ProMedica recently opened 
the ProMedica Wildwood Orthopaedic 
and Spine Hospital in Toledo, Ohio, which is ProMedica's first all-digital hospital. The new 70,000-square-foot facility includes six operating rooms and 36 private patient rooms, as well as a fully-integrated electronic medical record system. The hospital's president, Holly Bristoll, and Paul Fenton, MD, an orthopedic surgeon instrumental in the hospital's creation, discuss the finer points of their all-orthopedics facility.
Q: Why did you decide to construct an orthopaedics-focused hospital?
Holly Bristoll: The hospital leadership was already working with the orthopaedic groups to support our orthopaedic service line and our focus was always on how we could provide the best care for patients and their families. The first thing we did was develop best practice protocols. From there, I think the increasing demand for orthopedics from baby boomers provided a real need for specialized care. We decided to build a facility that would focus 100 percent on orthopedic and spine care and offer all relevant services in one convenient location.
Dr. Paul Fenton: When you've got such a focused center, you are going to improve the quality of care by working with specialized professionals. We wanted to work with orthopedic nurses and surgical techs, which would improve our quality and efficiency. Of course, the elephant in the room was always costs, and we wanted to find a way to keep costs down. We needed a facility where we could provide good quality care and be efficient, but also cost effective. In this focused center, we expect length of stay will be less, complications will be less and patient satisfaction will be higher.
Q: What about the orthopaedics-focused center is advantageous from a medical professional's prospective?
HB: There's a need to look at the type of operating room you put together; there are a lot of things orthopedists need in the OR. We also need to look at what the patients need postoperatively. All patient rooms are on the first floor, so there is no vertical travel. We also included a private discharge area so patients didn't have to come through the lobby when they were ready to leave. In the planning phases, we spent a lot of time working on patient flow and needs during their stay.
Additionally, everyone comes here with the same type of issue and our therapy team is focused solely on orthopedic and spine patient needs. Patients might develop a relationship with their neighbors because the neighbor had the same procedure. Our hallway is used for group therapy. We also have a Wii in the therapy room and balance board technology. Another part of our rehabilitation program is a car transfer simulator. We don't want the first time the patient transfers into the car to be in our parking lot when they leave.
Q: What measures does the hospital take to ensure high patient satisfaction?
HB: A lot of care went into designing patient flow that was efficient for physicians. The ORs are designed for them and we have the instrumentation they need constantly available. The patients are always moving forward in our hospital; once they come through preoperative care, we don't put them back in a public space. They keep moving forward.
We also have a hospitalist program and nurse navigators who make sure everything is ready to go when the patient is ready for surgery. The nurse navigator acts as a conduit between care providers and helps the patients prepare to go home. We also have a dietary program and room service for our patients. Instead of picking out dietary trays the night before, patients can order right from their room and receive the meal in 20-30 minutes. That seems to be a big patient satisfier because people can get what they want when they want it.
Q: What makes the facility completely digital?
HB: The hospital connects the surgical information system, anesthesia EMR and all nursing components. The information is in real time and readily available for all healthcare providers in the hospital. If a patient is going through the preoperative evaluation process and identifies an allergy, that note carries through the OR, PACU and inpatient unit so everyone can see it at a glance. When people are charting through the case, the information is available and our medical professionals can take the appropriate safety measures every step of the way.
PF: The real-time aspect is a significant time savings for us. Having the information at your fingertips is a real advantage in terms of time and clinical safety; it is also good for efficiency and efficacy.
Q: Could you expand on that thought — in what ways does the EMR system improve the hospital's efficiency?
HB: There are several ways the EMR helps with efficiency — one of our favorite components is transcription. The surgeons enter notes into the EMR instead of dictating them and then sending the notes for transcription. As soon as the physician enters progress notes on our patients, everyone can see them. Our partnership with the physicians has made this work for us because it does require an operational change. The physicians had to agree to the new system and learn how to input and extract information differently with the EMR.
PF: In a lot of communities, orthopedic groups are very fragmented. This hospital with the particular EMR system was conceptualized about five years ago. We took several measures, including EMR implementation and building design, to create an optimal environment for orthopedic care. The orthopedic community had to work together, which meant collaborating with some people who we might not have regularly interacted with before.
Q: How challenging was it to bring so many different people from the community together to make this hospital a reality?
PF: We impart a great deal of credit to Holly for bringing us together. Sometimes, when you are dealing with physicians, there are several opinions and intricate details to work out behind the scenes. Without Holly, the hospital wouldn't have been possible.
HB: It does take a lot of effort, but creating a venue for people who all have the same passion is what makes it work. It isn't easy every step of the way, but if you put talented people together who have the same passion for patient care and if you can sort out the goals in front of you, you're on the right track. When there are issues, sit down with the physicians and work together to solve the problem.
PF: It's like dangling a big carrot in front of a rabbit; you know what the ultimate prize is — opening a $30 million hospital that is a lot better for you and your patients than where you were before — and you're willing to go the extra mile to achieve that. Coming together is a lot easier when there is an ultimate goal in mind.
Q: What are your goals for the hospital in the future?
PF: The big goal has been to get the hospital open and functional. Now that we've completed that, we're considering new ways we can benefit our patients. One thing we'd like to begin here is educational programs at the regional and national level on orthopaedic and spine surgery. Our digital operating rooms provide us with the equipment to perform live surgeries and broadcast them across the country to teach other surgeons our techniques.
We also want to eventually provide acute care for our patients through a skilled nursing facility. Hospital stays have become much shorter these days, but some patients may not be ready to leave the hospital 48-72 hours after surgery. We want to provide those patients with the assistance they need.
HB: Our intentions are for patients to go directly home as soon as possible. We talk with them about that, and for some going directly home may not be possible. We have a few options for those patients today, but we want to make sure they continue seeing professionals who are orthopedics-focused after they leave our facility. As leaders in orthopedic care, we want to continue developing that side of the equation and make sure the people are giving our patients the same tight focus.
Related Articles on Orthopedic Surgery:
Success With a Physician-Owned Orthopedic Hospital: 7 Things to Know
9 Points for Orthopedic and Spine Surgeons on Forming Positive Relationships With Hospitals
5 Points on a Successful Orthopedic Department Business Plan
the ProMedica Wildwood Orthopaedic and Spine Hospital in Toledo, Ohio, which is ProMedica's first all-digital hospital. The new 70,000-square-foot facility includes six operating rooms and 36 private patient rooms, as well as a fully-integrated electronic medical record system. The hospital's president, Holly Bristoll, and Paul Fenton, MD, an orthopedic surgeon instrumental in the hospital's creation, discuss the finer points of their all-orthopedics facility.
Q: Why did you decide to construct an orthopaedics-focused hospital?
Holly Bristoll: The hospital leadership was already working with the orthopaedic groups to support our orthopaedic service line and our focus was always on how we could provide the best care for patients and their families. The first thing we did was develop best practice protocols. From there, I think the increasing demand for orthopedics from baby boomers provided a real need for specialized care. We decided to build a facility that would focus 100 percent on orthopedic and spine care and offer all relevant services in one convenient location.
Dr. Paul Fenton: When you've got such a focused center, you are going to improve the quality of care by working with specialized professionals. We wanted to work with orthopedic nurses and surgical techs, which would improve our quality and efficiency. Of course, the elephant in the room was always costs, and we wanted to find a way to keep costs down. We needed a facility where we could provide good quality care and be efficient, but also cost effective. In this focused center, we expect length of stay will be less, complications will be less and patient satisfaction will be higher.
Q: What about the orthopaedics-focused center is advantageous from a medical professional's prospective?
HB: There's a need to look at the type of operating room you put together; there are a lot of things orthopedists need in the OR. We also need to look at what the patients need postoperatively. All patient rooms are on the first floor, so there is no vertical travel. We also included a private discharge area so patients didn't have to come through the lobby when they were ready to leave. In the planning phases, we spent a lot of time working on patient flow and needs during their stay.
Additionally, everyone comes here with the same type of issue and our therapy team is focused solely on orthopedic and spine patient needs. Patients might develop a relationship with their neighbors because the neighbor had the same procedure. Our hallway is used for group therapy. We also have a Wii in the therapy room and balance board technology. Another part of our rehabilitation program is a car transfer simulator. We don't want the first time the patient transfers into the car to be in our parking lot when they leave.
Q: What measures does the hospital take to ensure high patient satisfaction?
HB: A lot of care went into designing patient flow that was efficient for physicians. The ORs are designed for them and we have the instrumentation they need constantly available. The patients are always moving forward in our hospital; once they come through preoperative care, we don't put them back in a public space. They keep moving forward.
We also have a hospitalist program and nurse navigators who make sure everything is ready to go when the patient is ready for surgery. The nurse navigator acts as a conduit between care providers and helps the patients prepare to go home. We also have a dietary program and room service for our patients. Instead of picking out dietary trays the night before, patients can order right from their room and receive the meal in 20-30 minutes. That seems to be a big patient satisfier because people can get what they want when they want it.
Q: What makes the facility completely digital?
HB: The hospital connects the surgical information system, anesthesia EMR and all nursing components. The information is in real time and readily available for all healthcare providers in the hospital. If a patient is going through the preoperative evaluation process and identifies an allergy, that note carries through the OR, PACU and inpatient unit so everyone can see it at a glance. When people are charting through the case, the information is available and our medical professionals can take the appropriate safety measures every step of the way.
PF: The real-time aspect is a significant time savings for us. Having the information at your fingertips is a real advantage in terms of time and clinical safety; it is also good for efficiency and efficacy.
Q: Could you expand on that thought — in what ways does the EMR system improve the hospital's efficiency?
HB: There are several ways the EMR helps with efficiency — one of our favorite components is transcription. The surgeons enter notes into the EMR instead of dictating them and then sending the notes for transcription. As soon as the physician enters progress notes on our patients, everyone can see them. Our partnership with the physicians has made this work for us because it does require an operational change. The physicians had to agree to the new system and learn how to input and extract information differently with the EMR.
PF: In a lot of communities, orthopedic groups are very fragmented. This hospital with the particular EMR system was conceptualized about five years ago. We took several measures, including EMR implementation and building design, to create an optimal environment for orthopedic care. The orthopedic community had to work together, which meant collaborating with some people who we might not have regularly interacted with before.
Q: How challenging was it to bring so many different people from the community together to make this hospital a reality?
PF: We impart a great deal of credit to Holly for bringing us together. Sometimes, when you are dealing with physicians, there are several opinions and intricate details to work out behind the scenes. Without Holly, the hospital wouldn't have been possible.
HB: It does take a lot of effort, but creating a venue for people who all have the same passion is what makes it work. It isn't easy every step of the way, but if you put talented people together who have the same passion for patient care and if you can sort out the goals in front of you, you're on the right track. When there are issues, sit down with the physicians and work together to solve the problem.
PF: It's like dangling a big carrot in front of a rabbit; you know what the ultimate prize is — opening a $30 million hospital that is a lot better for you and your patients than where you were before — and you're willing to go the extra mile to achieve that. Coming together is a lot easier when there is an ultimate goal in mind.
Q: What are your goals for the hospital in the future?
PF: The big goal has been to get the hospital open and functional. Now that we've completed that, we're considering new ways we can benefit our patients. One thing we'd like to begin here is educational programs at the regional and national level on orthopaedic and spine surgery. Our digital operating rooms provide us with the equipment to perform live surgeries and broadcast them across the country to teach other surgeons our techniques.
We also want to eventually provide acute care for our patients through a skilled nursing facility. Hospital stays have become much shorter these days, but some patients may not be ready to leave the hospital 48-72 hours after surgery. We want to provide those patients with the assistance they need.
HB: Our intentions are for patients to go directly home as soon as possible. We talk with them about that, and for some going directly home may not be possible. We have a few options for those patients today, but we want to make sure they continue seeing professionals who are orthopedics-focused after they leave our facility. As leaders in orthopedic care, we want to continue developing that side of the equation and make sure the people are giving our patients the same tight focus.
Related Articles on Orthopedic Surgery:
Success With a Physician-Owned Orthopedic Hospital: 7 Things to Know
9 Points for Orthopedic and Spine Surgeons on Forming Positive Relationships With Hospitals
5 Points on a Successful Orthopedic Department Business Plan