Transcript Workflow Mapping - Knee Osteo Baseline Map (DHMC)

TABLE 1. CURRENT DECISION-MAKING PROCESS IN END-STAGE
DEGENERATIVE ARTHRITIS OF THE KNEE
Patient has exhausted all medical,
surgical and lifestyle modification options
in treating advanced degenerative
arthritis of the knee and seeks discussion
with orthopaedic surgeon of further
options (total knee replacement).
Orthopaedic surgeon does not
recommend total knee
arthroplasty and suggests an
alternative
Orthopaedic surgeon
recommends total knee
arthroplasty as a treatment
option
PATIENT CONSIDERS
SURGEON’S
RECOMMENDATION
Patient chooses not to proceed
with total knee replacement
Patient chooses to proceed with
total knee replacement
TABLE 2. KNEE PATIENT TRIAGE ALGORITHM
KNOWN OA OR
CONSIDERATION FOR TKA
PROBLEM WITH EXISTING
KNEE ARTHROPLASTY
PROBLEM AFTER ACL
SURGERY
Bernini
Kantor
Lynch
Mayor
Shirreffs
Sparks
Tomek
Bernini
Kantor
Scudder
Shirreffs
Sparks
Tomek
Carr
Peterson
Sparks
KNOWN MENISCUS TEAR
KNOWN ACL OR PCL TEAR
OR SPORTS INJURY
PATELLOFEMORAL PAIN
Age < 40
Carr
Sparks
Carr
Karlson
Peterson
Shirreffs
Sparks
Karlson
Peterson
Scudder
Shirreffs
KNEE PAIN NYD
PAIN AFTER FRACTURE OR
TRAUMATIC DISLOCATION
Age > 40
Lynch
Sparks
Tomek
KNEE IN PATIENT UNDER
18 YEARS
Carney
Athletes:
Carr
Karlson
Peterson
Sparks
Peterson
Scudder
Shirreffs
Within last 6 mo
Cantu
Koval
More than 6 mo ago
Bernini Kantor
Lynch Mayor
Scudder Shirreffs
Sparks Tomek
Additional Notes:
Patients should always be
offered the option of
an appointment with
the provider that they
have seen previously.
Hemophilia patients should
continue to be
referred to Dr. Bernini
TABLE 3. EVENTS LEADING UP TO TOTAL KNEE REPLACEMENT
AND THE POST-HOSPITAL COURSE
Patient decides to proceed with total
knee replacement
Appointment is made with primary
care provider (usually an internist)
for medical clearance
A standard battery of preoperative
labs is performed including
complete blood count, chem-7
profile, electrocardiogram and
chest x-ray
Patient admitted to DHMC, has
total knee replacement and is
discharged to home or to extended
care facility
Patient attends total knee
replacement class
Regularly-scheduled follow-up
with orthopaedist at 6 weeks, 12
weeks, 6 months and one year.
Radiographs, interval history,
exam and standardized
radiographs are obtained at each
visit.
TABLE 4. PROPOSED DECISION-MAKING PROCESS IN ENDSTAGE DEGENERATIVE ARTHRITIS OF THE KNEE
Patient has exhausted all medical,
surgical and lifestyle modification options
in treating advanced degenerative
arthritis of the knee and seeks discussion
with orthopaedic surgeon of further
options (total knee replacement).
Orthopaedic surgeon does not
recommend total knee
arthroplasty and suggests an
alternative
Orthopaedic surgeon
recommends total knee
arthroplasty as a treatment
option
PATIENT CONSIDERS
SURGEON’S
RECOMMENDATION
Patient chooses not to proceed
with total knee replacement
SHARED DECISION MAKING AID
Patient chooses to proceed with
total knee replacement