An innovative, more patient-centric model of health care is helping joint replacement patients at Anne Arundel Medical Center in Annapolis, Md., heal at a faster rate and with fewer complications.

Developed more than a decade ago by Marshall Steele, MD, medical director of the facility's Joint Center and founder of Marshall Steele and Associates, the program strives to improve the patient experience by providing early education regarding surgical procedures, placing joint replacement patients together in a special ward to build camaraderie and support, and encouraging stronger family involvement.

"The traditional approach [to joint replacement surgery] was unfocused," says Steele, who has traveled the world promoting the new model. "Patients had multiple caregivers and often received conflicting information.

"I call it 'it depends' medicine because its success really depended on individual performance. If we had the right nurse, the right doctor, and the right physical therapist, then the patient could have a good experience. But if all of those caregivers didn't line up, sometimes the experience was not so good. It was really a lack of consistency that drove us [to change the system]," he says.

Early on, Steele saw a variety of issues he felt needed fixing. Joint patients typically spent most of the time alone in their rooms, fearful and concerned. Family involvement was hit or miss, if it occurred at all. And most of the education patients received was verbal, which meant there was very little retention.

Under the new model, patients receive detailed information about their procedures in advance of admission and are grouped together for mutual support, says Juli Pastrana, RN, BSN, ONC, joint care coordinator with the Joint Camp at Anne Arundel. Best of all, they see the same care team throughout their stay, so everyone is on the same page.

Placing joint replacement patients together is key to the program's success, says Tina Andersen, RN, BSN, ONC, the Joint Camp's care team coordinator.

"Assigning nurses a group of patients with similar diagnoses (i.e., joint replacement) allows them to closely monitor their patients' progress to maintain a standard of care," she says.

The group environment has healthful benefits for the patient as well, says Pastrana. "The patients find it motivating. They find the camaraderie fun," she says. "Patients rarely refuse to go to physical therapy because they feel like they have to go one better than the person next to them. They encourage each other along."

Small things can have a big impact on patient morale, Pastrana says. For example, the patients receive ice cream at the end of group therapy each day, which is when they really get to chat and come to know each other. And a toy car race called the Joint Camp Indy 500 helps motivate participants as the rooms compete against each other during rehabilitation.

"We start the group process in preop and focus a lot on group activities," Pastrana says. "The patients do come to wonder and worry about each other."

The role of the nurse is integral in making this patient-centric care model work efficiently, says Steele. "The traditional nursing role in the hospital for these patients isn't that different. The difference is that they get to take care of the same type of patients all the time."

Nurses are also an important part of what Steele calls the performance improvement team, a multidisciplinary group that meets monthly to discuss what can be done better. "The team works together in a regular committee to improve the process; it's not done in the hallway," Steele says. "As a result, the nurses are far more empowered, I think, to make changes in this system than they were in the old system."

Because the Joint Camp is so fine-tuned and schedule-driven, new nurses often find it difficult to adjust. "We call it Joint Camp because it truly runs like a camp," says Andersen. "Nurses can't just move at their own pace - there's a time frame for everything. It's often difficult to get float nurses to understand that."

The hard work of all involved is worth it. "When we started, our patients were staying in the hospital about five days, and 90% of them went to another facility for rehabilitation," says Steele. "Today, our patients are staying three days or less, and 90% are going home."

Because of its success with joint patients, Steele's patient-centric model is now being employed not only at Anne Arundel but also at other facilities nationwide with different patient groups, including those with vascular disease and spine disorders.

"This is the model of the future," says Steele. "I don't think we can fix health care globally, but I think we can fix it one piece at a time. This is the way to do that, with focus and consistency of care."