Cleveland Clinic's 'Joint Club' aims to get orthopedic patients involved

nursebedlam · Jun 2, 2004

May 31, 2004

There's a new club in town and eligibility is having worn-out joints.

Members of The Joint Club at Cleveland Clinic Naples qualify as partial knees, full knees or hips.

Every day they engage in some post-surgical golf in the west wing of the fourth floor, have a leisurely lunch and chat. They enjoy a fellowship that nobody would expect from a hospital stay for joint replacement surgery.

But it's Cleveland Clinic's new treatment philosophy for these patients, an approach that makes the patients intricately involved in their care from the moment they arrive to discharge. Gone are the days when the patient feels left in the dark and full of anxiety.

"The purpose is to make you, as a patient, involved and not being a victim of a big system," said Dr. Robert Zehr, an orthopedic surgeon and executive director of Cleveland Clinic. "The idea is to make the patient active participants in their care right off the bat. The more you know, the less worried you are."

The program with the hospital's Orthopaedic Center of Excellence takes off on the popularity of golf in Southwest Florida, incorporating some humor in the first few days of rehabilitation.

"We make it a lot of fun," said Lisa Ceto, a physical therapist. "They develop a good camaraderie."

A few hours after knee or hip joint replacement surgery, patients are up and taking their first steps with the support of a walker. Many do one or more trips around the hospital floor.

Plexiglass signs of a golfer are mounted on the wall around the hospital floor every 25 feet, which is one hole on the hospital's "golf course." Three trips around is a distance of 450 feet and that's playing 18 holes.

The patients track their progress on a golf game scoreboard near the nurses station, moving their individual magnetic golf cart across the board as they improve their distance. That way patients see how every one else is progressing, spurring one another along in their physical therapy.

The concept of making the patients active participants in their own care was borrowed from Anne Arundel Medical Center in Annapolis, Md., with the golf game elements added by staff with Cleveland Clinic's orthopedics department, Zehr said.

"Everything down here (in Collier) is tied to a golf club," he said, adding that one of the nurses came up with the "joint club' name. "The thought was you become a member of something special."

Patients recuperating after joint replacement surgery typically are not sick like traditional hospital patients. They get a T-shirt that says they belong to the joint club and wear their own street clothes during physical therapy.

Patients' spouses are given pins that say "caddy" and walk with their loved ones on the trips around the hospital floor. When a spouse is unavailable, a hospital volunteer fills in as a caddy.

Grace Martin, 86, of south Fort Myers, walked 150 feet the same day of her hip replacement surgery and two days later was going full tilt.

"I did 36 holes," she said one day last week, beaming a smile that seems perpetual. "I went across the chart. I feel good."

The thrust of the program is educating patients about every step in the process, from what they must do before surgery, what the surgery involves and what to expect from recovery and rehabilitation.

There are educational videos about knee, partial knee and hip replacement surgery in the outpatient waiting room and more videos and reading material in the examination rooms during a pre-operation visit.

"Repetition is what gives people greater comfort," Zehr said.

Each patient is given a guidebook that tells him or her about everything to expect, and the guidebooks are personalized, listing a patient's appointments.

"We want them to have as little to worry about as possible," Zehr said, adding that any question he's ever been asked from a patient is addressed in the guidebook.

In addition, every patient visits the orthopedics floor to meet the nursing staff and physical therapists before their scheduled admittance.

Zehr and another orthopedic surgeon on staff, Dr. Edward Stolarski, collectively do 15 to 20 joint replacements surgeries every week, using much smaller incisions so recovery is much faster.

The incision for a partial knee joint is 3 inches and the incision is 4 inches for a total knee joint replacement. For hip replacement surgery, the incision is 21/2 to 3 inches.

Patients stay in the hospital for 31/2 days for physical therapy and no longer are sent afterward to a rehabilitation facility for an indefinite stay. Instead the hospital arranges for their continued rehabilitation at home with physical therapists from a local coming to their home.

"I think people do better when they are able to go home," Zehr said. "Only the frail go to a rehabilitation center."

Because of the smaller surgical incision, the total rehabilitation is much shorter, averaging four weeks when it used to be 12 weeks.

Patients have group physical therapy twice a day together during their three-day hospital stay.

"Group therapy has made a huge improvement in attitude," Zehr said, visiting several patients in group therapy one day last week.

Judy Vail, 66, of Bonita Springs, who had joint replacement on her left knee, said the program's philosophy of having the patient fully clued in on what's happening makes a huge difference.

"It instills good confidence so you're oriented, you know exactly what's going to happen," she said.

Margaret Christensen, 56, of Naples, had a total joint replacement of her right knee and was focusing on getting better back on the tennis court.

"I'm planning on playing doubles again, not singles," she said.

http://www.naplesnews.com/npdn/news/article/0,2071,NPDN_14940_2926786,00.html