself in the occasional “patient-care specialist” who stops by beds and asks “Is everything OK?” Or a 30-minute emergency room “guarantee” that really isn't. But one particular specialty, orthopedics, actually is undergoing a dramatic transformation in the way it treats hospital patients. Driving the trend is the high demand for total joint replacements, as the nation's baby boomers age and experience accidents or suffer from arthritis. “There's probably nothing magical about people being grouped together from a biomechanical standpoint,” says Jim Crean, former Physician assistant and orthopedic coordinator at Pontiac Osteopathic Hospital's Joint Club. “But groups create camaraderie, and people become more active sooner. Some big old' strapping truck driver doesn't want some little old lady outpacing him. It's good for the patients to compare their progress with other patients.” Crean says hospital officials were astonished by results during the program's first year. No patient required more than a three-day hospital stay, and about 80 percent of patients left the hospital a day earlier than before the initiative began. “We're not rushing anybody out of the hospital, and we're not pushing anybody out,” he says. “They are getting better faster.” After his hip replacement surgery following a near-fatal motorcycle accident, David Williams of Clarkston recovered so quickly, he was released from the hospital in two days. “Other hospitals don't cater to you with the food, the orientation in the beginning or the staff - the nurses,” says Williams, 37, who previously underwent surgeries to rebuild his wrist, and the tibia and fibula bones in his legs. “Here, they cater to your needs.” Calandra Anderson, nurse manager of medical-surgical services who staffs the Joint Club, believes the model makes it easier to get over having surgery. “No one is alone,” she says. “You can grow together, learn together. Because it's a collaborative effort, patients have less anxiety, less fear and more quickly get back to their independence in life.” Dr. Marshall Steele, an orthopedic surgeon in Maryland, is credited with creating the concept that's become an international trend. In 1996, Steele started a program at Annapolis, Md.'s Anne Arundel Medical Center, now called the Joint Camp, after deciding there had to be a better way of helping patients get through joint replacement surgeries. He convinced hospital officials that patients would heal faster if they were better educated before surgery, doctors were more experienced and had management tools, and the hospital and operating room were run more efficiently. He came up with the orientation program, and determined the hospital needed to follow patients after surgery, by hosting a luncheon a month after surgery, and tracking their progress annually. The idea caught on so well that other orthopedic surgeons flooded the hospital with visits and calls. In December 2005, Steele launched Marshall Steele and Associates, a consulting firm dedicated to helping hospitals implement the model, and in less than two years, he's helped about 50 clients around the globe. “This is a worldwide phenomenon,” he says. “The health care industry is in trouble. It's too expensive, it's unfriendly, nobody measures outcome, and the public wants more. They want a better experience, knowing they are getting the best outcome. And they want it to be affordable. “We are trying to make all those things happen for the patient, the doctors and the hospitals. Insurance companies benefit, too.” Martin Beaulac, director of Ortho and Neuro Services at St. John Macomb-Oakland Hospital in Warren, says patients seem to love the experience. “We've had tremendous success getting people home after surgery,” he says after measuring the center's outcomes for the past few months. “More than 90 percent of patients go home (instead of a nursing home) immediately after surgery as opposed to 60 percent before.” Pierce says the program's nurses and physical therapists are like cheerleaders, and that helps. “They expect for you to do what you can do,” she says, “and they are right there for you. Others say, `Well, stay off of it.' It was horrendous the pain I've been in with no therapy. This has been such a good experience.” Steele expects the model to be adopted for other elective surgeries such as vascular and spine operations. “I call it the model for the future,” he says. “This model can be reproduced in multiple areas of medicine. Hopefully, we will succeed in some small ways so healthcare can change.” __
