Total hip and total knee replacement certification focuses on continuum of care

Late last year, The Joint Commission announced a new advanced certification program for total hip and total knee replacement. Developed in part because of the growing number of patients undergoing these procedures, this program is designed to elevate the quality, consistency, and safety of these services in critical access hospitals and ambulatory surgery centers (ASCs). The goal of the program is to foster more cost-effective and better-quality care.

The program also responds to the increased focus on adherence to standardized clinical pathways and clinical evidence-based patient care as they relate to pain management, quality-of-life issues, functional limitations on mobility, and the return to normal daily activities while minimizing postoperative complications, such as infection and thrombosis.

Program components

Key characteristics of the total hip and total knee replacement program—which addresses transitions of care—are as follows:

  • Consistent communication and collaboration among all health care providers involved in the patient’s care, as well as shared decision making throughout the continuum of care—from orthopaedic consultation through the follow-up visit.
  • Procedures should be performed in inpatient, hospital-based outpatient/same-day surgery units, and freestanding ASCs.
  • Patient education regarding the total hip and total knee replacement process in the preoperative, intraoperative, and postoperative phases.

As part of the program development process, The Joint Commission convened a technical advisory panel of clinical experts to evaluate programs seeking advanced certification. Joint Commission staff also conducted a field review and pilot surveys to assess the current state of total hip and total knee replacement care services and any operational challenges in addressing the continuum of care.

Requirements of the total hip and total knee replacement program include:

  • Establishment of an interdisciplinary team to manage all phases of care through initial phase of postoperative follow-up.
  • Detailed preoperative assessment of the patient’s home environment, risk profile, health status, and functional capacity with concomitant risk reduction and preoperative medical optimization.
  • Collaboration between one of the interdisciplinary team members, often a nurse referred to as the “case manager,” and the patient to arrange a follow-up appointment with the orthopaedic surgeon on a timeline that fits with the care needed for the individual patient, before patient discharge. The case manager also may assist in all transitions of care by engaging the patient as soon as the decision is made to proceed with surgery.
  • Immediate access to 24/7 postoperative urgent care via telephone, Internet, or referral to urgent or emergency care.
  • The discharge education process includes:
    • Prescribed medication usage
    • Activity level, weight-bearing status, and precautions
    • Infection prevention
    • Blood clot prevention
    • Diet
    • Incision care
    • Pain control
    • Information on when and how to schedule follow-up appointments

In addition to these requirements, in the on-site review, which is repeated every two years, the Joint Commission reviewer must observe either a total hip or total knee replacement. The program must continually collect and analyze data on clinical outcomes, quality of care, and variances from practice guidelines. Performance measurement criteria include:

  • Four process or outcome measures to monitor on an ongoing basis
  • At least two clinical measures
  • Up to two nonclinical measures—that is, administrative, utilization, financial, and patient satisfaction measures

Applying for accreditation

The Joint Commission is currently accrediting programs and has been accepting applications since December 17, 2015. The standard measures are scheduled to be finalized in 2017. Until then, an organization is required to submit non-standardized measures. Learn more on The Joint Commission’s website.

To learn more about the advanced total hip and total knee replacement certification program, visit The Joint Commission’s website.

To request an application, e-mail or call 630-792-5291.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.

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