OB 2015 blind final - UCLA Orthopaedic Surgeryortho.ucla.edu/workfiles/About_Us/Quality/Ortho QB 2015 (2).pdfQUALITY & OUTCOMES REPORT y 3 A MESSAGE FROM THE CHAIRMAN The UCLA Department

S e p t e m b e r 1 , 2 0 1 5 y 3 r d E d i t i o n

D e p a r t m e n t o f O r t h o p a e d i c S u r g e r y i n a l l i a n c e w i t h O r t h o p a e d i c I n s t i t u t e f o r C h i l d r e n

2015 Quality & Outcomes Report

T A B L E O F C O N T E N T S

3 Chairman’s Message

4 Our RAMS Team Quality Improvement Methodology Sharing Our RAMS Model

6 Our Mission Commitment to Quality Facilities & Partnerships

8 Surgical Volumes Clinic Volumes & Same/Next Day Visits

10 Procedural Statistics Departmental Outcome Measures

12 Readmission Reduction 30-day Readmission Rates Sepsis, Mortality, Infection Rates

16 Pediatric Orthopaedic Care

17 Comprehensive Fracture Care Hip Fracture Metrics

20 Total Joint Replacement Surgery Blood Transfusion Reduction Day of Surgery Physical Therapy

24 Patient Reported Outcomes HCAHPS Data, Fall Rates, Pressure Ulcer Rates

29 Orthopaedic Oncology

30 Spine Surgery Division

31 New Orthopaedic Faculty Orthopaedic Research Faculty

33 Community Outreach Operation Mend

34 Departmental Distinctions & Innovations New Orthopaedic Surgery Faculty

36 U.S. News & World Report Rankings Previous Quality & Outcomes Publications

37 Acknowledgements

U C L A D E P A R T M E N T O F O R T H O P A E D I C S U R G E R Y

Q U A L I T Y & O U T C O M E S R E P O R T y 3

A M E S S A G E F R O M T H E C H A I R M A N

The UCLA Department of Orthopaedic Surgery is committed to providing value-based care that meets the complex needs of our patients and community. Our Orthopaedic Surgery Quality Improvement Team is working to ensure that every patient receives the highest quality care in an efficient and cost-effective manner. When first assembled only three years ago, our Quality Improvement Team set out to dramatically reduce hospital ReAdmissions, Mortality, and Sepsis and therefore became known as the “RAMS” team. Since then, our RAMS team has grown significantly, both in scope and membership, and has made major improvements in our care delivery and outcomes. Our RAMS team has proven that effective change, sustained improvement, and overall better patient care requires the involvement and input of the entire team. From physicians to nurses, housekeeping staff to parking attendants, the RAMS motto is to include anyone and everyone that impacts the care of our patients and plays a role in their clinical outcome, satisfaction, and overall experience. By doing so, we’ve gained invaluable insight on how to improve patient experiences, care delivery, and clinical outcomes. As part of our ongoing commitment to quality and our mission to continuously improve patient care, we believe that our outcomes data should be transparent and easily accessible to patients and providers. Enclosed is our 3rd edition of the UCLA Orthopaedic Surgery Quality & Outcomes Report which provides even more detailed results, innovative strategies to improve clinical outcomes, and our next steps for the future. We are proud to present the 2015 Quality & Outcomes Report and we welcome your comments and feedback. Sincerely, J E F F R E Y J . E C K A R D T , M . D . Distinguished Professor & Chair UCLA Department of Orthopaedic Surgery

COMMITMENT TO QUALITY

MEET OUR RAMS QUALITY IMPROVEMENT TEAM


Peter G. Alexakis, M.D. Orthopaedic Surgeon

Benjamin C. Bengs, M.D. Orthopaedic Surgeon

Katie Denisova, R.N. Operating Room Nurse

Jeffrey J. Eckardt, M.D. Orthopaedic Surgeon

Roger M. Lee, M.D. Hospitalist

Devon M. Jeffcoat, M.D. Orthopaedic Surgeon

Julie Kielman, P.T. Rehabilitation Manager

Kimberly Ternavan, R.N. Nursing Unit Director

Alisa Trout, R.N. Infection Prevention

Deborah Winograd, R.N. Director of Quality

In addition to our 40 clinical faculty, 32 research faculty, nurse practitioner and physician assistant, the UCLA Department of Orthopaedic Surgery also has 32 residents, 2 hand surgery fellows, 2 sports fellows, a pediatric surgery fellow, and 2 physical medicine and rehabilitation fellows. Our mission to improve the quality of care for patients relies on the input and commitment of all of our staff, faculty and trainees. We have incorporated quality improvement training into our resident education curriculum and require all residents to participate in our RAMS team prior to graduating from the program. Here are our 2015-2016 RAMS residents. We look forward to their innovative contributions in the coming year.

I N C O R P O R A T I N G Q U A L I T Y I M P R O V E M E N T I N T O R E S I D E N T E D U C A T I O N

Nelson Soohoo, M.D. Residency Program

Coordinator

Adedayo Ashana, M.D. Benjamin Bluth, M.D. Michael Leathers, M.D. Trevor Scott, M.D. Dean Wang, M.D. Alexandra Stavrakis, M.D.

The pictured individuals make up our core RAMS team however, each month we invite several other physicians, nurses, and staff to join our meetings depending on the topics to be discussed. The RAMS team motto is to include anyone and everyone involved in the patient experience and in the delivery of care.

Richard Bowen, M.D. Assistant Program

Coordinator

Frank Petrigliano, M.D. Assistant Program

Coordinator

Quality Improvement Methodology

The UCLA Health “M.O.V.E.R.S.” Strategy The UCLA Health System Quality Council has established the following focus areas for clinical departments. In addition to several other quality measures, the RAMS team and UCLA Orthopaedics place high priority on these measures:

RAMS Publications We have published abstracts detailing our work and the significant improvements we’ve made in the American Journal of Quality in 2013 and 2014.

Sharing Our RAMS Model We were honored to present our RAMS model at the PULSE 2013 UHC Annual Conference on October 18, 2013 in Atlanta, Georgia.

M - Mortality O - Outcomes V - Value Based Clinical Redesign E - Experience, Patient Experience R – Readmissions, Reoperations & Registry Based Measures S - Safety

The RAMS Quality Improvement Process The below flow diagram illustrates our routine quality assurance (QA) process. This method allows us to identify important opportunities for improvement. Our culture of safety allows us to be transparent and honest with each other and with our patients.

RAMS review of ~200 cases per year…

Yields a list of approximately 48 cases (~4 per month) that are presented and discussed at the Ortho QA Conference (12 QA

conferences/year)

RN review of ~800 cases per year…

Yields a list of approximately 200 cases for RAMS multidisciplinary discussion and in-depth review using RCA

methodology (24 RAMS meetings/year)

8,000+ surgeries/admissions occur per year…

Methodology for identifying cases with potential for improvement or with learning opportunity (near misses) yields a

list of approximately 800 cases…

Deborah Winograd, RN presenting at the 2013 UHC Annual Conference

On October 24, 2014, we presented our quality improvement program for decreasing post-operative mortality in hip fracture patients at the REVOLUTION 2014 UHC Annual Conference in Las Vegas, Nevada.

Decreasing 30 Day Post-Operative Mortality Following Hip Fracture Surgery By Reducing Time to Surgery

DEBORAH WINOGRAD, RN, BENJAMIN BENGS, MD, DEVON JEFFCOAT, MD & JEFFREY ECKARDT, MD



O U R M I S S I O N

• To provide high-quality, cost-effective clinical care for adults and children

• To develop cutting-edge innovations in Orthopaedic Surgery research

• To provide excellent training and education to medical students, residents, and fellows

Hospitals and providers must be held accountable for the quality of care they provide their patients. Evaluating outcomes, closely-monitoring performance and standardizing processes has been proven to dramatically improve outcomes for patients while also lowering healthcare costs. Furthermore, transparency in reporting outcomes data builds trust between providers and patients and allows for more informed decision-making by both patients and providers. UCLA Orthopaedics is a pioneer in healthcare quality improvement and surgical outcomes monitoring. We are committed to a culture of continuous learning, innovation and improvement to ensure our patients receive the safest and best care possible. By providing timely and transparent data about our patient outcomes and surgical quality initiatives, we hope to empower patients with the knowledge they need to make the best choices for their healthcare. We also believe that measuring our performance and publically reporting our results will further motivate providers, staff and the global healthcare community to continuously strive for excellence while encouraging a team-based approach to implementing effective change.

In this report, we provide our progress, success and challenges with many initiatives designed to ensure that every single patient always receives the best care. Included is information about surgical complications, adverse events, patient satisfaction and patient-reported outcomes analyzed through several statistical parameters that measure the consistency and quality of the care we provide. With this report, we aim to be completely transparent so that we may identify all opportunities for improvement. We hope that this will give you valuable insight about our services and the quality of the care we deliver. We welcome your feedback and would love to hear your thoughts about how we can better meet the needs of our patients and our community.

L E A D I N G T H E W A Y W I T H O U T C O M E S T R A C K I N G , R E P O R T I N G A N D M E A S U R A B L E Q U A L I T Y I M P R O V E M E N T

ABOUT UCLA ORTHOPAEDICS


O U R F A C I L I T I E S & P A R T N E R S H I P S

UCLA Orthopaedics represents an important alliance between UCLA Health System and the Orthopaedic Institute for Children (OIC), joining programs with long standing traditions of service, academic excellence, and scientific advancement. Our partnership creates the platform for unparalleled contributions to patient care and scientific discovery in Orthopaedic surgery and musculoskeletal medicine. We strive to be a destination for patients, world-class faculty and inquisitive students, to create a new standard of musculoskeletal care for the 21st century. Combining the best in Orthopaedic medicine and surgical care with strong rehabilitation and diagnostic imaging programs, our practice is nationally recognized for outstanding Orthopaedic care and innovative research. The UCLA Department of Orthopaedic Surgery is ranked among the best Orthopaedic practices in the United States and holds the distinction of being listed on the U.S. News & World Report Best Hospitals Honor Roll. Several of our clinicians are consistently named among the “Best Doctors in America” and our Orthopaedic program is connected to one of the largest and most productive Orthopaedic research facilities in the world- The J. Vernon Luck, Sr., M.D. Orthopaedic Research Center located on the UCLA campus. Our faculty ranks among the top 10 in the nation for National Institutes of Health (NIH) medical-research funding.

• Arthritis

• Foot & Ankle

• Fracture Care

• Hand & Wrist

• Hip & Knee

The UCLA Health System academic medical centers include the Ronald Reagan UCLA Medical Center, a Level I Trauma Center, the Mattel Children’s Hospital at UCLA, and the Santa Monica-UCLA Medical Center & Orthopaedic Hospital. These world-class facilities allow us to offer musculoskeletal treatment and surgical intervention for the most challenging cases. We also provide Orthopaedic services to our nation’s veterans through our affiliation with the Veteran’s Administration Greater Los Angeles Healthcare System and to low income individuals through our arrangement with the Olive View-UCLA Medical Center and the Harbor-UCLA Medical Center. Due to our skill and wide-ranging experience in Orthopaedic care, we are the "practice of choice" for the UCLA athletic teams and perform inpatient and outpatient care for multiple conditions related to:

• Pain Management

• Shoulder & Elbow

• Spinal Disorders

• Sports Medicine

• Oncologic Disorders

Santa Monica UCLA Medical Center & Orthopaedic Institute for Children

Ronald Reagan UCLA Medical Center

O R T H O P A E D I C S U R G E R I E S P E R F O R M E D J U L Y 2 0 1 4 – J U N E 2 0 1 5

TOTAL PROCEDURES

15,208 (total CPTs billed)

TOTAL SURGERIES

7,515 (total OR encounters)

TYPES OF PROCEDURES

825 (total unique CPTs)

OUTPATIENT SURGERIES

INPATIENT SURGERIES

F Y 2 0 1 3 – F Y 2 0 1 5

39%

61%

SM INP 29%

SM OUT 31%

WW INP 12%

WW OUT 28%

F Y 2 0 1 5

2,442 3,041 3,211 3,299 3,261 3,492 3,884 4186

2232 2139 2263

2350 2387 2457 1,136

956 850 859 808 640 573

642 677 799 753

1,953 1,879 2,028 2,041

1,686 1,596 1,516

1770 1931 2064 2042

5,531 5,876 6,089 6,199

5,755 5,728 5,973 6,598

7190 7389 7515

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15

TOTAL SURGERIES BY FISCAL YEAR

SM Inpatient SM Outpatient WW Inpatient WW Outpatient

Volumes Data & Quality Measures represent cases performed at Ronald Reagan UCLA Medical Center (WW Inpatient), UCLA Medical Plaza Surgery Center (WW Outpatient), Santa Monica UCLA Medical Center & Orthopaedic Institute for Children (SM Inpatient), and the Santa Monica MOB Surgery Center (SM Outpatient)

Data source: UCLA Department of Orthopaedic Surgery Business Operations Office

SURGICAL VOLUMES



S U R G I C A L V O L U M E B Y D I V I S I O N J U L Y 2 0 1 4 – J U N E 2 0 1 5

T O T A L C L I N I C V I S I T S F Y 2 0 1 4 - 2 0 1 5

5 2 , 9 6 6

0 500 1000 1500 2000 2500

Foot & Ankle

General

Hand

Joints

Oncology

Pediatric

Physiatry

Spine

Sports Med

Trauma

Inpatient

Outpatient

C L I N I C V O L U M E B Y D I V I S I O N J U L Y 2 0 1 4 – J U N E 2 0 1 5

5 ,387 T O T A L S A M E / N E X T D A Y V I S I T S M A R C H 2 0 1 3 - A U G U S T 2 0 1 5



0100020003000400050006000700080009000

10000


Procedure Name Procedure Code (CPT) Total Case Volume

Average Patient

Age

% Male Patients

Average Length of

Stay

30-day Readmit

%

JOINTS - - - - - -

Hip Replacement 27130, 27132 259 72 46% 3.1 2.7%

Hip Revision 27033, 27132, 27134, 27137, 27138 52 75 44% 5.3 5.8%

Knee Replacement 27445, 27446, 27447 264 69 52% 3.1 2.3%

Knee Revision 27486, 27487, 27488 49 70 51% 5.2 6.1%

Shoulder Replacement 23470, 23472 48 68 47% 3.1 2.1%

SPINE - - - - - -

Spinal Fusion 22532, 22533, 22548, 22551, 22554, 22556, 22558, 22586, 22590, 22595, 22600, 22610, 22630, 22633, 22800, 22802, 22804, 22808, 22810, 22812

87 54 46% 3.8 2.3%

Decompression 63017, 63030, 63042, 63045, 63046, 63047, 63050, 63051, 63081, 63276 73 68 55% 3.6 1.4%

FRACTURE SURGERY - - - - - -

Hip 27217, 27218, 27227, 27228, 27235, 27236, 27244, 27245, 27248, 27513 244 81 41% 5.9 4.3%

Lower Extremity 27380, 27385, 27422, 27506, 27511, 27513, 27514, 27524, 27532, 27535, 27536, 27759, 27827, 27828, 27829

194 48 59% 5.6 3.6%

Upper Extremity 63017, 63030, 63042, 63045, 63046, 63047, 63050, 63051, 63081, 63276 177 54 57% 3.2 2.3%

SPORTS - - - - - -

Shoulder Arthroscopy 29806, 29822, 29823, 29824, 29827 351 49 54% N/A N/A

Knee Arthroscopy 29871 419 43 57% N/A N/A

ONCOLOGY - - - - - -

Soft Tissue Tumor 21554, 21936, 23078, 24073, 24079, 25078, 27355, 27356, 27364, 27365 147 58 54% 4.2 5.4%

Curettage of Bone 20245, 23150, 23156, 24110, 24116, 25126, 27066, 27355, 27356, 27638 98 51 51% 3.1 4.1%

Radical Resection of Bone

23200, 23220, 24900, 27059, 27075, 27640, 27645, 27598, 27880 102 57 49% 5.2 7.8%

HAND - - - - - -

Carpal Tunnel Release 64721, 29848, 20526, 29848, 64721, 64708, 25290, 25115 281 52 32% N/A N/A

Trigger Finger 26055, 26145, 26440 164 59 41% N/A N/A

FOOT & ANKLE - - - - - -

Hammertoe 28285, 28043, 64632 12 58 39% N/A N/A

Bunionectomy 28296, 28299, 28296, 28290, 28294, 28297, 28293, 28293 31 56 26% N/A N/A

Procedural Volumes & Statistics July 2014 –June 2015

Data source: UCLA Orthopaedic Surgery RAMS Team

6 2 %

Q U A L I T Y & O U T C O M E S R E P O R T y 1 1

D E P A R T M E N T A L O U T C O M E S J U L Y 2 0 1 4 – J U N E 2 0 1 5

S I N G L E P R O V I D E R A D M I S S I O N S

M U L T I P L E P R O V I D E R A D M I S S I O N S

3 8 %

UCLA Orthopaedics Outcome Measures July 2014 – June 2015

Management of our Orthopaedic surgery patients is complex and often involves co-management by multiple providers and specialists. In our efforts to reduce mortality, sepsis, and readmissions, and to improve the overall experience and quality of outcomes for our patients, we work closely with other disciplines to ensure streamlined care and seamless transitions from the many phases of care including transition from the hospital, to skilled nursing, to home.

Data source: Office of Healthcare Informatics and Analytics (OHIA) Value Analytics Report

Measure Description Value Numerator Denominator

All-cause 30-day readmission within 30 days of Orthopaedic Surgery admission 4.9% 108 2184

Mortality within 90 days of elective Orthopaedic Surgery admission 0% 0 1641

Surgical site complications within 30 days of Orthopaedic Surgery procedure 0.6% 47 7515

Return to operating room within 30 days of Orthopaedic Surgery procedure 8.1% 564 6951

Emergency room visit within 30 days of Orthopaedic Surgery procedure 4.5% 294 6548

Mortality within 90 days of hip fracture surgery 2.8% 6 211

Length of stay following elective inpatient Orthopaedic Surgery admission

4.2 days 6892 days 1641

Discharge to Acute Rehabilitation Unit or Skilled Nursing Facility following elective Orthopaedic Surgery admission

25.9% 425 1641

Blood transfusion within 7 days of Orthopaedic Surgery procedure 2.7% 203 7515

Hours between Emergency Department arrival and surgery start for all hip fracture surgery patients (“time to surgery”)

31.7 hours 6689 hours 211 cases

TOTAL INPATIENT ADMISSIONS FY 14-15

2,184

ALL CAUSE READMISSIONS

4.9% UNPLANNED

READMISSIONS

3.4% ORTHO-RELATED

SEPSIS

< 1% ORTHO MORTALITY

O/E

.62


R A M S T E A M R E A D M I S S I O N R E D U C T I O N I N I T I A T I V E

Here you will find our internal (RAMS) readmission rate data. Unlike the UHC readmission rate data, our internal data includes planned readmissions for chemotherapy and planned readmissions for staged surgeries or definitive treatment. We also include readmissions that are not related to Orthopaedic care and readmissions where Orthopaedic Surgery was only a consult service on the index admission. Although preventing some of these readmissions is beyond our control, we find it important to take responsibility for all unplanned returns to the hospital and to discuss and implement strategies for improved care coordination across disciplines. We have partnered with our colleagues in hospital medicine, anesthesia, nursing, and case management to reduce these readmissions and to ensure better outcomes for our patients.


30 Day Readmission Rates (%) by Month (July 2012 – June 2015)

Readmission Reduction Interventions Resident & Faculty Education •NO MORE EMERGENCY ROOM!! •Resident triage of patients •Faculty clinic coverage for wound issues •Same day and next day appointments

Increased Utilization of PAs •Follow up appointments scheduled prior to hospital discharge •Patient education regarding clinic hours, need for emergency room, and hospital paging system to connect with resident Early discharge planning •Patients encouraged to visits SNFs prior to surgery/hospitalization •Patients encouraged to attend pre-op class

FY 12-13 Average Rate

7.3% FY 13-14

Average Rate

5.1% FY 14-15

Average Rate

4.9% Sustained Improvement

13.7%

7.4%

10.7%

7.0% 7.5%

5.5%

6.7% 7.6%

5.7% 5.6% 5.1%

5.6% 5.5% 6.1% 6.3%

5.8% 5.7% 4.9%

5.3% 4.7% 4.4%

3.9% 4.4%

3.9% 4.4%

5.7% 6.1% 5.9% 5.6% 5.3%

4.6% 4.4% 3.9%

4.4% 4.6% 4.4%

Jul12

Aug12

Sep12

Oct12

Nov12

Dec12

Jan13

Feb13

Mar13

Apr13

May13

Jun13

Jul13

Aug13

Sep13

Oct13

Nov13

Dec13

Jan14

Feb14

Mar14

Apr14

May14

Jun14

Jul14

Aug14

Sep14

Oct14

Nov14

Dec14

Jan15

Feb15

Mar15

Apr15

May15

Jun15

Readmission Reduction

When we discharge a patient from the hospital, we want to ensure that we have provided them and their families with all of the necessary tools and resources for a quick and uncomplicated recovery. Whether you are going home or to rehab facility, we want you to leave the hospital physically and mentally prepared so that you won’t have to be admitted to the hospital again. 30 day readmission rates are a good indicator that we are doing our best to prepare patients for post-hospital recovery.

UHC 30 Day Readmission Rates (%) for “Orthopedic Surgery” Service Lines FY 2015

UCLA Health System is unique in that our Orthopaedic Surgery services are divided between two hospitals (the “UCLA Santa Monica” hospital and the “UCLA Ronald Reagan” hospital). On this graph, the bar labeled “UCLA SM & RR” represents the aggregate data of both our hospitals and thus best represents our department as a whole. This value is the most accurate for comparison with our peers across the country.

University Health Consortium (UHC) provides readmissions data for hospitals and for individual specialties. Below you will find readmission rates specific to the UHC grouping “Orthopedic Surgery” for several of the nation’s largest and most well-known academic medical centers.

UHC 30 Day Readmission Rates (%) for UCLA “Orthopedic Surgery” Service

FY 2012 – FY 2015

UCLA Orthopaedic Surgery Readmission Reduction since July 2012:

35% 48%

Overall reduction in 30 day readmissions

Reduction in unplanned 30 day readmissions


Data source: University Health Consortium (UHC) Hospital Outcomes by Service Line


1.42 1.63 1.65

1.91 2.06 2.17 2.20

2.67 2.75 2.92 3.27 3.31 3.39 3.44 3.48 3.58 3.61 3.63 3.63 3.69 3.72 3.82

4.12 4.34 4.51

4.99 5.16 5.25

5.80 5.99 6.00

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

FY 2012 FY 2013 FY 2014 FY 2015

RR SM RR & SM

UHC Academic Hospitals

UCL

A Sa

nta

Mon

ica

UCL

A RR

& S

M

UCL

A Ro

nald

Rea

gan


D E P A R T M E N T A L O U T C O M E S J U L Y 2 0 1 4 – J U N E 2 0 1 5

UHC “Orthopaedic Surgery” Sepsis Rates (%)


UHC “Orthopaedic Surgery” Mortality Rates (O/E ratio)


0.5% 0.7% 0.7% 0.7%

0.9% 1.1%

1.2% 1.3% 1.3% 1.4%

1.5% 1.6% 1.6% 1.6% 1.8% 1.8% 1.9% 1.9% 1.9% 1.9% 1.9% 2.0% 2.0% 2.1%

2.4% 2.5% 2.5% 2.6%

2.8%

3.2%

3.7%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%


0.21 0.23

0.39 0.45 0.46 0.47 0.49 0.52 0.52 0.56 0.58

0.64 0.65 0.71 0.71 0.74 0.79 0.79 0.79 0.84 0.89 0.89

0.98 1.08

1.21

1.45 1.52

1.59 1.68

2.32

0

0.5

1

1.5

2

2.5


UCL

A Sa

nta

Mon

ica

UCL

A Ro

nald

Rea

gan

UCL

A Sa

nta

Mon

ica

UCL

A RR

& S

M

UCL

A Ro

nald

Rea

gan

Departmental Outcomes| 2015

Surgical Site Infection Prevention of surgical site infections is a huge priority and in partnership with the hospital infection prevention department, UCLA Orthopaedics has taken many measures to ensure the risk for infection is as minimal as possible.

Return to Operating Room Many returns to the operating room are planned for staged surgeries or intentional re-operations. Unplanned returns to the operating room, however, generally signify complication. All returns to the operating room (planned or unplanned) are thoroughly reviewed so complications and opportunities for improvement may be detected and discussed.

Surgical Site Infection Rate (March 2013 – June 2015)

0.6% Average surgical site infection rate department-wide

5.8%

4.5%

Decrease in return to operating room from FY 13-14 to FY 14-15

Decrease in 30-day ER visits from Jan – Jun 2015

Return to Operating Room (March 2013 – June 2015)

Emergency Room Visits In addition to 30 day readmissions, the department also monitors all visits to the emergency room within 30 days of inpatient discharge or outpatient encounter. We value this metric as a likely indicator for improvement in clinical care and transition planning.

Emergency Room Visits (March 2013 – June 2015)

Q U A L I T Y & O U T C O M E S R E P O R T y 1 5 Data source: Office of Healthcare Informatics and Analytics (OHIA) Value Analytics Report

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Surgical Site Complications within 30 Days ofOrthopaedic Surgery Surgical Procedure


0%

2%

4%

6%

8%

10%

12%

14%

16%

Return to OR within 30 Days ofOrthopaedic Surgery Surgical Procedure


0%

1%

2%

3%

4%

5%

6%

7%

ED Visit within 30 Days of OrthopaedicSurgery Surgical Procedure

58% Decrease in average surgical site infection rate from FY 13-14 to FY 14-15

Mauricio Silva, M.D. William Oppenheim, M.D. Richard Bowen, M.D. Nicholas Bernthal, M.D.

The Santa Monica UCLA Medical Center Emergency Department offers comprehensive emergency services for all pediatric patients with our Board Certified Orthopaedic Surgeons available for consultation 24 hours per day, 7 days per week. The Renee & Meyer Luskin Children’s Clinic in Santa Monica offers same-day and next-day appointments for all non-emergent patients.

The Orthopaedic Institute for Children is located in downtown Los Angeles and offers urgent care services for pediatric patients 7 days per week. Patients in need of urgent hospital admission are transferred via ambulance to our pediatric unit at the Santa Monica UCLA Medical Center. All pediatric surgeries (urgent and non-urgent) are also performed at the Santa Monica UCLA Medical Center.

Lewis Zionts, M.D.

COMPREHENSIVE ORTHOPAEDIC CARE FOR PEDIATRIC PATIENTS

OIC Outpatient Medical Center, Downtown Los Angeles

Orthopaedic Institute for Children Research Center, Los Angeles

A N T H O N Y S C A D U T O , M . D . CEO, ORTHOPAEDIC INSTITUTE FOR CHILDREN


Meet Our Pediatric Orthopaedic Surgeons

Susan Bukata, M.D.

Devon Jeffcoat, M.D. Eric Johnson, M.D.

Francis Cyran, M.D. Bruce Brown, M.D.

Benjamin Bengs, M.D.

COMPREHENSIVE CARE FOR TRAUMATIC FRACTURES AND FRAGILITY FRACTUR ES

RONALD REAGAN UCLA MEDICAL CENTER is a Level I Trauma Center offering comprehensive, multidisciplinary care for all types of traumatic injuries. Board certified Orthopaedic Surgeons are available 24 hours per day, 7 days per week to care for patients coming through the emergency room and are ready to take patients to the operating room at any hour. SANTA MONICA UCLA MEDICAL CENTER & ORTHOPAEDIC INSTITUE FOR CHILDREN is a Level II Trauma Center and also offers comprehensive fracture care while specializing in long term care of fragility fractures and patients with osteoporosis.

Freda Hannafon, FNP-C Aurelia Nattiv, M.D.

Our osteoporosis team specializes in the long term care of patients with osteoporosis and offers comprehensive treatment plans to ensure fragility fracture prevention.

Susan Bukata, M.D.

Meet Our Fracture Care Surgeons

Meet Our Osteoporosis Specialists

Multidisciplinary Fracture Care


Eric Farrell, M.D.

Brad Aspey, M.D.

By diligently monitoring patient arrival in the Emergency Room and surgical start time, we have been able to identify delays, implement processes to eliminate these delays, and dramatically decrease time to surgery for our hip fracture patients. While we are pleased with our progress, we are still working daily to continue to decrease time to surgery with the goal of ensuring that all medically cleared patients are in the operating room within 24 hours of Emergency Room arrival.

Shown below are the 30-day mortality index scores following hip fracture surgery. The value is expressed as a ratio of observed to expected (O/E) mortality. This risk adjusted data is provided by the University Health Consortium (UHC). The O/E mortality index should always be less than 1.0. We are very proud of our success in decreasing mortality following hip fracture surgery.

Data source: UHC Outcomes Report by Hospital, filtered by Principle Procedure “Hip Fracture Surgery”

Fiscal Year

Average Time to Surgery (HOURS)

% of pts to surgery < 24 HOURS

2011 41.3 30%

2012 38.4 38%

2013 32.3 54%

2014 31.2 59%

2015 31.7 58%

Fiscal Year Santa Monica Ronald Reagan

2011 1.12 1.04

2012 0.91 0.94

2013 0.52 0.31

2014 0.34 0.73

2015 0.42 0.61

Hip Fracture Mortality

1.4 1.3

0.7 0.6 0.6

1.1 0.9

0.5 0.3 0.4

2011 2012 2013 2014 2015

Hip Fracture Mortality (O/E)

RR SM

Time to Surgery for Hip Fracture Patients

25

30

35

40

45

FY 2011 FY 2012 FY 2013 FY 2014 FY 2015

RR

SM

TOTAL

Average Time to Surgery (hours)



FY 2011 (July 1st 2010 – June 30th 2011)

HOSPITAL hospital of emergency room (ER) arrival TIME hours between patient arrival in the ER and surgery start LOS (length of stay) number of inpatient days not including outpatient ER hours pLOS (post surgery length of stay) number of inpatient days from surgery end time to hospital discharge. Only available for FY 2013 & FY 2014 VOLUME total number of hip fracture surgeries performed

Hospital Time LOS Volume

RR 37.4 7.29 57

SM 43.1 7.15 164

TOTAL 41.3 7.12 221

FY 2014 (July 1st 2013 – June 30th 2014)

FY 2015 (July 1st 2014 – June 30th 2015)

Hospital Time LOS pLOS Volume

RR 36.4 8.44 7.10 53

SM 30.2 6.30 5.01 161

TOTAL 32.3 7.98 6.35 214

FY 2013 (July 1st 2012 – June 30th 2013)


RR 31.4 6.07 5.84 67

SM 32.1 5.41 4.99 177

TOTAL 31.7 5.94 5.12 244

Patients who suffer hip fractures often require immediate surgical treatment. The longer surgery is delayed, the higher the risk of complication. At UCLA, we closely monitor how quickly our hip fracture patients are taken to surgery and we strive to minimize delays to ensure surgical intervention occurs as soon as possible.


Hip Fracture Quality Metrics (cont.)


48% Hip Fracture Quality Improvements:

Increase in time to surgery within 24 hours since 2011

17% Reduction in length of stay since 2011


RR 35.2 7.91 7.08 61

SM 29.1 5.91 4.83 167

TOTAL 31.2 6.84 6.12 228

Time to Surgery & Length of Stay by Hospital

FY 2012 (July 1st 2011 – June 30th 2012)

Hospital Time LOS Volume

RR 36.2 7.02 56

SM 39.5 6.99 145

TOTAL 38.4 7.07 201

51% Overall reduction (RR & SM combined) in O/E hip fracture mortality since 2011

Bert Thomas, M.D. Benjamin Bengs, M.D. Eric Johnson, M.D. Bruce Brown, M.D. Francis Cyran, M.D.

SURGICAL VOLUMES & OUTCOMES BY HOSPITAL

LOS: length of hospital stay in days RE %: 30-day readmission rate

THE SANTA MONCA UCLA MEDICAL CENTER & ORTHOPAEDIC INSTITUTE FOR CHILDREN is proud to offer comprehensive care for TJR patients. Specializing in knee, hip and shoulder replacement, UCLA orthopaedic TJR surgeons work closely with our specially trained and certified orthopaedic nurses, physical therapists and occupational therapists to ensure all patients are cared for by an expert and collaborative team of providers.

Total Hip Replacement Surgery

Total Knee Replacement Surgery

Hospital Volume LOS RE %

RR n/a - -

SM 264 3.09 2.3%

TOTAL 264 3.09 2.3%

Total Knee Arthroplasty FY 2015 (July 1st 2014 – June 30th 2015)

Hospital Volume LOS RE %

RR 62 3.24 1.8%

SM 197 3.11 2.9%

TOTAL 259 3.14 2.7%

Total Hip Arthroplasty FY 2015 (July 1st 2014 – June 30th 2015)

Meet Our Joint Replacement Surgeons

Total Joint Replacement (TJR) Surgery



TRANSFUSION RATES BEFORE March 2013 – April 2014: TKA - 13.5% THA - 27.5% TRANSFUSION RATES NOW May 2014 – June 2015: TKA - 2.4% THA - 12.8%

Excessive blood loss during surgery can effect hemodynamics and result in the need for blood transfusion. Blood transfusions put patients at risk for transfusion reactions and other post-operative complications. By improving surgical technique and achieving meticulous hemostasis along with improved perioperative protocols, we have been able to significantly reduce blood loss and and blood transfusion rates.

TJR Quality Metrics

Blood Transfusion Reduction 67% Reduction in TJR

blood transfusions


34% Increase in appropriate blood transfusion orders


0%

5%

10%

15%

20%

25%

30%

35%

Percent of Joint Replacement cases with at least one transfusion order following surgery

0%

10%

20%

30%

40%

50%

60%

Percent of transfusion orders following joint replacement surgerywith appropriate indication

Increase in appropriate indication for transfusions

Decrease in actual number of transfusions following total joint replacement surgery

In May of 2014 we began an aggressive initiative to implement physical therapy on the same day of surgery (POD 0) for all of our total joint replacement surgery patients. Below and on page 23 you will find our results which illustrate the major impact that POD 0 physical therapy has had on length of stay and pain reduction for our patients.

As shown in the graph below, since implementing our physical therapy on day of surgery program, TJR length of stay has decreased substantially. The graph shows the percentage of patients discharged on or before hospital day 3 (LOS = 3.0 or less)

Impact on Length of Stay

Physical Therapy on Day of Surgery




58% of our TJR patients receive physical therapy on the day of surgery (FY 15 average)

84% of our TJR patients are discharged on hospital day 3 / post-surgery day 2 (FY 15 average)

Despite our LOS reduction with same day physical therapy, the rate limiting factor for further reduction in LOS is the support of an Ortho-dedicated case manager on the weekends which currently is not available to our department.

0%

20%

40%

60%

80%

100%

Percent of Joint Replacement cases with physical therapy on day 0 following surgery

0%

20%

40%

60%

80%

100%

Percent of Joint Replacement cases discharged on day 3 following surgery

Physical Therapy on Day of Surgery (cont.)

Examining The Efficacy of Physical Therapy on Day of Surgery Innovation plays an important role in helping us provide our patients the safest and best care possible. We understand that by committing ourselves to a culture of continuous learning, self-evaluation, and improvement, we must implement new methods that we believe will improve patient outcomes. By combining timely reports with transparent data collection, we hope to measure the efficacy of our surgical quality initiatives, and provide patients with the necessary resources to make the best choices for their healthcare. In this study, we report our progress, success, and challenges with our Patient Day Zero Physical Therapy initiative. We studied the effect physical therapy has on patient surgical when given at different time periods during the first 24 hours after surgery.

Hospitals and providers must be held accountable for the quality of care that they provide their patients. Evaluation of performance, transparency in collecting data, and public reporting of results will motivate providers and the healthcare community to continually strive for excellence, while encouraging a team-based approach to improving patient care.

FY 14-15 Patient-Reported Pain After Receiving Physical Therapy within 24 Hours of Surgery

The chart on the left depicts the average patient-reported pain after receiving physical therapy within the first 24 hours post-surgery. The x-axis depicts patient-reported pain based on a numerical rating scale (a score of 0 indicates no pain, a score of 10 indicates severe pain, and numbers 1-9 indicate increasing pain intensity in numerical order). The y-axis indicates the type of surgery the patient received, and at which time period the patient received physical therapy (i.e. The category “Hip > 4” represents patients who underwent hip surgery, and received physical therapy within 4 hours post-surgery). 0 2 4 6 8 10

Knee < 24Hip < 24

Knee < 16Hip < 16

Knee < 8Hip < 8

Knee < 4Hip < 4

FY 14-15 Average Time Until Physical Therapy

Hip Fracture – 18 hours, 9 minutes

Hip Replacement – 11 hours, 42 minutes

Knee Replacement – 10 hours, 53 minutes

Spine Surgery – 19 hours, 7 minutes



0

1

2

3

4

5

6

PRE-OP 2-6 WEEKS 2-3 MONTHS 6-9 MONTHS

0

1

2

3

4

5

6

PRE-OP 2-6 WEEKS 2-3 MONTHS 6-9 MONTHS 1 YEAR

Evaluating Patient-Reported Pain Before Surgery and Throughout Recovery Methods to screen patient pain provide powerful tools that inform healthcare professionals about patient’s quality of life. Thus, patient pain screening allows clinicians to identify patients who could benefit from joint reconstructive surgery, and to track patients throughout the recovery process after undergoing surgery. By implementing numeric rating scales to assess pain, we hope to improve the effectiveness of treatment and clinical decision-making.

Pain symptoms are among the most common medical complaints and are diverse in terms of etiology, severity, and duration. As a result, measuring patient pain is difficult within clinical settings. Numeric rating scales (NRS) of pain attempt to address this issue by translating pain intensity onto a simple numerical scale. NRSs of pain are common diagnostic tools that assists healthcare professionals in assessing the severity and quality of pain experienced by patients. We used a NRS that consisted of a single 7-point numeric scaled: (0) No pain, (2) very mild, (3) mild, (4) moderate, (5) severe, (6) very severe.

FY 14-15 Patient-Reported Pain Total Knee Replacement

FY 14-15 Patient-Reported Pain Total Hip Replacement

Reduction in patient-reported hip pain within 6-9 months of total hip replacement surgery (n=107)

44%

Patient-Reported Pain


Reduction in patient-reported knee pain within 6-9 months of total knee replacement surgery (n=84)

46%



All patient reported outcomes data are collected from patients during face-to-face interviews or phone interviews conducted by our volunteer research interns. This team of interns is crucial to measuring our outcomes and developing improvements that impact patients.

Patient Reported-Outcomes Team

Matthew Nguyen Research Intern

Patient-Reported Outcomes (cont.)

Significance of Patient-Reported Outcomes In Healthcare Patient-reported outcomes (PROs) are methods used in clinical settings, where the results are collected directly from the patient. These outcomes inform clinicians and healthcare directors of patients’ symptoms, quality of life, and perceived health status. As a result, PROs generate both physical and mental health patient profiles, providing clinicians a more complete summary of patient satisfaction and experience. Overall, conclusions derived from patient reported outcomes can help healthcare professionals improve the quality of patient care by taking a more holistic approach to clinical decision-making.

SF-36 Patient-Reported Outcomes SF-36 is a nationally validated 36-question patient-reported survey that evaluates individual patient health status, and compares relative burden of disease. The survey yields a mental health score and a physical health score that can be used to evaluate the effectiveness of treatment. The higher the score, the lesser the degree of disability (a score indicates maximum disability and a score of 100 indicates no disability).

FY 14-15 SF-36 Results for Total Knee Replacement

Outcomes derived from the SF-36 Survey are helpful in determining: • Patient quality of life • Patient satisfaction • Areas of need for better clinical care

0

20

40

60

80

100

PRE-OP 2-6 WEEKS 2-3 MONTHS 6-9 MONTHS 1 YEAR

PHYSICAL HEALTH SCORE MENTAL HEALTH SCORE

0

20

40

60

80

100

PRE-OP 2-6 WEEKS 2-3 MONTHS 6-9 MONTHS

PHYSICAL HEALTH SCORE MENTAL HEALTH SCORE

FY 14-15 SF-36 Results for Total Hip Replacement

Within 6-9 months of surgery, patients undergoing total knee replacement (n=84) reported:

30% improvement in mental health

42% improvement in physical health

Within 6-9 months of surgery, patients undergoing total hip replacement (n=107) reported:

17%

38%

improvement in mental health

improvement in physical health




93 94

80

90 90 85 85

89 89

81

92

0

10

20

30

40

50

60

70

80

90

100

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

3NW WOULD RECOMMEND JUL'14-MAY'15

Scor

es in

Per

cent

ages

(%)

74 71

75

62 68 69

63

77

64 69

78

0

10

20

30

40

50

60

70

80

90

100


3NW GOT HELP AS SOON AS WANTED JUL'14-MAY'15

Scor

es in

Per

cent

ages

(%)

88

94

78 77

91

80 79

88

77

86 91

0

10

20

30

40

50

60

70

80

90

100


Scor

es in

Per

cent

ages

(%)

3NW DID EVERYTHING TO HELP WITH PAIN JUL'14-MAY'15

76 77

58 59

80

48

67 72

65 62

78

0

10

20

30

40

50

60

70

80

90

100


Scor

es in

Per

cent

ages

(%)

3NW PAIN WELL CONTROLLED JUL'14-MAY'15


Data source: NDNQI Database

3 North Wing (3NW) is the dedicated Orthopaedics unit at the Santa Monica UCLA Medical Center for all adult patients admitted for Orthopaedic care. The unit’s specialty-trained and certified staff are experts in Orthopaedic care and surgical recovery. Below you will find our inpatient satisfaction scores for the Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

3NW HCAHPS Data (Inpatient Care)

Peer group mean (Press Ganey database)

Peer group mean (Press Ganey database) Peer group mean (Press Ganey database)

Peer group mean (Press Ganey database)


Data source: NDNQI Database Data source: NDNQI Database

Ortho Unit Fall Rates

0.00

1.56

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

3NW FALLS W/INJURY FALLS W/INJURY PER 1000 PATIENT DAYS

(# OF FALLS WITH INJURY/PATIENT DAYS) X 1000



0.00

1.50

0.00

1.60 1.60

0.00 0.00 0.00

3.10

0.00 0.00 0.00 0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


3NW FALLS W/INJURY FALLS W/INJURY PER 1000 PATIENT DAYS

(# OF FALLS WITH INJURY/PATIENT DAYS) X 1000

1.60

4.50

3.20

1.60 1.60 1.50

0.00 0.00

4.60

0.00

2.90

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

3NW FALL RATE FALLS PER 1000 PATIENT DAYS

(# OF FALLS/PATIENT DAYS) X 1000


2013 – 2014

National Median Rate (NDNQI database)


0.00

4.68

0.00

2.92

0.00

4.30

0.00

1.36

3.17

2.77 2.87

0.00 0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

3NW FALL RATE FALLS PER 1000 PATIENT DAYS

(# OF FALLS/PATIENT DAYS) X 1000




Data source: NDNQI Database National Median Rate (NDNQI database)

2014 – 2015

2013 – 2014 2014 – 2015


0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00.20.40.60.81.01.21.41.61.82.0

Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

3NW ACQUIRED PRESSURE ULCER (UAPU) RATES

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00.20.40.60.81.01.21.41.61.82.0


3NW ACQUIRED PRESSURE ULCER (UAPU) RATES

Ortho Unit Pressure Ulcer Rates

4.0

0.0 0.0 0.0 0.0 0.0 0.0 0.0

3.9

0.0 0.0 0.0 0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5


3NW CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES

(# OF INFECTIONS/DEVICE DAYS) X 1000

Ortho Unit CAUTI Rates

2013 – 2014 2014 – 2015


Data source: NDNQI Database Data source: NDNQI Database National Median Rate (NDNQI database)

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

4.0

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5


3NW CATHETER ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES

(# OF INFECTIONS/DEVICE DAYS) X 1000

2013 – 2014 2014 – 2015


Data source: NDNQI Database Data source: NDNQI Database



Orthopaedic Oncology


The Musculoskeletal Oncology Service was established in 1980 by Dr. Jeffrey J. Eckardt of Orthopaedic Surgery and Dr. Fred Eilber of Surgical Oncology. The service manages all bone and soft-tissue tumors, benign and malignant, primary, recurrent, and metastatic, and all tumor-like conditions of bone and soft tissue. UCLA has been a pioneer in the development of limb-sparing surgical strategies for both malignant bone and soft-tissue sarcomas. It has one of the largest series of metal implants (endoprostheses) for bone tumors and resections for soft-tissue sarcomas.

Meet Our Orthopaedic Oncology Surgeons

The Musculoskeletal Oncology Service works together with several other disciplines to ensure the most comprehensive care possible. A weekly tumor board was established over 30 years ago and continues to meet today. Carefully planning and discussing each aspect of every patient’s care is crucial to optimal care and long term survivability.

Susan Bukata, M.D. Jeffrey Eckardt, M.D. Francis Cyran, M.D. Nicholas Bernthal, M.D.

From left to right (bottom row): Scott Nelson (Pathologist), Leanne Seeger (Diagnostic Radiologist), Bartosz Chmielowski (Medical Oncologist), Fred Eilber (Surgical Oncologist), Jeffrey Eckardt (Orthopaedic Oncologist), Fritz Eilber (Surgical Oncologist) From left to right (top row): Susan Bukata (Orthopaedic Oncologist), Noah Federman (Pediatric Oncologist), Josh Cohen (Gynecologic Oncologist), Nicholas Bernthal (Orthopaedic Oncologist), Francis Cyran (Orthopaedic Oncologist), Mitch Kamrava (Radiation Oncologist), Arun Singh (Medical Oncologist), Sandra Brackert (Medical Oncology Nurse Practitioner).

Procedure Volume Wound Issue Rate

Curettage of Bone 143 1.3%

Soft Tissue Tumor 237 0%

Radical Resection of Bone 118 0.8%

TOTAL CASES 498 0.6%

PATHOLOGY CONFIRMS

DIAGNOSIS

RADIOLOGY CONFIRMS

LOCATION

GROUP DISCUSSION DETERMINES

TREATMENT

Multidisciplinary Tumor Board

The UCLA Spine Center provides comprehensive clinical treatment for all spinal disorders. We are dedicated to advancing research and strive to be on the cutting edge in all areas of research studying spinal disorders.

Within 6-9 months, patients undergoing spine surgery (n=46) reported:

42% improvement in mobility

39% reduction in pain

UCLA Spine Center, Santa Monica

Meet Our Spine Surgeons

Nick Shamie, M.D. Orthopaedic Spine Surgery

Don Park, M.D. Orthopaedic Spine Surgery

David Fish, M.D. Physical Medicine & Rehab

Jae Jung, M.D. Physical Medicine & Rehab

Ulrich Batzdorf, M.D. Neurological Spine Surgery

Langston Holly, M.D. Neurological Spine Surgery

Duncan McBride, M.D. Neurological Spine Surgery

Daniel Lu, M.D. Neurological Spine Surgery

Sina Pourtaheri, M.D. Orthopaedic Spine Surgery


COMPREHENSIVE SPINE SURGERY CARE

New Orthopaedic Faculty


2010 & 2011

Andy Schwartz, M.D. General Orthopaedics

Devon Jeffcoat, M.D. Orthopaedic Trauma

Frank Petrigliano, M.D. Operative Sports Medicine

Bruce Brown, M.D. General Orthopaedics

2011 & 2012

Eric Farrell, M.D. Orthopaedic Trauma

Pete Alexakis, M.D. General Orthopaedics

Keith Markolf, PhD Bioengineer

Jae Jung, M.D. PM&R

Dan Boguszewski, PhD Bioengineer

Freda Hannafon, FNP Osteoporosis

Susan Bukata, M.D. Oncology & Osteoporosis

2013 & 2014

Deborah Krakow, M.D. Genetic Development

Dan Vigil, M.D. Non-Operative Sports

Kris Jones, M.D. Operative Sports Medicine

Nick Bernthal, M.D. Orthopaedic Oncology

John Lawrence, M.D. Non-Operative Hand

Peter Vezeridis, M.D. Operative Sports Medicine

Joan Williams, M.D. Foot & Ankle

2014 & 2015

Josh Goldman, M.D. Non-Operative Sports

Kit Song, M.D. Administration & Pediatrics

Brad Aspey, M.D. General & Sports

Don Park, M.D. General & Spine

Cas Dowd, M.D. Hand Surgery

Sina Pourtaheri, M.D. Spine Surgery

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

$7,000,000

2010 2011 2012 2013 2014

#1 Ranked Ortho Dept

UCLA Ortho Dept NIH PI Funding

Mean (of 40 Depts Ranked)

#40 Ranked Ortho Dept

Top 10 Orthopaedic Surgery Departments FY 2014

#1 Washington University #2 University of California San Francisco #3 University of Pennsylvania #4 Johns Hopkins University #5 University of Rochester #6 Duke University #7 University of California Los Angeles #8 University of California San Diego #9 University of Michigan #10 New York University School of Medicine

Blue Ridge Institute for Medical Research Ranking Orthopaedic Surgery Department Rankings for NIH Primary Investigator (PI) Funding

John Adams, M.D. Distinguished Professor & Vice Chair of Research

#14

#8 #7 #7 #6

Dan Cohn, PhD Karen Lyons, PhD Deborah Krakow, M.D. Chia Soo, M.D. Bruno Peault, PhD Ben Wu, PhD Kang (Eric) Ting, DDS

Orthopaedic Surgery Research Faculty

Pat Campbell, PhD Eileen Fowler, PhD Maria Ascenzi, PhD Ed Ebramzadeh, PhD Sophia Sangiorio, PhD Sang-Hyun Park, PhD Fabrizio Billi, PhD


$30 million in total extramural funding (2014)


T R A N S I T I O N P L A N N I N G

As many of our patients transition from the inpatient hospital setting to skilled nursing facilities (SNFs) prior to returning home, we’ve made it our goal to make this care transition as seamless as possible for patients, their families, and for all providers. We work closely with the physicians, nurses, and entire staff at many of the SNFs in our community to coordinate the transfer of care and ensure that patient needs are met at all times. We have also developed many quality metrics with our community SNFs to monitor efficiency and clinical outcomes of our patients. We believe that our efforts have greatly improved the care and outcomes for our patients.

COMMUNITY OUTREACH

• Fireside Convalescent Hospital

• Berkeley East Convalescent Hospital

• Berkeley West Convalescent Hospital

• Brentwood Nursing & Rehabilitation

OPERATION MEND

C A R I N G F O R O U R W O U N D E D W A R R I O R S UCLA Orthopaedics is very honored to participate in Operation Mend, a program that provides much needed specialized medical care to our wounded warriors. Several members of the UCLA Orthopaedics faculty are participants of this great program.

Marching in NYC on Veteran’s Day in 2014. From left to right: Shannon O’Kelley (UCLA Health Chief Operating Officer), Chris Crisera (UCLA Plastic Surgery), Kodi Azari (UCLA Orthopaedics Hand Surgery), Sharon Hame (UCLA Orthopaedics Sports Medicine Surgery).


R O B O T L I G A M E N T T E S T I N G M A C H I N E

Our biomechanics research team continues to study knee ligament injuries using a state-of-the-art robotic testing system.

DEPARTMENTAL DISTINCTIONS & INNOVATIONS

G O R I L L A S U R G E R Y , A U G U S T 2 0 1 4

UCLA Orthopaedic Surgeons Nicholas Bernthal, MD, Devon Jeffcoat, MD, and UCLA Orthopaedics resident alumni Tad Kremen, MD were asked to operate at the Los Angeles County Zoo when a 400-lb male gorilla suffered a femur fracture.

From left to right: Steven Bilbrey, D.V.M., Kirk Wendelberg, D.V.M, Nicholas Bernthal, M.D., Devon Jeffcoat, M.D., Tad Kremen, M.D.

Preparing the gorilla for surgery

From left to right: Nirav Joshi, M.D., David McAllister, M.D., Katie Moses (intern), Dan Boguszewski, PhD.

Keith Markolf, PHD Bioengineer


From left to right: Eric Ting, D.D.S., Chia Soo, M.D., Benjamin Wu, Ph.D., Jinny Kwak, D.D.S.

I N T E R N A T I O N A L S U R G E R Y R O T A T I O N

Through a partnership between the UCLA Department of Orthopaedic Surgery and Soddo Christian Hospital in Ethiopia, UCLA Orthopaedic surgeons and residents are able to perform surgeries in Ethiopia and help teach Ethiopian medical residents. Since the program began in 2012, we’ve been able to send four UCLA Orthopaedic Surgery residents to serve in Ethiopia (pictured to the right).

International Space Station

The UCLA Department of Orthopaedic Surgery will be going to space with a new research project led by Chia Soo, M.D. Dr. Soo and her team (pictured below) will take their groundbreaking bone stem cell research to the International Space

Station with a $300, 000 grant from the Center for the Advancement of Science in Space, Inc. (CASIS). The project will test whether a molecule of their discovery, NELL-1, will build bone in microgravity as will be experienced by astronauts in future

long duration space flights to other planets in our solar system.

Nicholas Bernthal, M.D. Cas Dowd, M.D.

Scott Montgomery, M.D. Michael Leathers, M.D.

O S T E O P O R O S I S R E S E A R C H I N O U T E R S P A C E


U.S. News & World Report Rankings

U C L A O R T H O P A E D I C S U R G E R Y I S I N T H E T O P 1 0

2010 - 2011 UCLA ORTHOPAEDICS RANKED

#19 2014 - 2015

UCLA ORTHOPAEDICS RANKED

#11 2015 - 2016

UCLA ORTHOPAEDICS RANKED

#8

Transparency is the KEY to Improving Care

O U R Q U A L I T Y & O U T C O M E S P U B L I C A T I O N S

BASELINE REPORT 1ST EDITION 2ND EDITION 3RD EDITION


IS AN ANNUAL PUBLICATION OF THE UCLA

DEPARTMENT OF ORTHOPAEDIC SURGERY QUALITY IMPROVEMENT TEAM

EDITORS

Jeffrey J. Eckardt, M.D. Deborah Winograd, R.N.

DEPARTMENT CHAIR

Jeffrey J. Eckardt, M.D.

DIRECTOR OF QUALITY Deborah Winograd, R.N.

FACULTY QUALITY OFFICERS

Benjamin Bengs, M.D. Devon Jeffcoat, M.D.

QUALITY IMPROVEMENT TEAM

Peter G. Alexakis, M.D. Benjamin C. Bengs, M.D.

Katie Denisova, R.N. Jeffrey J. Eckardt, M.D.

Devon M. Jeffcoat, M.D. Julie Kielman, P.T.

Roger M. Lee, M.D. Kimberly A. Ternavan, R.N.

Alisa Trout, R.N. Deborah Winograd, R.N.

SPECIAL THANKS

Robin Clarke, M.D. Andrew D. Hackbarth

Ashley Lucia Matthew D. Nguyen

Tina Nguyen

For inquiries about the Orthopaedic Surgery Quality & Outcomes Report, please email:

[email protected]

O R T H O P A E D I C S U R G E R Y Q U A L I T Y & O U T C O M E S R E P O R T

ACKNOWLEDGEMENTS

Department of Orthopaedic Surgery David Geffen School of Medicine 10833 Le Conte Avenue BOX 956902, 76-143 CHS Los Angeles, CA 90095-6902

NON PROFIT ORGANIZATION

U.S. POSTAGE

PAID

U C L A

PLEASE DELIVER TO:

UCLA ORTHOPAEDIC SURGERY WESTWOOD CLINIC 100 UCLA Medical Plaza, Suite 755 Los Angeles, CA 90095 (310) 319-1234 ortho.ucla.edu

UCLA ORTHOPAEDIC SURGERY SANTA MONICA CLINIC 1250 16th Street, Suite 2100 Santa Monica, CA 90404 (310) 319-1234 ortho.ucla.edu

UCLA ORTHOPAEDIC SURGERY SANTA MONICA SPINE CENTER 1131 Wilshire Blvd, Suite 100 Santa Monica, CA 90401 (310) 319-3475 spinecenter.ucla.edu

Documents

OB 2015 blind final - UCLA Orthopaedic Surgeryortho.ucla.edu/workfiles/About_Us/Quality/Ortho QB 2015 (2).pdfQUALITY & OUTCOMES REPORT y 3 A MESSAGE FROM THE CHAIRMAN The UCLA Department