Last month, MultiCare’s Valley Hospital announced it had earned the Joint Commission’s gold seal of approval for advanced certification for total hip and total knee replacement, an evaluation that requires impartial evidence of the quality of care, treatment, or services delivered to patients.

While Valley Hospital claims to be the first and only hospital in the state of Washington to have earned the designation so far, MultiCare Valley Hospital President Greg Repetti says others will likely follow soon. 

“We’re starting to see more and more hospitals that are focused on improving patient outcomes and overall experience,” he says.

Although the certification isn’t intended to be used as a marketing tool, it could still prove helpful in attracting patients, Repetti says.

“These are elective procedures, meaning people are researching and seeking the best facility at which to have them done,” he says. “For those who care to check, this certification demonstrates we’re at the top of our game and shows our staff is dedicated to good patient outcomes.”

Repetti says demand for joint replacement surgery is already high enough that hospital representatives are considering how best to expand their hip and knee replacement program here.

“We do expect the program will need to grow,” he says. “We’re currently working on some ideas for expanding to meet that need.”

He adds, “Orthopedics is a big part of what we do here, which is part of why we’ve been so focused on achieving this certification.”

Repetti says that while the certification recognizes the hip and knee replacement program staff’s dedication to their patients, it also serves as motivation to continue improving.

“When you have a staff that does a lot of these procedures, they start to become really good at it,” he says. “But these types of surveys also encourage us to evaluate our current practices and look for new ways to improve and advance quality of care.”

Founded in 1951, the Joint Commission is an Illinois-based nonprofit organization that evaluates and accredits more than 21,000 health care organizations and programs in the United States.

Holly Payne is a registered nurse and coordinator for the total joint restoration center at Valley Hospital, which occupies about 2,500 square feet of space on the building’s second floor, at 12606 E. Mission.

Payne says that when it comes to Joint Commission certifications, there are two levels, core and advanced. Valley Hospital has been working toward the former since 2011 and the latter since 2016.

“For each of these certifications, the Joint Commission requires an application and a minimum of 4 months of data,” she says. “The process is not easy, and you must obtain core certification first before you’re able to apply for advanced.”

Payne says core certification requires a one-day survey to observe a facility’s processes, while advanced certification requires a more detailed, two-day survey that covers all aspects of the patient experience.

  “The advanced certification process requires you streamline starting in the surgeon’s office, through admission, course of stay, and well beyond the patient’s discharge,” she says. 

“The biggest difference between the two is the level of communication needed between staff, in order to ensure everything runs efficiently from start to finish.”

Payne says once a hospital has achieved the advanced certification, the Joint Commission checks in again every two years to make sure it continues to meet guidelines that ensure patient satisfaction and quality surgical practices. 

“The hospital also sends the Joint Commission quarterly results on patient outcomes, to further prove our efficiency,” she says.

Payne says the most recent quarter’s survey results showed MultiCare Valley Hospital’s hip and knee patients now spend a full day less than the national average in the hospital and report an 89 percent satisfaction score, 18 percent above the national average.

“The length of time a patient stays at Valley Hospital for these surgeries is about 1.6 days, compared to the national average of 3.1 days,” she says.

Payne says up to 30 different staff members work within the hip and knee replacement program each day; including surgeons, nurses, post-operative nurses, rehabilitation/physical therapists, and case managers.

“From 2016 to 2017, we completed 817 total knee and hip replacement surgeries, an average of 52 each month,” she says. “That number increased by 43 percent from 2011 through 2017.”

She attributes that increase to the increased efficiency of the hospital’s joint replacement program, as well as improved patient outcomes and word-of-mouth advertising.

“Our staff is very well educated and experienced,” she says. “Part of what makes our program unique is that all knee and hip replacement patients are required to attend a class at least three weeks before their scheduled surgery.”

Payne says program staff also occasionally attend the education class, so that everyone is thoroughly educated on all aspects of the patient experience. 

“We try to provide as clear an explanation as possible, so there aren’t any surprises,” she says. “Patients who’ve been through the program also serve as examples and resources for new patients with questions.”

Payne says presurgery education classes have an average size of 30 people, half of whom are friends or family members of patients who have agreed to aid in transportation and recovery processes.

“Classes are about two hours long and cover the procedure as well as patient paperwork,” she says. “We go over questions and also discuss discharge plans and pain management.”

Payne says part of her job as coordinator also involves calling patients prior to class to ensure they have access to transportation and remind them to bring paperwork.

She says the hospital works with patients to schedule post-surgery physical therapy appointments, and also helps to arrange for home health agencies to look in on those who may need in-home caregiving as they recover.

Dr. Jon Keeve, an orthopedic surgeon and medical director of the Valley Hospital hip and knee replacement program, says candidates for total knee or hip joint replacements typically are individuals in their mid-60s, who’ve already exhausted nonsurgical options for relief of joint pain.

Keeve says most knee or hip replacement surgeries take about an hour to complete, and the amount of time in the hospital post operation has declined.

Ten years ago, the procedures required a one-week hospital stay, he says. Now, most knee or hip replacement patients at Valley Hospital only need to stay overnight.

“Here our patients have surgery in the morning, and are encouraged to be up and about later that same day,” he says. “We try to discharge them the next day and send them home to recover, as that’s also been shown to improve outcomes.”

Keeve says the hospital uses special software to track patient results and progress and tries to learn from experiences in which an outcome didn’t go according to plan.

“When you’re able to develop a consistent program that runs effectively using correct processes and procedures, that allows us more time to address those little details and individual patient needs that ultimately result in better outcomes,” he says.

He says the hospital also occasionally hosts patient reunion luncheons to receive further feedback and suggestions from patients who’ve been through program.

“There’s not just one aspect that’s most important,” he adds. “The biggest thing is making it a predictable experience. Patients want that in their health care, so that’s what we’ve tried to accomplish.”

Both Payne and Keeve say part of what helps the joint replacement program function so well is its focus on presurgical education and efforts to streamline discharge plans and pain management.

“Surgical preparation and pain management are two areas that have improved greatly,” says Keeve. “Everyone is much better educated about the process, which keeps things running smoothly.”

“We also work closely with other departments to ensure we use as many non-narcotic pain medications as possible so that patients are able to manage pain without risking addiction,” he says. 

Keeve says attaining the Joint Commission certification has been a good target for him and his staff to aim for these last six years.

“We asked all those involved in the patient experience for input, and put our heads together to come up with the most comprehensive program we could,” he says. “The Joint Commission’s standards for patient care are pretty high, so it’s really rewarding to be able to confirm our program meets them.”

Looking ahead, Keeve says he hopes to see the hospital continue expanding the joint replacement program.

 “Currently, we only have so much space, and demand for knee and hip replacements is only going to increase,” he says. “We need to be prepared for that, which may mean adding to our facilities here.”

A Tacoma Wash.-based nonprofit, MultiCare Health System purchased Deaconess Hospital, Rockwood Clinic, and Valley Hospital last July.

In addition to its facilities here, MultiCare operates five hospitals on the West Side. Its network also includes primary care, specialty care, and urgent care clinics, and community outreach services, as well as the MultiCare Medical Associates physician group. The organization employs more than 12,000 people.