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Health Business Case: Knee Replacement Surgery Risk Analysis

Question

Task: Your assignment is to:

Develop a business case to use as a decision guide.

Your business case should include (but note: this is not an exclusive list):

  • Evidence to support the use of the technology
  • The identification and rating of the risks and benefits for such an introduction.
  • Clinical factors: Safety, Efficacy and suitability of patient group
  • Financial impacts: costs, value for money, and funding

Make a recommendation to your manager, based on the business case and risk assessment, on whether to introduce the equipment and procedure.

Outline how you would communicate such a recommendation to the stakeholders including the surgeons and the manufacturer.

Outline any policies and procedures necessary and training processes to commence the use of this new technology.

Answer

1. Introduction
Osteoarthritis, rheumatoid arthritis and psoriatic arthritis are the main reasons for which a knee replacement surgery with the use of prosthesis is necessary. In a knee replacement surgery, the weight-bearing surfaces of the knee joints are replaced with prosthesis. Such a surgery possesses a high risk depending on the disease by which the patient is suffering from. The new technique promises a longer lifetime and smaller incision.

The following business case for health will explicate the different benefit and risk analysis to derive the feasibility of incorporating the knee replacement technique in the private facility.

1.1 Literature review
Knee replacement procedures are one of the most common major surgical procedures. Knee replacement surgery offers a life of mobility, freedom from pain and an improved quality of life for the patients as exercise and everyday activities become easier. Most knee replacement surgeries include replacing the joint surface at the end of the femur (thigh bone) and the joint surface at the top of the tibia (shin bone). (Amiri et al.2014)

Thermostocles Gluck was the first person who gave the concept of knee replacement surgery in 1880. In 1951, the first knee replacement hardware was created and it was used till 1970. Two more proposals were developed in 1970. They were developed by Dr. Sumiki Yamamoto and the Hospital for Special Surgery in New York. This surgery was considered to be a poor operation in the 1970’s and 1980’s. However, in recent years, knee replacement surgeries have a survival rate of 85% at 13 years. The major risks in knee replacement surgeries are bleeding, infection and blood clots in the leg. Another risk of knee replacement surgery is improper placement or malfunction of the implant. (Andrawis & Bozic, 2018)

Most replacements last for more than 20 years, however, surgery might have to be repeated if the patient is overweight, does manual work or plays vigorous sports. The average cost for knee replacement surgery is $49,500.

2.0 Evidence to support the technology
The new knee replacement technique that was introduced at the conference is TGA approved and promises a longer lifetime (before replacement) and a reduced number of incisions within the procedure. Knee replacement techniques use prosthetics to replace the injured or damaged knees and help the patient to be able to live a painless life. These prosthetics reduce pain and save people from being in distress due to constant pain. Through extensive study in this business case for health it has been found out that almost 90% who undergo knee replacement surgery have experienced great mobility and lesser pain. Knee replacement is said to be the most profitable for hospitals, clinics and private facilities. They not only give patients a new knee but also provide profits to the private facilities. This technique has been in use for the past 10 years and according to the statistics that have been drawn it is clear that the prosthetic replacements last for more than 20 years. Even if the cost of the surgery equipment that is required is more, they will ensure a patient complete benefit. Clinicians who provide this facility have given a positive review of the technology used. (Bagaria et al.2016).

3.0 Benefit Analysis
Introducing the knee replacement techniques will have a number of benefits to the private facility. Since knee replacement benefit the patients and provide them with a pain-free lifestyle, most patients seek hospitals that provide the service. The technique has been into practice for more than 10 years and has proven to be effective 90 percent of the times. The new knee replacement technique that uses prosthetics to replace injured knees will benefit the facility in the following ways. (Hawker et al.2015)

Increase in the number of patients: Pertaining to the popularity of the surgery, the number of patients interested in the surgery will get admitted in the hospital. With its high success rate, patients will not doubt the procedure used by the hospital and will oblige by the rules. With five orthopaedics on board with the idea of commencing the use of this technology, patients will not have to wait for a specific doctor as is the case with many small clinics. The tenure of these orthopaedics together will give the patients a sense of relief as they can trust them with the surgery. c(Wickramasinghe et al.2015)

Increase in market value: Since there are only a few clinics and hospitals that offer this treatment, adding it to the treatments provided by the private facility will in turn increase their market value. The market value will also help in the increase of their popularity as one of the few institutes that provide the surgery. The cost of the treatment has been found to be around or more than $49,000. With the increase in patients, there will be an increase in the profit of the private facility.

4.0 Risk Analysis
Even with the number of benefits that are offered by the surgery, there are still risks that will be faced by the facility pertaining to it. The following risks have been identified.

  1. Clinical & Patient Safety related risks: Patient related safety is an important factor when adopting new techniques in the private facility. Risks related to patient health may rise when the technology or the technique is relatively new. Infections need to be avoided at all costs. The risk of spreading infections to other patients or the medical staff is high. The patients after the surgery have a weak immunity and can be infected easily. Therefore, there is a risk of the patients’ health being in danger.
  2. Financial investments related risks: When adopting new technologies huge investments are needed to be made. All the required equipment must be purchased after referring to experts. There are also costs of maintaining the equipment. This all will increase the facility’s revenue by $2000. The risk here is, there may not be enough return on investment in case there are not enough patients to cover the total increase in revenue invested for incorporating the technology in the facility. The top insurers haven’t provided insurance to the technique yet so in case the equipment fails there won’t be any insurance for it.
  3. Technological risks: When adopting new technique, understanding the whole process is important. Since only 5 out of the 10 orthopaedics are on board with the idea, it is their responsibility to educate the others and the medical staff about the technology. There can be mistakes or missing of few points when doing so. There may even be cases where the staff does not understand some technicalities leading to risks in the procedures. (Hoffman & Del Mar, 2015).

5.0 Clinical Factors
Clinical factors regarding the knee replacement technique with the use of prosthetics include the safety regulations that the hospitals need to follow to ensure the safety of the patients, the effectiveness of the knee replacement technique and the patient groups that are suitable for the surgery. All these have been discussed in detail below. (Johnson, 2016)

5.1 Safety of patients
Safety of the patients has to be maintained before, during and after the surgery. The most important thing to keep in mind is that no infection must happen to the patient. For this, the hospital will have to follow strict sanitization protocols. Multiple sterilizing kits including the gowns, caps, gloves, sanitizers have to be kept ready for the patients at all times. Keeping the infections at bay is the most important for patients that are to undergo the surgery. Sterilizing all the equipment used for the treatment is also necessary. Post-surgery, the vitals of the patients need to be kept under control for speedy recovery. Physiotherapy is an important aspect for the patients to restore their mobility. All the medical staff dealing with the patient need to wear an apron, gloves, masks and caps at all times whenever they are in contact with the patients so that there is no chance of the patients coming in contact with any kinds of bacteria or funguses. These patients need to have a special room for themselves as they cannot be kept in a generic ward. (Kappel et al.2019)

5.2 Efficacy of knee transplantation technique
The knee replacement techniques as discussed in this business case for health have been used in hospitals for the long time and the studies have shown that 90 percent of the time these procedures are proven to be effective with no side effects at all. The remaining ten percent may face side effects like blood clots in the leg which can be treated by using different blood thinners. But the risk of it happening is minimal. The life of the knee replacement prosthetics is more than a decade and 80 percent of the time the patients end up using it for 20 years before they need to be replaced. According to the different studies conducted, the level of pain goes down considerably after the replacement. People who go through the procedure have experienced a lot less pain compared to the pain before the surgery. Their quality of life has improved a lot over time. They experience a better mobility in their knees and their movements have become a lot better in the knees. (Kiellberg & Kehlet, 2016)

The technique that was taught as referred business case for health in the conference used a different and advanced type of prosthetics that help reduce the incisions and have a longer term of life before they can be replaced.

5.3 Suitability for treatment
Commonly there is no age limit for undergoing knee replacement. Depending on the level of pain and disability the patient is suffering from the recommendations about the surgery are made to the patients. Knee replacements are mostly done when the patient is between the ages of 50 to 80. Even then, the orthopaedics study every case thoroughly before recommending a knee replacement. Some cases do not require the surgery at all and can be treated based on the medications, injections and physiotherapy.

6.0 Financial impacts
Total knee replacement surgery has improved the life of many patients. These surgeries are considered to be standard surgical procedures in orthopaedics. Knee replacement surgeries impact the hospitals financially. In 2004, a survey of hospitals in the US showed that a total number of 488,000 patients were admitted for knee replacement surgeries. Even though increased demand and costs of implants cause economic risks and declining profit margins, hospitals continue to offer these surgeries with the equipment needed by the physicians as they fear that the physicians might leave the hospital. Many hospitals have specific vendors through whom, they buy all the equipment needed for the surgery. This can cause underlying conflict surrounding costs. (Leopold, 2018)

6.1 Cost
The cost of implant procedures for hospitals is very high. Each hospital needs to consider the physician’s needs as the surgery is a complicated one and nothing should go wrong. Many physicians demand for specific equipment and this mainly increases the cost of the surgery for the hospital as well as the patient. The hospitals meet the demands of the physicians as they do not want the physician or the patient to shift to another hospital as this will decrease the profits of the hospitals and may also take a toll on the hospital’s reputation. (Mehta et al.2018)

Many hospitals have taken an initiative to use generic equipment and constrain the physicians in order to reduce costs of the surgery. This has neither proved to be successful nor is it unsuccessful. Any efforts made by the hospital to reduce costs by using generic equipment are either rejected or overlooked by the physicians. This impacts the hospital financially. Physicians who generally need already decided equipment in order to perform the surgery face pressure from the hospitals to reduce costs and use the equipment that has already been purchased from the vendor. Hospitals can also save money on bone cement, which is used to hold the implant against the bone.

6.2 Value for Money
A knee replacement surgery can cost the hospital anywhere between $5000 and $30,000 but, it costs the patient more that $45,000 as the patients have to not only pay the costs of the surgery, but , they also have to pay additional charges like charges of the room depending on the duration of the stay, type of implant and the charges for it and also the charges of the treatment of any complication that may occur during the hospital stay.

Total knee replacement surgeries are one of the most common procedures performed. More than one million replacement surgeries are performed every year and that number is expected to increase by 2030. Many hospitals spend about $2000 to $4500 for labour in the procedure room. This cost has to be paid by the patient during the final billing. Hospitals generally try to reduce costs by purchasing equipment from a specific vendor. The amount to be paid by the patient also changes if the patient has any pre existing conditions like obesity, anaemia, hypertension, diabetes or any other such conditions. Additional charges also include any special equipment prescribed by the physician like walkers or crutches. The cost of the surgery is more in countries like the United States as compared to other countries like Mexico or Taiwan. (Namin et al.2018)

6.3 Funding
Knee replacement surgery is very costly for patients as well as hospitals. Hospitals are mainly financed by government budgets and statutory insurance funds. Since statutory insurance funds are difficult as the procedure is not yet covered by major insurance companies, the facility will have to depend on government funds and donations. (Nwachukwo et al.2015)

7.0 Recommendations
Depending on the business case, benefits and risk assessments the following recommendations have been made:

  1. 1. The knee replacement technique has been approved by TGA and is being used already by different health facilities. Visiting these facilities and surveying their technique of incorporating the procedure will help in understanding different ways to incorporate this technology. With the orthopaedics who have already attended the conference, it will be easier to gain the information.
  2. Introducing the technology will increase the cost by $2000 per procedure, but with the current rate of the one procedure being almost at $40,000 and more will help the facility to overcome the costs. The maintenance and sterilizing cost can also be covered along with it.
  3. For purchasing the new equipment for the new technology, having a tie up with a local wholesaler will let the facility buy the equipment in a cheaper rate without compromising on the quality of the equipment.
  4. The new technique can be introduced by using different trainings and educational programs in order to avoid any risks related to the understanding of the technology. These training and educational programs will be conducted until the facility is sure that the medical staff is ready to use the technology.
  5. Instead of educating the entire staff at the same time, there can be different groups created so that after the pilot group, if there need to be any changes in the training programs can be made and have a new and improved program for the next batch. This will only include the quality of the training for the upcoming batches.

7.1 Communication of recommendations to the stakeholders
Recommendations can be communicated by using the following methods

Planned meetings:Planned meetings s discussed in this business case for health are the most common type of communications in a business setting. This ensures that only the required members are a part of the meeting and the information is not shared outside. Meetings should mostly be a dialogue between two different parties in order to ensure maximum positive usage of the time invested in the meetings. Every person who is a part of the meeting should see to it that no miscommunication or misinterpretation takes place while a meeting is under process. (Schwartz et al.2019)

Planning meetings with all the stakeholders in order to inform them about the new techniques will be useful as they will be able to raise questions if they have any, regarding them. The meeting will also be helpful in explaining the process well to the stakeholders so that no points are left uncovered and there is a complete sharing of knowledge between the two parties.

Conference Calls: Conference calls are made when everyone is not able to be at the same place at the same time. So, in order to include everyone in the meeting, conference calls are held. This technique is used to a lot in presently to save time wasted during travel. These calls can be made by using the different paid and free applications that will allow the people to communicate with each other. Every person on the call must have a strong network connection so that there are no hitches in communications. Just like meetings, the conference calls also have people who will develop the minutes of the meeting and will send it to everyone so that everyone is on the same page once the call has ended. In case someone was not able to attend the meeting or the call, the minutes of the meeting will help them understand all the important points that were discussed and he or she can hold another conference call in case he or she has a question about the points discussed or any helpful suggestions about them. (Stacey et al.2016)

EmailsEmails are one-way communications that will explain all the information about a particular topic to the stakeholders in details. As inferred in this business case for health these emails can contain various documents like word, excel and PowerPoint presentations to communicate the ideas and information in a detailed manner and in depth. These emails are a bit risky as there will be no knowledge if everyone has read them as there won’t be any feedback for it. So, a feedback will be important to make sure everyone has read the email and there aren’t any missing stakeholders who hadn’t received the email. (Trenaman et al.2017)

8.0 Policies and Standards necessary and training processes to commence the use of Technology
The different policies and standards necessary are:

  1. Utilization standards: Limiting the use of the technology only when necessary after a written communication has been made by the doctor in charge of the patient.
  2. Safety policy: All care should be taken by the medical staff in order to ensure safety and health of the patient as long as they are a patient of the facility. All their needs should be met to ensure complete comfort of the patients so that they are all better and are comfortable with the prosthetic knee.

Training processes in order to commence the use of new technology at the facility can include:

  1. Training in batches as handling a small number of people is easier than handling many of them. The batches will ensure that there is an open communication between the trainers and the trainees. It will also make sure that all the doubts that the trainees may have about the process are cleared. Every aspect of the technology can be well understood and it will be easier for the trainer to keep a track of all the members of the batch and pay attention to their queries regarding the new technology.
  2. Trainings must take place after work hours so that the work culture is not disrupted for the facility. This will ensure that there is no shortage of staff at the facility. It will also help the trainees understand the new technology well. (Waddell et al.2017)

9.0 Conclusion
Knee replacement has been performed by different orthopaedics for a long time in order to relive patients of the constant knee pain that they experience. As inferred in this business case for health patients are mostly elderly people between the age of 50 to 80 years. With these techniques, the prosthetics will have a longer term of life and the procedure promises smaller incisions. They technology will benefit the organization as there is a promise of improved quality of life for the patients which will lead to an increase in the market value of the facility. People are always looking for facilities that promise a procedure that will reduce their pain for a longer period of time rather than a smaller one. Though there are some financial and safety risks, these can be overcome by following the safety norms and standards set by the government and other health governance bodies of the world. The financial risks as inferred in this business case for health these are high in the beginning but can be covered over the period of time with constant improvements in the services that have been provided by the facilities. The various benefits and risks regarding the new knee replacement technologies have been identified along with an evaluation of the new technology that was introduced for knee replacements. The clinical factors that the facility must be aware of while incorporating the technology were discussed with the different financial factors like the cost of the treatment, value for money and sources from which funding can be made available for the procedure. Recommendations have been in this business case for health are made based on the risk analysis and benefit analysis, and the different clinal and financial factors of the new technique of knee replacement. Health Business Case assignments are being prepared by our nursing homework help experts from top universities which let us to provide you a reliable university homework help service.

10.0 References
Amiri, A. R., Kanesalingam, K., Cro, S., & Casey, A. T. (2014). Does source of funding and conflict of interest influence the outcome and quality of spinal research?. The Spine Journal, 14(2), 308-314.

Andrawis, J. P., & Bozic, K. J. (2018). Health Policy and Financial Issues Related to New Total Knee Arthroplasty Technology. Techniques in Orthopaedics, 33(1), 7-10.

Bagaria, V., Shah, S., & Bhansali, R. (2016). Using 3D-printed Patient-optimized Surgical Tools (3D POST) for Complex Hip and Knee Arthroplasty. In Arthroplasty-A Comprehensive Review. IntechOpen.

Hawker, G., Bohm, E. R., Conner?Spady, B., De Coster, C., Dunbar, M., Hennigar, A., ... & Noseworthy, T. (2015). Perspectives of Canadian stakeholders on criteria for appropriateness for total joint arthroplasty in patients with hip and knee osteoarthritis. Arthritis & Rheumatology, 67(7), 1806-1815.

Hoffmann, T. C., & Del Mar, C. (2015). Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review. JAMA internal medicine, 175(2), 274-286.

Johnson, H. (2016). The impact of a focused factory on intraoperative cost per case in elective total knee replacement surgery. DeSales University.

Kappel, A., Blom, C. S., & El-Galaly, A. (2019). Custom-made asymmetric polyethylene liner to correct tibial component malposition in total knee arthroplasty—a case report. Acta orthopaedica, 1-3.

Kjellberg, J., & Kehlet, H. (2016). A nationwide analysis of socioeconomic outcomes after hip and knee replacement. Dan Med J, 63(8), A5257.

Leopold, S. S. (2018). Editor’s Spotlight/Take 5: 2017 Chitranjan S. Ranawat Award: Does Computer Navigation in Knee Arthroplasty Improve Functional Outcomes in Young Patients? A Randomized Study. Clinical orthopaedics and related research, 476(1), 3.

Mehta, S., Rigney, A., Webb, K., Wesney, J., Stratford, P. W., Shuler, F. D., & Oliashirazi, A. (2018). Characterizing the recovery trajectories of knee range of motion for one year after total knee replacement. Physiotherapy theory and practice, 1-10.

Namin, A. T., Jalali, M. S., Vahdat, V., Bedair, H. S., O'Connor, M. I., Kamarthi, S., & Isaacs, J. A. (2019). The Adoption of New Medical Technologies: The Case of Customized Individually Made Knee Implants. Value in Health.

Nwachukwu, B. U., Bozic, K. J., Schairer, W. W., Bernstein, J. L., Jevsevar, D. S., Marx, R. G., & Padgett, D. E. (2015). Current status of cost utility analyses in total joint arthroplasty: a systematic review. Clinical Orthopaedics and Related Research®, 473(5), 1815-1827.

Schwartz, A. J., Bozic, K. J., & Etzioni, D. A. (2019). Value-based Total Hip and Knee Arthroplasty: A Framework for Understanding the Literature. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(1), 1-11.

Stacey, D., Taljaard, M., Dervin, G., Tugwell, P., O'Connor, A. M., Pomey, M. P., ... & Hawker, G. (2016). Impact of patient decision aids on appropriate and timely access to hip or knee arthroplasty for osteoarthritis: a randomized controlled trial. Osteoarthritis and cartilage, 24(1), 99-107.

Trenaman, L., Stacey, D., Bryan, S., Taljaard, M., Hawker, G., Dervin, G., ... & Bansback, N. (2017). Decision aids for patients considering total joint replacement: a cost-effectiveness analysis alongside a randomised controlled trial. Osteoarthritis and cartilage, 25(10), 1615-1622.

Waddell, B. S., Carroll, K., & Jerabek, S. (2017). Technology in arthroplasty: are we improving value?. Current reviews in musculoskeletal medicine, 10(3), 378-387.

Wickramasinghe, N., Moghimi, H., Haddad, P., De Steiger, R., & Schaffer, J. (2015, January). Leveraging Key Aspects of Collaborative Techniques to Assist Clinical Decision Making: The Case of Hip and Knee Arthroplasty. In 2015 48th Hawaii International Conference on System Sciences (pp. 794-802). IEEE.

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