Rochelle Igrisan

Rochelle Igrisan, MBA, MSN, RN is MARCQI’s Senior Project Manager.

Established in 2012, The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), essentially focuses on hip and knee procedures, such as joint replacements and revisions of those procedures. MARCQI currently works with 60 member hospitals using clinical data to track the progress of these hospitals in improving patient outcomes related to joint surgery. Several of the quality initiatives initiated by MARCQI and utilized at participating hospitals have proven to be valuable and successful at improving patient outcomes while also reducing costs.

Optimize Use of Blood Transfusions Post Joint Replacement

By disseminating data on usage, sharing and promoting the American Red Cross (ARC) Guidelines for blood transfusions, and reviewing best practices regarding the standard for blood transfusions after joint replacement surgery MARCQI recognized the use of transfusions as an area to address among their member hospitals. The ARC guidelines suggest:

  1. Providing blood transfusions post joint replacement (unilateral) if the patient’s hemoglobin level is less than eight; and
  2. Only transfusing one unit of blood at a time and then testing the patient’s hemoglobin levels again to assess further treatment.

Following implementation of these guidelines, MARCQI member hospitals the use of blood transfusions after joint replacement decreased from 9.8% to 2.6%. This best practice has not only helped improve patient care by providing an appropriate and necessary amount of care for the patient, but has also helped reduce costs for hospitals. It has also reduced blood utilization throughout the state of Michigan allowing this precious commodity to be available for other occasions.

Improving Patient Care and Self-Management Post Joint Replacement

A second initiative MARCQI participants worked on has been geared towards decreasing the inappropriate use of skilled nursing facilities after joint replacement surgery. The majority of joint replacement patients have better post-operative outcomes if they are sent home. Thus, hospitals provided patients with guidance on how to better self-manage their condition post joint replacement. Prior to implementation of this quality initiative, about 33 to 50 percent of patients went to a nursing home following joint replacement surgery. However, after working on this initiative, only about 15 percent of patients are sent to nursing homes post joint replacement.

Other initiatives MARCQI is working on are better understanding of pain management post joint replacement, and reducing surgical site infections in post joint replacement candidates. Overall, the different quality initiatives that MARCQI has worked on has helped improve patient outcomes and save hospitals millions of dollars. In 2014-2015, MARCQI member hospitals saw a shared cost savings of $3,453,424. This cost savings goes hand in hand with helping improve patient experience and quality of care related to joint replacement surgery.

To promote hospital and CQI collaboration, MVC and MARCQI work on a Joint Replacement Workgroup together. If you are interested in learning more about MARCQI or the Joint Replacement Workgroup, please contact Deby (debevans@med.umich.edu), Abeer (abeery@med.umich.edu) or Rochelle Igrisan from MARCQI (igrisanr@med.umich.edu)