The future of orthopedic care has arrived. And it’s much more than a beautiful new facility. The Lancaster General Orthopedic Center is changing the approach to orthopedic care—from education and rehabilitation to pain management and surgery.

“We are focused on safety, quality outcomes and providing patients and their families with a positive hospital experience,” explains Stacey Youcis, Assistant Vice President, Musculoskeletal and Surgical Services.

The Orthopedic Center welcomed its first patients on Dec. 6, 2004. Patients and medical teams were equally eager to start using the seven operating rooms and 42 private patient suites.

“Orthopedic care touches every age group in our community,” Stacey says. As a Level II Trauma Center, Lancaster General Hospital treats the majority of traumatic injuries in Lancaster County. More than half of those injuries are orthopedic in nature. Total joint replacement and other reconstructive surgeries are increasing in number as the aging baby boomers desire to stay more physically active later in life. The patient-centered philosophy of the new center will hopefully go a long way in helping patients prepare for and recover from orthopedic surgeries and injuries.

“Surgery can be scary, but part of that comes from the fear of the unknown. The more information patients have about what to expect, the better prepared they can be, both mentally and physically,” Stacey says.

To help alleviate that fear, total joint replacement surgery patients are encouraged to select a coach—a family member or friend to help them throughout the process.

“We provide the coach and patient with the same information. Coaches can be as involved as they would like to be during the entire hospital stay,” Stacey says.

In addition to having a coach, total joint surgery patients are offered an in-home visit and pre-surgical consultation 2-3 weeks prior to surgery. An experienced nurse meets with patients to explain what will happen before, during and after surgery. She will also assess the patients’ home environments to see what special needs they may have after surgery. For instance, some patients may need to use equipment like a walker. The nurse will look around patients’ homes to make sure they can use the equipment safely. She may even suggest moving furniture or throw rugs to ensure that patients will be able to move safely around their homes. Other patients may need additional care such as home health services or a short-term nursing home stay. After determining a person’s needs, the nurse can contact social work and the inpatient nursing team, if necessary, to jump-start the discharge planning process.

“We want to make sure that when patients are ready to go home, they’re able to go home.   We also want to make sure their home environment is safe and provides them with what they need right after discharge to fully recover,” says Cindy Stauffer, RN, Nurse Manager of the Orthopedic Center and Total Joint Unit.

Also during the initial home visit, total joint replacement patients receive a helpful handbook. This guide contains directions on how to do specific exercises to promote mobility and outlines recovery goals and objectives. Patients can record their progress in the diary section and then share the information with their orthopedic surgeon and physical or occupational therapists.

Many patients are particularly concerned about how much pain they may experience. Effective pain management contributes to every aspect of a patient’s recovery—mental and physical. The center’s anesthesiologists, in collaboration with the orthopedic surgeons, have developed new protocols for pain management, both during and after surgery.

“Our goal as an anesthesia care team is to guide patients through the surgical period safely and comfortably. We want to accomplish this by providing optimum operating conditions for the surgeon while trying to minimize the impact of both surgery and anesthesia on patients. Our efforts can have an effect on how quickly patients progress with rehabilitation and recovery,” says Joseph Gibson, MD, Chair of the Department of Anesthesiology.

“Effective pain management allows patients to approach their rehab programs more aggressively,” explains Dr. Gibson. “Obviously, if patients are too uncomfortable, they cannot maximize their movement, and this limits the level of their success in therapy.”

An emerging trend in orthopedic anesthesia and surgery is the increased use of nerve blocks. Nerve blocks are procedures that involve placing local anesthetic drugs along the nerves that supply feeling to the area of the body being operated on. By doing this, pain impulses can be diminished during and after surgery. This can reduce the amount of general anesthetic and pain medications patients may need and therefore minimize the unwanted side effects associated with larger doses of these drugs.

Other surgical pain management options include the use of epidural, intravenous and oral medications. Epidural medications are local anesthetic and narcotic pain-relieving drugs that are administered through a tiny tube placed in the patient’s back. This is the same technique commonly used in the relief of labor pain. Intravenous and oral medications are other options to control pain. Intravenous medications can be given by the patients’ nurses, or more commonly, by the patients themselves via a PCA pump (patient controlled analgesia).

Indications for which mode of pain therapy to use for patients depends on their health status and the surgical procedure they are undergoing. The anesthesiologist and surgeon work together to determine an appropriate approach for each patient.

Once a patient’s pain is controlled, the orthopedic team encourages him or her to start the rehabilitation process. The therapy gym is located directly beside the total joint replacement nursing unit, which is helpful for the patient, physician, rehabilitation team and nursing team—all of whom must work together.

“Our nursing staff goes through rigorous training to provide care in the specialty of orthopedics,” Cindy explains. “They work closely with the surgical and rehabilitation staff so that they fully understand every aspect of patient care.”

Elizabeth Gardner, PT, Manager, Physical Therapy, says the size of the new gym gives all types of orthopedic patients and therapists more room to work. The gym also features a full kitchen, bedroom, bathroom and living area to simulate a home setting so patients can better prepare for their discharge.

All total hip and total knee replacement patients can expect to attend two physical therapy sessions and at least one occupational therapy session a day as long as they are in the hospital—including weekends. If patients choose, one of those daily sessions may involve group therapy with other patients in the same phase of recovery. The treatment plans for non-total joint replacement patients may also involve therapy.

“We encourage total joint replacement patients to set goals, to sit up in the chair instead of the bed, to use the bathroom on their own and to wear their own clothes,” Elizabeth says. “We want to prepare patients to leave the hospital so that when they go home, there’s no question about what they can do.”

The center’s comprehensive philosophy grew from a multidisciplinary approach involving past patients, community members, nurses, physical and occupational therapists, surgical staff, surgeons, anesthesiologists, social workers and more. “All members of the team have contributed to the success of the Orthopedic Center,” Stacey says. “They are focused on what they can individually and collectively do to make this center and the care experience exceed patient expectations.”

For more information on the Lancaster General Orthopedic Center, call 544-7400.

Patients and visitors entering Lancaster General Hospital can now do so through our new main entrance. Located off James Street, the main entrance and lobby area are conveniently located close to the main patient and visitor parking garage.

Main Entrance & Lobby Highlights:

• Welcoming & helpful reception staff
• Comfortable waiting areas
• Gifts in General gift shop
• Chapel
• Health resource library
• James Street Café
• Walkway connecting Orthopedic Center to Skylight Waiting Area
• Separate children’s waiting and play area
• Water wall to promote relaxation