Campaign for the Third Century of MGH Medicine

Two years ago the MGH launched the largest fundraising campaign in its 200-year history. The three-year effort to raise 1.5 billion dollars, called the “Campaign for the Third Century of MGH Medicine,” will create funds necessary to enable the MGH and our physicians to continue to deliver the highest quality care, conduct pioneering biomedical research, address pressing health care needs locally and globally, and educate the caregivers of tomorrow. Our Department has adopted the motto, “You don’t have to be a patient at the MGH to be cared for by the MGH.” This lofty goal is demonstrated by the numerous translational activities that go on within the Department and have reached patients globally. These include new techniques for total hip arthroplasty after acetabular fracture, improved methodologies for ligament reconstruction of the knee, a better understanding of the kinematics of the lumbar spine and spine disc replacements, generations of new polymers to decrease wear in total hip and total knee arthroplasty, innovative new knee designs, and the list goes on and on!

One important part of the campaign was the opening of the Lunder Building. Peter and Paula Lunder of Maine donated $35 million toward the building and received naming rights to the wonderful new tower. This new state-of-the-art facility houses Radiation Oncology, Radiology, inpatient and outpatient surgery (including Orthopaedic Surgery) and a cutting-edge surgical center with new operating rooms. The top five floors offer increased inpatient capacity for Cancer, Neurology and Neurosurgery. The Orthopaedic operating rooms are located on the third floor and have undertaken an aggressive campaign–called the Orthopaedic Innovation Project–to increase the quality, safety and efficiency of care for our patients.

Orthopaedic Innovation Project

Last summer, a senior leadership team including Jeanette Ives Erickson, RN, DNP, Greg Pauly, Ann Prestipino, Jeanine Wiener-Kronish, MD, and I, came together to launch the Orthopaedic Innovation Project. The goal of this project is to build a culture and perioperative system supporting the motto of the new Lunder 3 operating rooms, “Great Care,On Time, Every Time.” The senior leadership team charged Wilton Levine, MD, Director of Compliance, Regulatory Affairs and Disaster Management, Department of Anesthesia, Critical Care and Pain Medicine, to lead this effort along with Mark Vrahas, MD, Chief of Partners Trauma Service, Eddie Belmar, Orthopedic Equipment and Instrument Coordinator, Jim Barone, RN, Clinical Nurse Manager, Main Orthopaedic Operating Rooms, Lauren Lebrun, Administrative Fellow, and Robert Peloquin, MD, Division Chief of Orthopaedic Anesthesia. The team is responsible for managing daily operations on Lunder 3 as well as associated improvement initiatives. The strongest element of this project has been team engagement, both at the senior leadership level and at the front-line staff level. A testament to this engagement was the 140-person attendance at the multidisciplinary perioperative retreat in July 2012, held at the Liberty Hotel and hosted by OIP operational leaders.

Currently, the team, together with Lunder 3 staff, has implemented a successful “on-time start” initiative resulting in a 20% average increase in the number of first cases starting on time. Additional improvement efforts have centered on decreasing room turnover times, leading to an overall 15% decrease. To facilitate further OR efficiencies, the team is currently working on streamlining pre-surgical patient preparation processes. Our orthopaedic surgical volume is increasing and our efficiency metrics continue to improve. Although this work is still in its infancy, I am enthused by our progress to-date.

Arthroplasty Care Redesign

In early 2011, hospital and physician leadership launched an institutional-based Care Redesign initiative that is similar to an effort underway at Partners. The MGH/MGPO-based Care Redesign Program focuses on reengineering care delivery for specific patient diseases or episodes of care in an effort to improve patient care and in preparation for payment reform, to make it more affordable. One of the areas of focus is total joint replacement procedures.

Leading the Total Joint Replacement Redesign effort is Andrew Freiberg, MD, Vice Chair, Department of Orthopaedic Surgery, Robert Peloquin, MD, Division Chief of Orthopaedic Anesthesia, Greg Pauly, Chief Operating Officer of the MGPO, and a large clinical and administrative team. Following months of research and small-scale pilot programs, the team launched the Total Joint Replacement “EXCELerated Recovery Program” in March 2012. The program employs elements of enhanced patient education, early mobilization and medical management changes and focuses on decreasing average patient length of stay. To date, this program has resulted in a significant decrease in PACU time and a 20% decrease in average patient length of stay. Our patients report that the care offered through the program is patient-centered and highly coordinated. Congratulations and well done!