Upstate Medical University’s Swift Knee and Swift Hip surgery program has grown exponentially since the program started five years ago.

Swift Knee and Swift Hip offers one-day total knee or hip replacement, in which eligible patients have surgery at Upstate Community Hospital and go home the same day.

Before COVID-19, the program only saw about 10 participants per year.

Then, faced with a shortage of beds, and a backup of patients needing surgery, Program Manager Lia Fischi, MSN, RN, ONC, developed criteria and a scoring system to determine which patients would qualify for the same-day surgery.

With the new criteria developed, the program saw volumes increase for Swift Knee and Swift Hip. Cases more than doubled in 2022 and volumes continue to rise this year.

A scoring system along with defined inclusion and exclusion criteria set by the surgeons and a risk assessment determines if the patient is eligible for the same-day surgery. The calculation takes into account the patient’s willingness to be discharged on the same day, the availability of assistance at home and other health issues of the patient.

Before the surgery, patients are required to do several things. They attend a special class and undergo pre-tests, including labs and imaging, and schedule their first post-operative physical therapy appointment.

They also meet one-on-one with an orthopedic nurse navigator who educates the patient about expectations, post-operative complications, such as pain management and education about avoiding complications like pneumonia, and blood clots. Patients meet with a physical therapist before they are discharged and are expected to start physical therapy 48 hours after surgery.

The nurse navigator will visit the patient in the hospital, follow up with them by phone 24 to 48 hours post-surgery and then remain available to the patient for 90 days.

Having the ability to work with the nurse navigator post-surgery helps increase patient satisfaction, keeps a direct line to the surgeon open if necessary and decreases emergency room visits for non-emergent issues that can arise and be handled by the surgical team.

Orthopedic surgeon Robert Sherman, MD, one of the four surgeon’s performing Swift knee and hip procedures, credits the entire care team, from administrative support to physical therapists with the program’s success.  “Our Swift program allows the benefits of outpatient care with the safety of a hospital, he said. “Our patients do great, both immediately after surgery and longterm.  Most importantly, almost everyone has a wonderful experience and utilizes the program for the next joint replacement. Patients have a great experience, outcomes are great, the program is safe, and patients and their families love it."

And Sherman is right, patients are satisfied.

The overwhelmingly positive reviews laud the entire care team. One patient who underwent Swift Hip offered: “Such a great experience. From the nurse navigator, PT, pre-op nurse, post nurse, my surgeon. Truly a well-oiled machine. I’m having knee surgery in December and I’m coming to you.”

Another patient wrote: “Everyone was absolutely fantastic! I felt comfortable and at peace in their care.”

"The Swift surgery program reduces the demand for inpatient beds at the hospital, while also affording patients the opportunity to recuperate within the comfort of their own homes, surrounded by their familiar environment," Fischi said. "This promotes better healing and enhances overall comfort for the patients."

Fischi said that the same-day discharge success rate is closely monitored by the team and that it maintains a department goal of 90 percent or better who discharge the same day.

Key members of the Swift surgery program include orthopedic surgeons Timothy Damron, MD, Robert Sherman, MD, Emil Azer, MD, and Zachary Telgheder, MD, orthopedic program manager Lia Fischi MSN, RN, ONC, and nurse navigators Pete Jaskula BSN, RN, ONC and Theresa Reaume RN

For more visit: https://www.upstate.edu/orthopedics/services/swift-knee.php

Caption: Orthopedic surgeons conducting the Swift Knee and Swift Hip procedures are, from left, Emil Azer, MD; Zachary Telgheder, MD; Timothy Damron, MD; and Robert Sherman, MD.