1. Good Samaritan Hospital Zero in on Zero: Improving Joint Replacement Outcomes Mark Snyder, MD, Medical Director, Orthopedic Center of Excellence Kathy Eten, BSN, RN, CCM, Program Administrator, OCE Bob Pritts, Administrator, Musculoskeletal and Rehabilitation Services

2. PROJECT SELECTION Prediction that Total Hip and Total Knee demand will increase between 18.6 – 69.4% by 2016 Delays in surgery will result in poorer outcomes Increasing disease burden on the health care system Strategic decision to focus on musculoskeletal service line, construction of dedicated unit in 2007 and hiring of Medical Director Desire to pursue clinical excellence through disease specific certification 2

3. SITUATIONAL ANALYSIS Focus on improving clinical and service outcomes Identified the top 10 most important areas of clinical focus to strengthen the program. Performed a causal event analysis of adverse events utilizing a before, during and after approach using extensive review of current literature Identified and implemented strategies before, during and after surgery to decrease adverse events Used consensus decision making to gain physician support and compliance with implementing best practices Targeted zero as the goal for all adverse events 3

4. PROJECT SOLUTIONS Review of evidence using the before, during and after model Multi-disciplinary team of current staff Using current physician structure to review and approve strategies Implementation of solutions using PDCA and small tests of change Sharing successes and failure by established communication vehicles and consistent messaging by Program Administrator to all groups TARGETING ZERO!! 4

5. PROJECT RESULTS Prophylactic Antibiotics 100% within 1 hour for the last 4 months Zero joint infections in 452 cases February – June 2011 Blood utilization decrease from around 20% in July 2009 to less than 5% and still going down. Overall patient satisfaction has improved from the HealthStream 73 rd percentile to the 80 th percentile Patient satisfaction with pain management by staff has improved from the HealthStream 78 th percentile to the 90 th percentile Fall rate has decreased by 50% Received Joint Commission Disease Specific Certification for Hip and Knee Replacement in March 2011. Only one in Greater Cincinnati. Received Blue Distinction, United Premium Specialty Care Designation and Aetna Institute for Quality all in 2010. 5