History
During the early 1980's the hospital length of stay for a patient undergoing a total hip or total knee surgery was fourteen days. Length of stay for patients having revision surgery was even longer. Insurance companies usually paid in full for these hospitalizations, and as hospital costs continued to mount, it became apparent that changes in hospital insurance and patient care policies were necessary. With physical therapy, occupational therapy, dressing changes, and other treatments being available in either the patient's home or an outpatient setting, the push to reduce hospital length of stay intensified.
To respond to these needed changes the orthopedic community began to look at different ways to allow the patient to return home earlier. As new post-operative routines in physical therapy, discharge planning, and improved surgical procedures became more and more accepted the orthopedic surgeon was able to allow patients the ability to be discharged home in about 5-7 days. This was always dependent on the patients general health and their ability to receive appropriate care in their home or at facilities that specialized in what was termed "sub acute" care or rehabilitation care. With continued improvements these hospital stays were reduced to 4-5 days. Now with changes in the approach to total hip and total knee replacements over the last few years the patient is able, in many cases to be discharged home in 2 days. Often times with no additional services needed. One of the unexpected side benefits of this approach was that orthopedic surgeons discovered that patients and their families actually recovered more quickly when they were in their home environment.
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Goals
The goals of surgical management are to:
- Provide the highest level of patient care in the most cost-effective manner possible.
- Improve coordination and efficiency of the patient's surgical experience- pre-operatively, during hospitalization, and after discharge.
- Provide the patient with the proper monitoring needed post-operatively to assure optimum care in the hospital.
- Assist in establishing any services needed in transferring the patient from an inpatient care status to an outpatient (home) care status.
- Assure proper follow-up of the patient during the post-discharge phase, detect any problems, and treat those problems as necessary.
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Patient Contact
If you have scheduled surgery with Dr. Nessler, you will have a variety of people who will follow your case pre-operatively, during your hospitalization, and after you are discharged home.
Pre-Operative Phase
THE PRE-OPERATIVE PHASE IS ONE IN WHICH THE EMPHASIS IS PLACED ON PLANNING, EDUCATION, AND CAREFUL ESTABLISHMENT OF A TEAM OF SPECIALIZED PEOPLE TO ASSIST YOU, THE PATIENT, IN ALL ASPECTS OF YOUR CARE.
Initial contact with this team occurs when you are seen and evaluated by Dr. Nessler and a determination that surgery is the best treatment for you. A surgery scheduling professional will then meet with you at Dr. Nessler's office. The purpose of this contact is to assist you in scheduling your surgery for a date that is mutually beneficial to you and Dr. Nessler as your surgeon. In addition, a brief medical and surgical history, a listing of medications, and demographic information is obtained. By conducting the pre-operative interview, the patient is introduced to a contact person for himself and family members. Any questions, problems, or concerns can then be brought to the surgery scheduler's attention throughout the pre-operative phase. These schedulers have direct contact with Dr. Nessler or his assistant to answer any of your questions or concerns relating to your surgery and or admission to the hospital. In addition, the pre-operative phase includes inviting and encouraging the patient and family members to attend a pre-operative class concerning total joint surgery. These classes are held at St Cloud Hospital and are very useful in helping you learn more about your surgery, your post-operative hospital care and planning for your discharge from the hospital. The classes will also give you a chance to evaluate you possible need to additional services that may be needed by you or your family after you are discharged from the hospital.
Hospitalization Phase
DURING THE HOSPITALIZATION PHASE EMPHASIS IS PLACED ON MAINTAINING YOUR GENERAL HEALTH FOLLOWING YOUR SURGERY AND ADJUSTING THE DISCHARGE PLANS AND PROVIDING ACCESS TO HOME CARE NEEDS IN A SAFE AND TIMELY FASHION.
During this phase, Dr. Nessler, his assistant, and/or one of his surgeon partners follows you and reviews the discharge planning. The discharge planner from the hospital will meet with you and your family to help set up any additional help or care that you might need when you are discharged from the hospital. All of the information is communicated to Dr. Nessler so that he can write needed orders and establish your rehabilitation goals with these service providers. Any adjustments to the original plan or referrals to other areas are then made. The discharge planner and Dr. Nessler will be overseeing the discharge plans and coordinating any post discharge services required by physical therapy, nursing, or other home care programs. It is also during this phase of interaction that the patient is given instructions regarding scheduling follow-up appointments and the reporting of post-discharge problems to Dr. Nessler or his assistant.
Post Discharge Phase
EMPHASIS DURING THE POST DISCHARGE PHASE IS PLACED ON FOLLOW-UP CARE, MAINTAINING CONTACT, AND EARLY INTERVENTION IN THE EVENT OF ANY POST DISCHARGE PROBLEMS.
After your discharge from the hospital, a recheck or follow-up appointment is scheduled with Dr. Nessler or his assistant, Jerry Nelson. The most important thing to remember is that if you have any problems before your follow-up appointment you should contact Dr. Nessler's office and speak with his secretary. This information is relayed to Dr. Nessler so that he or Mr. Nelson can evaluate your concerns to determine if you need to be examined sooner than your scheduled appointment. Just because you have an appointment scheduled doesn't mean you should wait with your concerns until then. Sometimes it is necessary to evaluate you sooner to prevent any possible complications from occurring.
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Our Commitment
Dr. Nessler and his staff are committed to making certain that you receive the best result possible from your surgery. Our goal is to help you reestablish your normal lifestyle with improved function so that you can continue to get the most satisfaction from you daily activities and your life. Dr. Nessler has been and will continue to be committed to improving the efficiency and coordination of your care from the outpatient setting to the hospital and back to the home environment. It is our belief that through the surgeon /patient relationship these goals can be achieved safely, effectively, and in a timely manner.
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