Northside Hospital Forsyth in Cumming, Georgia, reported the lowest hospital average length of stay for joint replacements in the U.S., averaging 0.64 days in 2016. The hospital also reported the lowest complication rates in Georgia and the third lowest in the nation.

The facility’s Fast Track Joint Program allows patients to experience exceptionally short hospital stays – some patients are home within four hours of surgery. Mark Hamilton, M.D., lead anesthesiologist for the program, said adopting a multimodal analgesia protocol and eliminating opioids are the keys to better outcomes.

“The protocol includes multiple modes of non-narcotic medications. Years ago, after a joint replacement, patients were loaded up with morphine. They would become drowsy but still be in pain,” Dr. Hamilton said. “They couldn’t go home because they were hurting, sedated, vomiting and breathing poorly.”

The Fast Track Joint Program relies on thorough communication between nurses, surgeons, anesthesiologists, physical therapists and others included in the patient care process. Ninety-two percent of the program’s patients go home on the same day as surgery, and 90 percent leave the hospital without receiving opioids.

Dr. Hamilton said the move away from opioids can be a difficult one, but patients will benefit from the change. Eliminating opioids lowers the risk of side effects and decreases the potential for addiction, a crisis that many patients have fallen victim to around the nation.

The Fast Track Joint Program has been so effective that Northside Hospital Forsyth has expanded the technique to additional service lines and surgeries. As of Jan. 1, 2018, the hospital implemented a system-wide protocol change, and the program recently expanded to two other hospitals in the Northside area.

Dr. Hamilton considers opioid reduction through a strong multimodal analgesia program to be a best practice – not just for joint surgeries, but for all pain management.

“Patients do well if you’ve eliminated narcotics, but you can only eliminate them if you’ve done a great job of multimodal pain management,” Dr. Hamilton said. His patients receive up to nine different medications that work in conjunction with each other to treat pain more effectively than opioids and without significant side effects.

Surgeons at Northside Hospital Forsyth are able to perform more operations each year due to improved outcomes and faster recovery times. Dr. Hamilton expects 2017 patient recovery statistics to surpass the 2016 numbers, and the hospital continues to expand the non-opioid pain management to other surgical specialties.