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HAP Achievement Award Spotlight: St. Luke’s University Hospital—Improving the Safety of Joint Replacements

February 08, 2019

HAP Achievement AwardSt. Luke’s University Hospital was awarded HAP’s “In Safe Hands" 2018 Achievement Award for its success in reducing post-operative complications for patients undergoing elective total knee and hip replacement.

Based on analysis of data about patients’ post-operative complications, the Orthopedic Performance Improvement team decided to focus on reducing acute kidney injury and hypotension complications. The team set an ambitious goal for their “Save a Kidney:  Orthopedic Total Joint Acute Kidney Injury Reduction” project:  Reduce the rates for these complications by 25 percent within one year of the project’s start.

A series of initiatives were implemented, including:

  • Establishing criteria and processes for identifying and managing high-risk patients
  • Advising patients to follow up with primary care physicians and nephrologists based on their preoperative glomerular filtration rate and any medical history of chronic kidney disease or diabetes
  • Evaluating medication and pre-operative fluid management prior to surgery
  • Creating and implementing a nursing hypotension protocol for post-surgical care
  • Including best practice advisories in the electronic health record to guide physicians when ordering pre- and post-operative medications and labs

As a result of this work, rates for both types of complications were cut nearly in half:

  • The acute kidney injury rate decreased from 6.02 percent to 3.18 percent—a 47 percent reduction
  • The hypotension rate decreased from 14.54 percent to 8.07 percent—a 44 percent reduction
  • Patient length of stay also decreased

In addition, St. Luke’s established a multidisciplinary team to work toward the long-term goal of performing in the top 10 percent of similar, “peer” providers achieving low rates of post-operative acute kidney infection and hypotension complications.

St. Luke’s award-winning submission includes details to help other organizations reduce these complications. Learn more about this successful program at HAP’s website.

Questions about the HAP Achievement Awards may be directed to HAP Member Services at (717) 561-5359.

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