Massachusetts General Hospital

Harry E. Rubash, MD

Harry E. Rubash, M.D.

Edith M. Ashley Professor of Orthopaedic Surgery
Harvard Medical School

2012-13 Chief's Report

Care Redesign


Since 2010, we have established several care redesign teams to streamline and improve patient care delivery. Over the past three years, many teams have completed their work and new teams are being formed. Much of the work done by the Total Joint Replacement Team has already been integrated into our standard of practice.


Leading the total joint replacement redesign effort is Dr. Andrew Freiberg, Arthroplasty Service Chief and Vice Chair of the Department of Orthopaedic Surgery, Dr. Robert Peloquin, Division Chief of Orthopaedic Anesthesia, and Lauren Lebrun, MGPO Project Director, together with a large clinical and administrative team. The executive sponsor is Greg Pauly, Senior Vice President for Orthopaedic Surgery and MGPO Chief Operating Officer.


In early 2012, the Arthroplasty Care Redesign team launched the Total Joint Replacement EXCELerated Recovery Program. The program employs elements of enhanced patient education, early mobilization and medical management changes, and focuses on decreasing average patient length of stay. Since implementing the program the team has reduced average length of stay across all joint replacement patients by 17 percent (26 percent for patients enrolled in the EXCELerated program), saved an average of 900 inpatient days per year, decreased PACU recovery time by 19 days per year and maintained high levels of patient satisfaction and outcomes.


Earlier this year, Dr. Freiberg presented the results of this project to the MGH General Executive Committee, which credited this work as a model for future institutional care redesign initiatives. The project results will be published later this year in a New England Journal of Medicine-Harvard Business School joint publication.


Other teams included Neurovascular, Transplant, COPD, and Rheumatoid Arthritis. A back pain care redesign team is working on a number of initiatives, from triage to shared care guidelines, to improve access and coordination of care.


Decision Support


In addition, we are utilizing decision support tools to help assess our procedure appropriateness. Using our provider order entry program (PrOE), as well as our radiology order entry (ROE) templates, we recently launched a procedure order entry application. PrOE integrates clinical guidelines and personalized perioperative risk assessment to inform and document procedural decision-making. It also helps standardize treatment options and greatly promotes specialist collaboration. Key features of this program include personalized consent forms, shared decision-making materials, and integration of scheduling systems to provide increased operating room access for our patients. I will relay more about PrOE activities in next year’s annual report.

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