Outcomes REPORT 2016

Orthopedics

32

04 MESSAGE FROM THE PRESIDENT

06 INTRODUCTION

08 OVERVIEW – HOSPITAL ISRAELITA ALBERT EINSTEIN

10 OVERVIEW – EINSTEIN ORTHOPEDICS

12 LOCOMOTOR PROGRAM

16 SERVICE STRUCTURE AND VOLUME

34 CLINICAL STAFF

38 QUALITY AND CLINICAL OUTCOMES

72 PATIENT EXPERIENCE

76 EDUCATION AND SCIENTIFIC EVENTS

82 RESEARCH AND SCIENTIFIC PRODUCTION

88 SOCIAL RESPONSIBILITY

90 BRAND DISSEMINATION AND MANAGEMENT

92 STAFF & CONTACT INFORMATION

List of Contents

4

Message from the President

Defined as a strategic area for Einstein

for almost a decade, Orthopedics has

been reinforcing year after year its capacity

to incorporate practices and processes of

excellence that fuel quality of care and patient

safety. In addition, it has emphasized its vocation

to break with barriers and create new paradigms,

such as the Spine and Cranial Maxillofacial

programs, which are based on transparent,

qualified and ethical assessments that contribute

to prevent unnecessary surgeries. Similarly to

its clinical achievements, our Orthopedics has

also given attention to knowledge generation

and dissemination by adopting teaching

and research activities together with social

responsibility actions.

This report brings information and indicators

about all these dimensions. Internally, we use

these data as a management tool to guide our

improvement processes. However, we also think

they are of interest to people from outside the

organization. By transparently and broadly

sharing them, we provide to physicians, patients

and other stakeholders objective information

to guide their choices and decisions. Moreover,

by showing the path we have taken we want to

inspire other professionals and organizations to

follow along, disseminating these practices of

excellence throughout the country.

Counting on a highly qualified clinical staff,

specialized multidisciplinary teams to treat

orthopedic patients, advanced technological

resources, protocols and procedures constantly

reviewed and integrated with the remaining

areas of the organization, Einstein orthopedics

has been yielding increasingly positive results.

You can confirm that by checking the outcome

indicators, quality and safety data contained in

this report. At the same time, we have reduced

the average length of stay, which benefits

the patient, reduces costs and the risk of

complications, in addition to providing better

bed management by the organization.

Our Orthopedics area has also stood out in

research, by being entitled to funding for three

major projects and constantly increasing its

number of publications (25 in 2016). Concerning

teaching, resident physicians and graduate

students have completed their courses. The area

has also held events such as the 1o Simposio de

Coluna (1st Spine Symposium), which attracted

a significant number of participants interested in

learning about our protocols and other relevant

aspects of the Spine Program.

Concerning social responsibility, numbers mean

more than a thousand words: in 2016, there

were over 8,400 orthopedic visits at Hospital

Municipal Dr. Moyses Deutsch - M’Boi Mirim,

which amounts to 25% of the total volume of

outpatient visits in the year.

It all confirms that our Orthopedics Area is

permanently committed to building qualified

and sustainable care, aligned with the pillars

of Triple Aim Initiative, from the Institute

for Healthcare Improvement (IHI): improved

quality of care, lower costs and promotion of

population health.

The area of Orthopedics has been confirming its capacity to incorporate practices and processes of excellence; in addition, it has emphasized its vocation to break with barriers and create new paradigms, such as the Spine and Cranial Maxillofacial programs.

Sidney Klajner, MDPresident of Sociedade Beneficente Israelita Brasileira Albert Einstein

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6

Introduction

2016 was a year of important breakthroughs for

the areas of Orthopedics and Rheumatology

at Einstein. The launch of innovative initiatives

at the Locomotor Program, continuous

improvement of our guidelines and evidence-

based protocols that ensure better care to

patients, the actions that provide smart use of

resources to optimize costs, and the investments

in new technologies are examples of the advances

that have consolidated Einstein as a reference in

orthopedics.

In our journey, we have been leading transforming

and inspiring initiatives. Seven years ago, we

successfully launched the Spine Program, a

second opinion program for patients who

have indication for surgical treatment of spine

conditions: the analyzed cases have shown that

almost half of the patients could benefit from

conservative treatment. Based on this very

successful model, we have launched the Cranial

Maxillofacial Program, offering a second opinion

for the treatment of orthognathic pathologies,

temporomandibular joint diseases and sleep

apnea, based on the multiprofessional assessment

of at least two surgeons from the specialty and

the best scientific evidence. Our results are quite

surprising: within one year of activities, we have

noticed that 90% of the patients who had surgical

indication and came to ask for a second opinion

could benefit from conservative treatment, which

is less aggressive and more affordable.

Constantly trying to bring together quality,

effectiveness and sustainability, we have also

promoted in 2016 the standardization of materials

used in spine, oral maxillofacial, arthroplasty and

arthroscopy procedures. In this process, we could

focus on the best available implants in the world,

reducing the number of suppliers. In other words,

standardization means efficient management of

materials and favors the patients, who can have

high-quality implants.

We have maintained our investment in

technology. The highlight in 2016 was the

acquisition of an endoscope used in

minimally-invasive spine procedures

that combine efficiency, safety and

quicker recovery of patients. Thus, our

Spine Center has all existing surgical

resources available in the market.

As important as any of the actions

mentioned above, we have yielded

results from the use of protocols and

procedures that impact quality of care

and patient safety. This report brings

many outcome indicators that confirm

our alignment with the international

benchmark. One of them is the low

surgical site infection rate in orthopedic

procedures. In 2016, the rate was 0.17 –

even lower than in previous years (0.4

in 2014 and 0.3 in 2015). Just to take it

into perspective, the literature indicates

world infection rates in orthopedic

surgeries ranging from 1 and 2.5%.

This publication also presents the

information that showcases our

vitality in teaching, research and

social responsibility activities. Seen

as a whole with our clinical activities,

they show that we have set a virtuous

cycle in orthopedics, adding value to

our patients, the society and medical

practice, helping to pave the future of

orthopedic medicine.

We hope you enjoy the reading.

Mario Ferretti, MDMedical Manager of the Locomotor Program, Hospital Israelita Albert Einstein

This report brings many outcome indicators that confirm our alignment with the international benchmark. One of them is the low surgical site infection rate in orthopedic procedures.

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OverviewHospital Israelita Albert Einstein

2.7% Increase in number of

outpatient visits

6.6% Increase in number

of credentialed physicians at

Einstein

16.5% Increase in performed

surgical procedures

Hospital Israelita Albert Einstein

Medicina Diagnóstica

e Ambulatorial (Diagnostic

and Outpatient Medicine)

Instituto Israelita de

Ensino e Pesquisa (Teaching and

Research)

Instituto Israelita de

Responsabilidade Social (Social

Responsibility)

Instituto Israelita de Consultoria

e Gestão (Consulting

Management)

Einstein facts and figures 2015 2016 Variation %

Number of operational beds 615 646 5.04%

Number of ICU beds (Adults) 44 40 -9.09%

Number of patients/ day 196.726 185.949 -5.48%

Mean length of stay (in days) 3.91 3.51 -10.23%

Occupancy rate 84.86% 82.57% -2.70%

Hospital Discharges Total - Morumbi

- Vila Mariana- Perdizes-Higienópolis

53,25253,128

1195

52,97552,969

06

-0.52%-0.30%

-100.00%20.00%

Surgical procedures Total - Morumbi

- Perdizes-Higienópolis

43,77842,262

1,516

51,03148,520

2,511

16.57%14.81%

65.63%

Deliveries 4,669 4,295 -8.01%

Tests Total- Morumbi

- Alphaville- Jardins

- Ibirapuera- Perdizes-Higienópolis

- Cidade Jardim

7,711,1106,248,813443,283448,349570,665714,26734,387

7,060,1255,565,717

408,127450,746635,535674,643

37,651

-8.44%-10.93%-7.93%0.53%11.37%

-5.55%9.49%

Visits (Outpatients) Total- Morumbi

- Alphaville- Perdizes

304,517242,098

46,33216,087

313,001242,893

49,35220,756

2.79%0.33%6.52%

29.02%

ED Visits Total- Morumbi

- Centro Médico Ambulatorial (CMA)

- Oncologia- Alphaville- Ibirapuera

- Perdizes-Higienópolis

331,504130,977

1,582458

55,42282,35060,715

335,667131,135

1,092703

55,72786,251

60,759

1.26%0.12%

-30.97%53.49%

0.55%4.74%0.07%

Number of credentialed physicians:Staff (hired employees)

7,73512,755

8,25212,929

6.68%1.36%

Hospital Israelita Albert Einstein is a not-for-profit general hospital focused on high complexity and capable of covering all healthcare dimensions: promotion, prevention, diagnosis, treatment and rehabilitation.

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10

9,098 hospital

discharges

39,294 orthopedic

medical visits

8,930 orthopedic surgeries

performed in 2016

OverviewEinstein Orthopedics

Surgical specialty

Surgical procedure 2015 2016 Variation %

Bucomaxillofacial Surgery

Bucomaxillofacial Surgery 1,370 923 -33%

Maxillary sinusectomy – endonasal access 456 743 63%

Videolaparoscopic intranasal ethmoidectomy 503 658 31%

Intranasal ethmoidectomy 278 623 124%

Videolaparoscopic sphenoidal sinusotomy 306 391 28%

Intranasal maxillary anthrostomy 228 462 103%

Sphenoidal sinusotomy 216 464 115%

Intranasal frontal sinusotomy 173 454 162%

Videolaparoscopic intranasal frontal sinusotomy 232 297 28%

Videolaparoscopic intranasal maxillary anthrostomy 165 151 -8%

Videoendoscopic endonasal maxillary sinusectomy 162 111 -31%

Transmaxillary sinusectomy (Ermiro de Lima) 45 79 76%

Orthopedics and Traumatology

Diagnostic arthroscopy with/ without synovial biopsy

291 369 27%

Tenolysis of osteofibrous tunnel 147 203 38%

Surgical debridement of wounds or extremities 220 129 -41%

Transposition of more than 1 tendon – surgical treatment

130 200 54%

Single microneurolysis 110 190 73%

Arthroplasty (any technique or hip version) - surgical treatment

113 144 27%

Tenoplasty/ tendon grafting – surgical treatment 111 119 7%

Segmented percutaneous rhizotomy – any method 101 116 15%

Fracture and/or dislocation (including elbow-wrist epiphyseal detachment) - surgical treatment

80 107 34%

Osteotomy or pseudoarthrosis of metatarsus/ phalanges – surgical treatment

83 96 16%

NUMBER OF ORTHOPEDIC SURGERIES – KEY PROCEDURES

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Locomotor Program

The Locomotor Program is a strategic area focused on orthopedics and rheumatology that

works in matrix with all clinical areas of Hospital Israelita Albert Einstein, Medicina Diagnostica e

Ambulatorial (Diagnostic and Outpatient), Instituto Israelita de Ensino e Pesquisa (Teaching and

Research), Instituto Israelita de Responsabilidade Social (Social Responsibility), Instituto Israelita

de Consultoria e Gestão Corporativo (Consulting Management). Its main goal is to manage

orthopedics in all its arenas by means of designing and implementing institutional protocols,

control of indicators, and strategic plans that promote growth and continuous improvement,

in addition to managing innovative projects, such as the second opinion program for spine and

cranial maxillofacial surgery.

The actions of the Locomotor Program are guided to patient quality and safety, management of

the clinical staff, social responsibility and sustainability, teaching, research and innovation.

FLOW CHART OF LOCOMOTOR PROGRAM 2016

Dr. Mario Ferretti

Medical Manager

Dr. Mario Lenza

Medical Coordinator

Gerusa Silva

Administrative technical assistant

Thais Rosa

Administrative technical assistant

Renata Lima

Administrative technical assistant

Vanuza de Oliveira

Administrative technical assistant

Isabela Paião

Nurse

Luciana Machado

Nurse

Eliane Antonioli

Researcher

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Timeline

• Management of

hip protocol

• Management

of knee

protocol

• Spine

Excellence

Center

• Opening of

orthopedic

offices

• Implementation

of Locomotor

Program

• Standardization

of spine materials

• Medical Residency

Program

• Multidisciplinary

Graduate Program

• Spine Guidelines

• Cranial Maxillofacial

Project

• Foot Center

• Design of the Spine

Protocol and Manual

• Home Care Program

for Total Knee

Arthroplasty (TKA)

• Outcomes for TKA

• Anterior cruciate

ligament (ACL) protocol

• Beginning of

management of ACL

• Interruption of

prophylactic

antibiotics within

24 hours for TKA

and THA (Total Hip

Arthroplasty)

• Outpatient flow

for simple knee

arthroplasty

• Beginning

of Cranial

Maxillofacial

Project

• Management and

standardization

of materials (oral,

spine, arthroplasty

and arthroscopy)

• Actions to

prevent infections

in orthopedic

surgeries

• Acquisition of

the new spine

endoscopy

2007 2008 2009 2010 2011 2012 2013 20152014 2016

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Service Structure and Volume

HOSPITAL ISRAELITA ALBERT EINSTEIN ORTHOPEDICS

Different areas of the Hospital are important for the diagnosis and care of orthopedic patients.

The main ones are:

1. Emergency Department

2. Medical offices

3. Diagnostic and Outpatient Care

4. Rehabilitation Center Gisele and Jacques Szlezynger

5. Operating Suite and Day Clinic I4

6. Inpatient unit – 11th floor, Building A

1. EMERGENCY DEPARTMENT

The Emergency Department is ready to provide comprehensive and high-level

care to patients with orthopedic trauma disorders. It has an orthopedic backup

team that is frequently trained and updated to promote the best care to patients.

The units are divided into strategic sites, such as Morumbi, Perdizes, Alphaville

and Ibirapuera.

Medication room, Emergency Department

Central nursing station

Mobile unit to transfer urgency and emergency patients

Care provided in the mobile unit during transfer of urgency and emergency patients

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18

Number of orthopedic visits per Emergency

Department Unit

9,47210,210

9,313

3,9804,0263,302

4,6794,826

5,948

18,69618,190

16,786

UPA Morumbi UPA Ibirapuera UPA Alphaville UPA Perdizes

2014

2015

2016

2. ORTHOPEDIC MEDICAL OFFICES – 3RD FLOOR BUILDING A1

The Outpatient Medical Center has seven rheumatologists and 48 orthopedists in all

orthopedic subspecialties, such as spine surgeons, shoulder and elbow, hand, hip, knee,

foot and ankle surgeons, in addition to trauma and pediatric orthopedic surgeons.

The Orthopedics Program has proposed to the clinical staff and the orthopedic medical

board to create groups of subspecialties. These groups develop protocols and guidelines

for diagnosis and treatment, promoting discussion of clinical cases and standardizing

case management, in addition to helping with the training of Orthopedics and Trauma

resident physicians at Einstein. Medical office at the Outpatient Center

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20

Procedure room at the Outpatient Center

2009

22,471

2011

40,724

2010

30,735

2013

43,564

2014

43,610

2015

43,117

2012

42,900

2016

39,294

Number of orthopedic visits – Unit Morumbi

Number of orthopedic visits – Unit Morumbi

Orthopedic visits have reached a plateau, stabilized due to the pre-defined occupancy.

However, as shown in the chart below, the orthopedic visits represent a number of about

40,000 visits per year in the Outpatient Medical Center.

3. DIAGNOSTIC MEDICINE

The Outpatient and Diagnostic Medicine team at Einstein works in an integrated

fashion and uses latest generation equipment, providing medical follow up and all

imaging and laboratory tests. Einstein has many units around the city of Sao Paulo

and in Alphaville.

X-RAY

X-ray is a test that exposes part of the body to a small amount of ionizing radiation

to produce images from inside the body. It is used to assess bone abnormalities,

to detect foreign objects, assess lesions such as fractures or damage caused by

infections, arthritis, abnormal bone growth or osteoporosis, to guide orthopedic

surgeries, such as vertebral spine repairs, joint replacements or fracture reductions,

to determine if there is fluid buildup in the joint and around the bone, to ensure

that a fracture has correctly healed and to check whether a bone is fractured or a

joint is displaced.

Patient submitted to hip x-ray

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COMPUTED TOMOGRAPHY SCAN

Computed tomography scan (CT) is a diagnostic method that uses x-rays to take images from

different parts of the body. However, differently from conventional x-rays, which take a panoramic

view of part of the body to be studied, CT scan acquires sliced sections of our body. These sections

are disposed on the computer screen and then photographed. Thus, CT scan technology produces

much clearer images than conventional x-ray.

Computed tomography device

Ultrasound device

MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI)

is a test that portrays our organs

in high-definition images, through

the use of a magnetic field.

One of the differentials of the test

is the capacity to visualize the

so-called soft tissues. The technique

is especially effective in the diagnosis

of muscle, tendon and ligament

diseases. The test is capable of

tracing disorders by scanning the

anatomy of the internal structures.

To reach such level of preciseness,

the technology is one of the most

complexes among imaging tests.

ULTRASOUND

Ultrasound (US) provides the assessment of traumatic lesions in soft parts, such as

muscles, tendons and ligaments, as well as the characterization of occult fractures

and foreign bodies. It is a method that does not use any type of radiation and does

not have side effects.

Being dynamic, the ultrasound enables the examiner to reach additional information

about muscle or tendon tears by asking the patient to make flexions or extension of

the joint. The physician may observe the behavior of the damage in movement.

Magnetic resonance device

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4. REHABILITATION CENTER GISELE AND JACQUES SZLEZYNGER

The Rehabilitation Center Gisele and Jacques Szlezynger at Einstein was

opened in May 2013, being a pioneer in the integration of this type of service

in a high-complexity general hospital. To present, it is a national reference

in rehabilitation. Housed in a pleasant 2,000 m2 area, the center has latest

generation devices and a highly qualified team. There are 119 professionals,

being 16 physical therapists and three occupational therapists.

Orthopedic rehabilitation focuses on musculoskeletal dysfunctions such as

vertebral spinal diseases, joint sprains, muscular damage and postoperative

care after orthopedic surgeries, among other chronic, recurrent or acute

diseases. Physical therapy has the role to control pain and restore the

impaired function, in addition to educate the patient about care and

precautions to be taken in daily living activities and sports practice.

Orthopedic care has been continuously growing and in 2016 it showed 4% increase

compared to 2015. This progress is an indication of the commitment and quality of

the care provided.Gymnasium of the Rehabilitation Center

Stationary bikes at the Rehabilitation Center

2011

20,611

2012

22,264

2013

24,438

2014

27,121

2015

34,156+4%

2016

35,655

Number of visits

HIGH TECHNOLOGY QUALITY EQUIPMENT

Stationary bikes equipped

with monitoring

The bikes simulate

movements but do not

cause impact on joints,

muscles and tendons,

favoring the execution of

physical activities in people

with joint problems.

The benefits include easier

limb movement, improving

blood circulation and

strengthening lower limb

muscles.

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Gait trainer

The device provides safe functional gait

training. Using a hanger, it enables early

gait practice, with no risk of fall.

The purpose of the equipment:

• Provide early orthostatic position;

• Improve symmetry of the right and

left step;

• Improve the pace of the gait;

• Improve symmetrical weight bearing

on the lower limbs;

• Useful in rehabilitation of lower

limb surgeries, such as hip and knee

surgeries.

Equipment in the gymnasium of the Rehabilitation Center Swimming pool for hydrotherapy at Rehabilitation Center Gisele and Jacques Szlezynger

HYDROTHERAPY

It is an extremely

relevant therapeutic

resource to treat many

diseases, including

musculoskeletal

disorders, and can be

used in many subareas

of physical therapy.

Applied in a warm pool,

hydrotherapy intends

to prevent diseases,

promotes and maintains

health, treat, cure and

rehabilitate functional

muscle disorders and reintegrates the subject back into society by using specially

developed techniques.

The artificial structure that houses the water reservoir and the attached areas

provides to patients and professionals the appropriate working conditions,

hygiene, accessibility, comfort and safety, which favor logical, reliable and

efficient outcomes. Therapeutic exercises in the swimming pool minimize

problems resulting from several physiological, mechanical and psychological

alterations and transformations.

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LEME – MOVEMENT STUDY LABORATORY

LEME – Laboratorio de Estudo do

Movimento Einstein (Einstein Movement

Study Laboratory) was devised to measure

and describe gait. Infrared cameras,

strength platforms, reflective markers,

electromyography and software are offered

as part of the advanced technology used by

Leme. The technology provides the precise

analysis of movement, identifying possible

abnormalities and facilitating the diagnosis

and treatment of patients with gait disorders

or neurological problems.

The process of movement analysis starts

from orthopedic and neuromuscular physical

examination of the patient, followed by

5. OPERATING SUITE AND DAY CLINIC I4

Einstein Surgical Unit has two Operating Suites and Central Sterilization and

Supplies Departments located in separated areas. The Operating Suite works 24

by 7 and has material available for the performance of all procedures, including

emergency situations, which enables performance of high complexity surgeries

with quality and safety.

OPERATING SUITE OF PAVILION VICKY AND JOSEPH SAFRA – BUILDING A1

The set of biomedical clinical engineering resources provides the performance of

imaging-guided minimally invasive surgeries, combined or not with conventional

procedures, in addition to enabling treatment and diagnosis to be performed

simultaneously. There are 18 surgical rooms and nine of them have video for

arthroscopic surgeries.

The same area houses Day Clinic I4, intended for minor surgery patients. There is

a considerable number of orthopedic surgeries performed as an outpatient flow.

Between April and May 2015, we started the outpatient flow for simple knee

arthroscopy. Well-accepted by physicians, the action generates faster flow to

patients, who start the process of rehabilitation in the anesthetic recovery room.

Percentage of compliance with the outpatient flow for

simple knee arthroscopy

0%

Jan/1

5

0%F

eb

/15

0%M

ar/

15

25%

Beginning of outpatient flow

Ap

r/15

0%

May

/15

33%

Jun/1

5

20%

Jul/

15

69%

Aug

/15

50%

Sep

/15

65%

Oct

/15

43%

No

v/15

90%

Dec/

15

67%

Jan/1

6

71%

Feb

/16

100%

Mar/

16

88%

Ap

r/16

73%

May

/16

67%

Jun/1

6

50%

Jul/

16

67%

Aug

/16

83%

Sep

/16

100%

Oct

/16

93%

No

v/16

70%

Dec/

16

weight and height measures and placement of

markers and/or electrodes on the skin.

While the patient walks along the laboratory

track, a video recording is made for

observational analysis. Simultaneously, the

computer documents kinematic, kinetic and

dynamic electroneuromyography data. The

process is monitored by a biomechanical

specialized engineer, which starts data

processing.

This study guides technical corrections for

specific sports, such as running, in addition

to indicating surgeries for patients with

cerebral palsy, recommending the muscle

groups that require surgical repair.

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Hybrid Room

The Hybrid Room at

Hospital Israelita Albert

Einstein spreads on 180m2

and combines state-of-

the-art technology that

provides the performance

of high complexity

procedures, in addition to

having imaging devices

for minimally invasive

techniques done with

maximum precision and

high level of safety.

OPERATING SUITE ON THE 5TH FLOOR - EDIFICIO MANOEL TABACOW HIDAL – BUILDING D

This Operating Suite has 14 rooms, equipment for all specialties, including trauma and orthopedic

procedures

The chart above shows the stabilization of high complexity surgeries, such as hip,

knee and shoulder arthroplasty, spine fusion and other major surgical procedures

that require the use of medical and hospital resources, braces, implants and special

materials.

In 2016, there was 30% increase in number of orthopedic surgeries performed at Unit

Morumbi, compared to the previous year.

2012

4,991

2013

4,846

2014

4,820

2015

6,594

2016

8,558

Number of surgical procedures – Unit Morumbi

2010 2011

29%

42%

2012

36%

2013 2014

60%64%

2015

65%

2016

68%

Rate of high complexity procedures

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At Unit Perdizes, there has also been increase in number of surgeries. This advance

results from the strategic location of the unit and the availability of schedule and

resources.

Spine and tumor surgeries amounted to most of the 31% increase in surgical volume.

In 2016, the number of orthopedic surgeries in both units showed 31% increase

compared to 2015.

2012

2012

217

5,208

2013

2013

217

5,063

2014

2014

207

5,027

2015

2015

227

6,821

2016

2016

372

8,930

Number of surgical procedures – Unit Perdizes Number of surgeries by subspecialty – Unit Morumbi

Number of surgical procedures – Units Morumbi and Perdizes

6. INPATIENT UNIT – 11TH FLOOR, BUILDING A

The Orthopedic Inpatient Unit is located on the 11th floor of Building A, with 36 beds,

two nursing stations and a reception area. The multiprofessional team is formed by 23

registered nurses, 35 nursing technicians, 10 nursing assistants, 13 physical therapists,

one psychologist, one dietitian and one pharmacist.

Nursing station of the Orthopedic Inpatient Unit Room of the Orthopedic Inpatient Unit

110211229

299

478536

807911

1,116

157259

579

388

552522

941

1,4471,370

1,015

225

1,0201,001

451325

771923

1,458

Knee Shoulder OthersWrist and hand

Ankle and foot

HipTrauma Spine Tumor

2014 2015 2016

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Clinical Staff

The Clinical Staff of Orthopedics and Rheumatology is comprised of 673 physicians, divided into 604 orthopedists, 45 rheumatologists and 24 physiatrists.

Measuring a set of criteria comprised of over 70 indicators, there is constant assessment

of the physicians in the Clinical Staff.

These criteria are distributed into four main pillars: Quality, Volume of Care, Teaching

and Research and Social Responsibility and the physicians can check them by clicking

on “My Outcomes” (Meus Resultados).

QUALITY

• Completion of medical records;

• Compliance with protocols and clinical

practices;

• Continuing Medical Education (CME);

• Relationship Survey (Multiprofessional

team);

• Medical Occurrences (complaints and

compliments made to the Customer

Care);

• Compliance with administrative routines

(discharge, surgery cancellation, first

surgical time, length of stay in managed

procedures, clinical pre-scheduling).

TEACHING AND RESEARCH

Indicator from Instituto Israelita de

Ensino e Pesquisa (Teaching and

Research)

• Participation in research, teaching and

training activities at SBIBAE.

VOLUME OF CARE

• Encounters (admissions and tests);

• High complexity encounters;

• Time of credentialing at Hospital

Israelita Albert Einstein;

• Exclusive credentialing at Hospital

Israelita Albert Einstein;

• Internal referrals at Hospital Israelita

Albert Einstein.

SOCIAL RESPONSIBILITY

Participation in voluntary/ non-paid

activities:

• Non-paid admissions and surgeries;

• Transplant, Cardiology and Neurology

programs;

• Medical Boards;

• Page Epoca;

• Support to digital media.

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MEDICAL INDICATOR

Einstein has a Medical Indicator, developed based on merit criteria.

This is also a tool to encourage the adoption of best practices and the

involvement with the organization.

Access to Medical Indicator can be made through the website www.

einstein.br or the Call Center (55 11) 2151-1233.

The Orthopedics Medical Indicator includes pediatric, shoulder and

elbow, hip, knee, foot, hand, spine and general orthopedics and trauma

specialists.

Based on the score of these pillars, the physicians are classified into the segmentation

Premium, (AAA), Advanced (A), Evolution (B), and Special (C). In 2016, we had 37 Premium

(AAA), 66 Advance (A), 154 Evolution (B) and 416 Special (C) professionals.

We maintain close relationship with our Clinical Staff through meetings of

subspecialties, breakfasts, clinical meetings, medical residency programs, orthopedic

and rheumatology forums and feedback sessions.

Focusing on continuous improvement of processes and excellence in quality, since 2008

we have had medical feedback sessions in partnership with Medical Quality and Health

Economics. It promotes in-person meetings between physicians and the team members

of Medical Quality, Health Economics and Locomotor Program, in order to provide

information about their practice in the organization.

In 2016, we carried out 100% feedback sessions in the Spine Program and 100%

feedback sessions for physicians involved in the managed protocols of hip and knee

arthroplasties.

Evolution of the Medical Segmentation

5680

66

154171

154

279

362

416

29 27 37

Premium (AAA) Advance (A) Evolution (B) Special (C)

2014

2015

2016

37

38

Quality and Clinical Outcomes

MANAGED PROTOCOL OF HIP ARTHROPLASTY

Since 2008, the Locomotor Program has managing patients submitted to

hip arthroplasty. The objective is to ensure safety and quality, in addition

to monitor their progression during pre, intra and post-hospital care.

The protocol has been designed and reviewed by orthopedists, nurses,

physical therapists and occupational therapists, based on best practices

and literature evidence.

NUMBER OF HIP ARTHROPLASTY SUGERIES

In 2016, the volume of total hip arthroplasty has been stable, confirming

the surgical complexity of orthopedics and evidencing the reflexes of

population aging.

2010 2011

107

132

2012

144

2013 2014

189182

2015

187

2016

179

Surgical volume – Hip Arthroplasty

Epidemiology – Distribution of patients that have undergone hip

arthroplasty by age range in 2016

31.4%

0.5%

59.1%

9.1%

0-25 years

26-45 years

46-65 years

>65 years

39

40

Rate of antibiotic administered up to 60 minutes before

surgical incision – Hip Arthroplasty

MEAN LENGTH OF STAY

As a result of pre and post-operative home care visits to patients, the mean length

of stay is decreasing, still maintaining safety and quality of care, following the

example of what happens in Europe and the United States.

Patients eligible to undergo total hip arthroplasty are visited by the Home Care

team before the procedure to help them adapt their houses and for general

education. After hospital discharge, the same team makes two other visits to

ensure the necessary general care required for patient recovery.

PROPHYLACTIC ANTIBIOTIC INDICATOR

This indicator is divided into three items: antibiotic administered up to 60 minutes

before the incision, choice of correct prophylactic antibiotic, and suspension of

antibiotic within 48 hours.

This is an extremely important indicator because it refers to infection prevention.

Efficacy of prophylaxis is directly related to correct choice and mode of

administration of the medication (which should be performed within 60 minutes

before surgical incision to ensure the peak concentration of the antimicrobial

agent at the time the tissues are exposed).

In 2015 and 2016, the Locomotor Program proposed discussions about the topic

and promoted an active action of the nurses and pharmacists of the inpatient

units close to patients that were submitted to surgery. As a consequence, almost

all surgeons comply with prophylactic measures against postoperative infection.

2010

2010

2011

2011

6.19

92%

6.25

84%

2012

2012

5.69

98%

2013

2013

2014

2014

5.12

98%

4.23

96%

2015

2015

3.79

98%

2016

2016

3.52

99%

Rate of correct antibiotic – Hip Arthroplasty

2010 2011

92%100%

2012

100%

2013 2014

100% 100%

2015

100%

2016

100%

Mean length of stay – Hip Arthroplasty

41

42

In 2015, the team adopted the recommendation to interrupt prophylactic antibiotic

within 24 hours after the first dose, as the antibiotic has no additional role to play

and its continuous use increases the risks of medication-resistant microorganisms.

Rate of prophylactic antibiotic interruption within 48 hours

– Hip Arthroplasty

Rate of prophylactic antibiotic interruption within 24 hours

– Hip Arthroplasty

2011

19%

2012

65%

2013

96%

2014

95%

2015

98%

2016

100%

2015

57%

2016

92%

INFECTION RATE

The surgical site infection rate is an important indicator. Orthopedics has focused on

reducing the risks of infection and adopting the appropriate antibiotic for prophylaxis,

which provides more safety to patients.

The annual mean rate of infection in total hip arthroplasty at Einstein is 0.6%, lower than

the world literature1.

1. Pruzansky JS, Bronson MJ, Grelsamer RP, Straus E, Moucha CS. Prevalence of modifiable surgical site infection risk factors in hip and total knee arthroplasty. ARD Online First, 2011, 10.1136/ard.2010.148726.

COMPLIANCE WITH VENOUS THROMBOEMBOLISM PREVENTION PROTOCOL

Deep venous thrombosis is the obstruction of deep veins by a thrombus (blood clot)

and its most severe complication is pulmonary embolism, which may cause respiratory

and circulatory difficulties and may even lead to cardiac arrest. Among the risk factors

for thromboembolism we may include reduced mobility, prolonged surgical time and

age older than 45 years. In general, these conditions are presented by hip arthroplasty

patients. However, as an intra-hospital practice, we use the prevention protocol, which

has shown good compliance.

READMISSION RATE WITHIN 30 DAYS

The low rate of readmissions shows that the quality of care at Einstein contributes to

good patient outcomes.

Rate of compliance with venous thromboembolism protocol

– Hip Arthroplasty

2010 2011

98% 98%

2012

97%

2013 2014

99% 99%

2015

100%

2016

100%

Readmission rate within 30 days – Hip Arthroplasty

2010 2011

0.0%0.8%

2012

0.7%

2013 2014

0.5% 0.5%

2015

1.0%

2016

0.6%

43

44

OUTCOMES OF HIP ARTHROPLASTY PATIENTS

In partnership with Einstein Outcomes Center, the Locomotor Program follows

up patients after hospital discharge. The patients answer questionnaires before

the admission and, after discharge, they receive periodic calls to answer the same

questionnaires in order to analyze their progression and possible complications

throughout the years. There are two questionnaires that are used to monitor

patients submitted to total hip arthroplasty: EuroQoL and Womac.

EuroQoL is a simple and general questionnaire, comprised of two main

components. The first one defines health-related quality of life (HR-QoL) in five

dimensions: mobility, self-care, usual activities, pain/ discomfort and anxiety/

depression. The second component consists of a numbered Visual Analog Scale

(VAS) ranging from 0 to 100, in which zero is the worst imaginable health status

and 100, the best.

WOMAC

The Western Ontario and McMaster Universities (Womac) is a functional scale of

affected joints and it assesses intensity of pain, rigidity and functionality grade.

We have observed significant improvement after two years of follow up (the lower

results indicate the better outcomes).

Pre 30 days

0.439

650.721

78

60 days

0.802

82

90 days 6 months

0.826

82

0.839

83

1 year

0.844

84

2 years

0.82784

Quality of Life

EQ-5D

Visual Analog Scale

MANAGED PROTOCOL OF KNEE ARTHROPLASTY

The knee arthroplasty protocol was implemented one year after the success of the hip

protocol, following the same assumptions.

2010 2011

69

88

2012

81

2013 2014

106 104

2015

109

2016

84

Surgical Volume - Knee Arthroplasty

Pre 30 days

46.1

27.9

60 days

19.6

90 days 6 months

14.811.6

1 year

10.6

2 years

9.9

WOMAC

BETTER

45

46

Distribution of patients who have undergone Knee Arthroplasty by

age range up to 2016

0-25 years

26-45 years

46-65 years

>65 years28.4%

0.6%

68.5%

2.4%

MEAN LENGTH OF STAY

The mean length of stay has been decreasing gradually, which improves intra-hospital

care and enables the patient to quickly resume daily activities.

In 2014, we started Einstein Home Care Program for patients submitted to total knee

arthroplasty (TKA). It has helped reduce length of stay and maintain safety and quality

of care, following the example of the best hospitals abroad. The process is the same

that has been adopted by patients submitted to hip arthroplasty (see page 40).

RATE OF PROPHYLACTIC ANTIBIOTIC

Similarly to the previous year, the rate of antibiotics administered up to one hour

before surgical incision reached 99%. Equally expressive are the rates of correct

antibiotic and interruption within 48 hours after the procedure, which reached 100%.

2010

2010

20102011

2011

2011

6.21

99%

100%5.96

71%

92%

2012

2012

2012

5.95

91%

93%

2013

2013

20132014

2014

2014

4.90

99%

100%

4.06

98%

100%

2015

2015

2015

3.96

99%

100%

2016

2016

2016

3.94

99%

100%

Mean length of stay – Knee Arthroplasty

Rate of antibiotic up to 60 min before surgical incision –

Knee Arthroplasty

Rate of correct antibiotic prophylaxis – Knee Arthroplasty

47

48

Rate of prophylactic antibiotic interruption within 48 hours

– Knee Arthroplasty

Rate of antibiotic prophylaxis interruption within 24 hours

– Knee Arthroplasty

2015

45%

2016

88%

2010 2011

45%51%

2012

56%

2013 2014

86%

95%

2015

100%

2016

100%

COMPLIANCE WITH VENOUS THROMBOEMBOLISM PREVENTION PROTOCOL

For two consecutive years, the compliance rate with this protocol has reached

100%, preventing deep venous thrombosis and its complications (see explanation

on page 43).

READMISSION RATE WITHIN 30 DAYS

In 2016, there was no case of readmission within 30 days after hospital discharge.

2010 2011

100%93%

2012

99%

2013 2014

99% 99%

2015

100%

2016

100%

Rate of compliance with venous thromboembolism

protocol – Knee Arthroplasty

Rate of readmission within 30 days – Knee Arthroplasty

2010 2011

0%

4%

2012

0%

2013 2014

2%0%

2015

0.9%

2016

0%

49

50

OUTCOMES OF KNEE ARTHROPLASTY PATIENTS

In partnership with Einstein Outcomes Center, the Locomotor Program follows

up patients after hospital discharge. The patients answer questionnaires before

the admission and, after discharge, they receive periodic calls to answer the same

questionnaire in order to analyze their progression and possible complications

throughout the years.

Visual analog scale (VAS) - Pain

Direct measuring technique that gives the patient the chance to score pain (0 means

total absence of pain and 10 represents the worst possible pain).

Utility - EuroQol

As explained before, one of the components of EuroQoL is the questionnaire that

assesses quality of life.

KOOS - Knee injury and Osteoarthritis Outcome Score

KOOS is directed to patients with knee lesions, such as osteoarthritis, meniscal

lesions, anterior cruciate ligament lesion, among others. It has five subscales: pain,

symptoms, daily living activities, sports and quality of life related to the knee. The

answers are standardized and each question is given a score from 0 (extreme

symptoms) to 100 (no symptoms).

Pre

6

6 months

2

1 year

1

2 years

2

Pain Visual Analog Scale – Knee Arthroplasty

BETTER

Pre

0.495

6 months

0.801

1 year

0.871

2 years

0.867

Quality of Life – Knee Arthroplasty

BETTER

KOOS

Pain

49

8186 87

56

8388

91

47

7983

90

21

2834

56

22

6872

77

Symptoms Daily living activities

Sports Quality of life related to the knee

Pre

6 months

1 year

2 years

HOME CARE PROJECT The Locomotor Program, in partnership with the Home Care area, has implemented a

pre and post-surgical home visit to ensure safe discharge from hospital. The project

started in 2012, with hip arthroplasty and, in 2014, we started the action with knee

arthroplasty. Both specialties experienced very positive results.

The charts that follow show that length of stay was shorter for patients who received

visits before the surgery.

51

52

MANAGED PROTOCOL OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

Implemented in 2014, this protocol standardized the procedure to reconstruct

the anterior cruciate ligament (ACL) based on scientific evidence to ensure the

best outcomes.

Greatly associated with practicing sports, such as basketball, skiing and soccer,

the latter very prevalent in Brazil, ACL damage affects mainly young active adults.

The patients with indication for surgical reconstruction of the ACL lesion are

eligible to this protocol.

As shown in the charts below, the number of surgeries has been stable, as well as

the length of stay of 1 to 1.2 days, which is ideal to this kind of procedure.

Mean length of stay – Home Care Program – Hip Arthroplasty

Mean length of stay – Home Care Program – Knee Arthroplasty

Did not receive pre-procedure visit

4.41

Received pre-procedure visit

3.85

4.183.74

Distribution of patients who have undergone anterior cruciate

ligament reconstruction surgery

Number of surgeries – Anterior Cruciate Ligament Reconstruction

Jul-Dec/2014

118

2015

274

2016

256

0-25 years

26-45 years

46-65 years

>65 years

23.9%

17.1%

0.2%

58.8%

Did not receive pre-procedure visit

Received pre-procedure visit

53

54

Mean length of stay - Anterior Cruciate Ligament

Reconstruction Surgery

Rate of antibiotic up to 60 min before surgical incision – Anterior

Cruciate Ligament Reconstruction Surgery

Rate of correct antibiotic prophylaxis – Anterior Cruciate Ligament

Reconstruction Surgery

Rate of antibiotic prophylaxis interruption within 24 hours – Anterior

Cruciate Ligament Reconstruction Surgery

Rate of readmission within 30 days – Anterior Cruciate Ligament

Reconstruction Surgery

Jul-Dec/2014

Jul-Dec/2014

Jul-Dec/2014

Jul-Dec/2014

Jul-Dec/2014

1.16

91%

100%

80%

0%

2015

2015

2015

2015

2015

1.12

95%

100%

76%

0%

2016

2016

2016

2016

2016

1.2

99%

100%

85%

0%

MEAN LENGTH OF STAY

RATE OF PROPHYLACTIC ANTIBIOTIC

The adoption of the protocol and many other dissemination and education actions

focused on the multidisciplinary team have contributed to continuously improving

the antibiotic prophylactic rate. The charts that follow show the administration of

the correct antibiotic, within one hour before the surgery, and its interruption within

24 hours after the procedure.

READMISSION RATE WITHIN 30 DAYS

Since the day the protocol was implemented in 2014, there has been no case of

patient readmission within 30 days from discharge after anterior cruciate ligament

reconstruction surgery.

55

56

SPINE PROGRAM

The purpose of the Spine Program is to provide safe second opinion, carefully

assessing the need for surgery. The hospital offers multiprofessional care, including

physiatrist, orthopedist and, if necessary, spinal surgeon. If the surgeon confirms

the need for surgery, the case is discussed in the Spine Board, which will reach a

consensus on the best procedure to be offered to the patient.

This clinical flow has been created to transparently show that surgical indications are

being made to offer the best to the patient and always based on professional ethics.

The project has been created to serve patients who own healthcare insurance plans

which otherwise would not have access to Einstein services. Once the diagnosis and

most appropriate treatment are defined (conservative or surgical management), the

patient can decide to undergo it or not.

Considering medical practice, the program favors ethical behaviors, as the patient

has the possibility to receive a second opinion about the disease treatment and

can learn more about it. The second opinion is impartial and the final management

has to be approved by the patient. The whole process is also ruled by an informed

consent document that is signed by the patient.

Since the creation of the program, in 2011, 7,092 patients have been referred to it

and 3,933 were fully assessed. A total of 59% of the cases were defined as non-

surgical, that is, the patients could benefit from conservative treatment.

Out of 2,303 patients who had surgical indication, 1,061 decided to undergo the

procedure at Einstein.

Referrals to Spine Project

2011

166

2012

931

2013

1,742

2014

1,404

2015

1,417

2016

1,432

Indication of Treatment at Einstein – General

n=3,933

General Surgical Management

General Conservative Management

1,630(41%)

2,303(59%)

57

58

As a result of enhanced confidence and increase in number of patients referred to

be assessed, the number of surgical procedures has been increasing throughout the

years in the Spine Program, as shown by the chart below.

Standardization and scientific-evidence based protocols guide the management of

specialists in the Spine Board, providing continuous improvement of quality of care and

increasing the referrals and performed procedures.

The chart below compares the main surgical techniques for spine degenerative

diseases – more invasive interventions (fusions) and less invasive interventions (surgical

decompression), indicating increase of the latter.

The mean length of stay includes all surgeries performed by the Spine Program, including

decompressions, fusions and spine surgery revisions. The quarterly feedback actions have

contributed to reduce length of stay throughout the years.

In 2014, we started performing outpatient facet infiltrations in the Interventional Radiology

Center of the hospital. The procedure is performed by a specialized radiologist, after case

discussion with the patient’s surgeons. Due to this new flow, there is no need for hospital

admission. It reduces the risk of infections or complications and patients can quickly resume

their regular activities.

2013

100%

2014

100%

2015

99%

2016

100%

Compliance with Spine Guidelines

LUMBAR SPINE GUIDELINES

Supported by the Spine Board, in 2013 the Locomotor Program created the

guidelines for treatment of the main vertebral spine degenerative diseases. These

guidelines have significantly changed surgical indications, favoring the use of less

invasive techniques without implant materials, which provide faster patient recovery

and outcomes that showed improvement in patient quality of care.

Annual Surgical Volume – General

Mean length of stay – Spine Program

Comparison between Fusions and Lumbar Decompressions

2011

2011

20

3.7

2012

2012

136

3.1

2013

2013

165

2.6

2014

2014

180

2.2

2015

2015

245

1.9

2016

2016

315

1.5

n=1,061

2011

45%

55%

2012

59%

41%

2013

24%

76%

2014

18%

82%

2015

78%

22%

2016

10%

90%

Lumbar Decompression

Lumbar Fusion

59

60

PROPHYLACTIC ANTIBIOTIC RATE

Similarly to knee and hip arthroplasty protocols, other spine surgeries also monitor

the prophylactic antibiotic use. As shown by the charts that follow, in 2016 we

observed prophylactic antibiotic administered up to 60 minutes before surgery in

96% of the cases; the correct prophylactic antibiotic was administered in 100% of

the cases, and 98% of them had the medication interrupted within 48 hours after

the procedure.

INFECTION RATE

We manage all patients who are admitted with spine diseases. The patients

submitted to surgical interventions are monitored during the entire time, for early

detection of suspected infections. In 2016, the infection rate in spinal surgery at

Einstein was 0.4%, a much lower rate than the international benchmark, which

ranges from 1.9% to 13.8%2.1

2. Cizik AM, Lee MJ, Martin BI, et al. Using the spine surgical invasiveness index to identify risk of surgical site infection: a multivariate analysis. J Bone Joint Surg Am. 2012;94(4):335-42.

Rate of antibiotic up to 60 min before surgical incision

– Spine Program

Rate of correct antibiotic prophylaxis – Spine Program

Rate of antibiotic prophylaxis interruption within 48 hours

– Spine Program

2011

2011

2011

63%

100%

94%

2012

2012

2012

98%

99%

93%

2013

2013

2013

97%

100%

91%

2014

2014

2014

92%

100%

92%

2015

2015

2015

94%

100%

95%

2016

2016

2016

96%

100%

98%

Infection Rate – Spine Program

2011

0.0%

2012

1.5%

2013 2014

1.2%

0.7%

2015

0.5%

2016

0.4%

61

62

OUTCOMES OF PATIENTS IN THE SPINE PROGRAM

We monitor the progression of patients with lumbar or cervical spine diseases

that have undergone surgical or conservative treatment at Einstein using specific

questionnaires that are internationally validated. For lumbar diseases, we use

Roland-Morris questionnaire; for patients with cervical spine diseases, we use

the Neck Disability Index. In addition to these specific questionnaires, we apply

the Visual Analog Scale (VAS) to all patients, which helps us measure their pain

intensity, and EuroQol, which assesses quality of life.

The questionnaire is applied by nurses and physical therapists on the first day of

intervention (surgery or physical therapy). The first questionnaire is used as the

baseline (pre-procedure questionnaire) and after the intervention, the Outcomes

Center contacts the patients 30, 90 days and 6, 12, 18, 24 and 36 months after

the procedure, using the same questionnaires, to assess the patients’ progress

concerning quality of life, pain and spinal function.

If, at any time, the patient reports worsening of the clinical presentation, the

Orthopedics Program will call the patient to the unit to carry on with management,

regardless of being rehabilitation or surgery. There is also general education about

posture and daily living habits, such as physical exercises and appropriate nutrition.

OUTCOMES OF PATIENTS AFTER LUMBAR SPINE SURGICAL TREATMENT

Visual analog scale (VAS)

The chart shows that our patients presented pain intensity grade 8 before the

intervention and progressed to 4 after surgery. In other words, pain has been reduced

by half.

Roland Morris Questionnaire

It is a questionnaire that measures physical disability self-reported by patients with

spinal pain. It comprises 24 questions scored 0 to 1 (Yes and No). The final scores

may range from 9 (no disability) to 24 points (severe disability).

The chart below shows that, before surgery, Einstein patients presented on average

15 points. After treatment, they improved gradually their lumbar function, reaching

on average 3 points, which indicates a very significant clinical evolution.

Utility – EuroQol

This questionnaire, as mentioned before, includes items related to mobility, autonomy,

ability to carry daily living activities, pain/ discomfort and anxiety/ depression. The

chart below shows significant improvement of quality of life.

Pain Scale (VAS)

(Ranging from 0 to 10, being 0 no pain and 10 worst pain)

Functional Scale (Roland Morris)

(Ranging from 0 to 24, being 0 normal function and 24 dysfunction)

Quality of Life (EQ-5D)

(Ranging from 0 to 1, being 0 inappropriate quality of life and 1 appropriate quality of life)

30 days

30 days

15.05

0.38

8.1

6.39

0.613.7

90 days

90 days

5.71

0.68

3.4

6 months

6 months

12 months

12 months

5.83

0.69

3.6

5.26

0.7

3.7

18 months

18 months

4.23

0.79

4.2

24 months

24 months

3.04

0.84

4.3

30 days 90 days 6 months 12 months 18 months 24 monthsPre-procedure

Pre-procedure

Pre-procedure

63

64

Roland Morris Questionnaire

As described before, this is a questionnaire that measures physical disability.

Before treatment, patients presented on average 12 points. After it, they progressed

positively and presented significant clinical improvement of the lumbar function.

The quality of life improvement in non-surgically treated patients shown by the chart

above indicates that rehabilitation is still the initial treatment of choice for patients with

lumbar spine degenerative diseases.

Quality of Life (EQ-5D)

(Ranging from 0 to 1, being 0 inappropriate quality of life and 1 appropriate quality of life)

OUTCOMES OF PATIENTS AFTER CERVICAL SPINE SURGICAL TREATMENT

From the beginning of the Spine Project in May 2011 to the end of 2016, 53 patients with

cervical spine disease decided for surgical treatment at Einstein. The outcomes of these

patients are demonstrated in the charts that follow.

Visual Analog Scale (VAS) – Neck pain

There has been significant improvement after surgery.

7

4

3

4

5

4

Pain Scale (VAS)

(Ranging from 0 to 10, being 0 no pain and 10 worst pain)

OUTCOMES OF PATIENTS AFTER LUMBAR SPINE CONSERVATIVE TREATMENT

From the beginning of the Spine Project in May 2011 to the end of 2016, 445 patients

with lumbar spine diseases decided for conservative (non-surgical) treatment at

Einstein. The outcomes of these patients are demonstrated in the charts that follow.

Visual Analog Scale (VAS) – Low back pain

Pain Scale (VAS)

(Ranging from 0 to 10, being 0 no pain and 10 worst pain)

7

5 5 5 5 5

4

Functional Scale (Roland Morris)

(Ranging from 0 to 24, being 0 normal function and 24 dysfunction)

12.22

10.24 9.859.2 9.12 8.51

6.14

Utility - EuroQol

As mentioned already, this questionnaire measures quality of life.

0.48

0.80.85

0.7 0.7 0.73 0.73

Pre-procedure

30 days 90 days 6 months 12 months 18 months 24 months

30 days 90 days 6 months 12 months 18 months 24 monthsPre-procedure

30 days 90 days 6 months 12 months 18 months 24 monthsPre-procedure

30 days 90 days 6 months 12 months 18 monthsPre-procedure

65

66

Utility - EuroQol

The chart above shows that there has been significant improvement in quality of life

12 months after the procedure.

Quality of Life (EQ-5D)

(Ranging from 0 to 1, being 0 inappropriate quality of life and 1 appropriate quality of life)

There has been a two-point improvement in the pain scale in the 12-month follow up,

which corresponds to clinically significant difference.

Pain Scale (VAS)

(Ranging from 0 to 10, being 0 no pain and 10 worst pain)

BETTER

BETTER

Neck Disability Index

OUTCOMES OF PATIENTS AFTER CERVICAL SPINE CONSERVATIVE TREATMENT

From the beginning of the Spine Project in May 2011 to the end of 2016, 243 patients

with cervical spine diseases decided for conservative treatment at Einstein. The

outcomes of these patients are demonstrated in the charts that follow.

Visual Analog Scale (VAS) – Neck pain

BETTER

There has been stability in the score of patients undergoing conservative treatment.

Functional Scale (Neck Disability Index)

(Ranging from 0 to 50, being 0 normal function and 50 dysfunction)

Neck Disability Index

Twelve months after the surgical treatment, patients improved 11 points in functions and

skills to carry on daily living activities.

Functional Scale (Neck Disability Index)

(Ranging from 0 to 50, being 0 normal function and 50 dysfunction)

BETTER

23

0.4

17

0.69

17

0.69

15

0.59

15

0.74

12

0.79

7

20

5

19

5

17

5

18

5

18

5

16

4

17

30 days 90 days 6 months 12 months 18 monthsPre-procedure

30 days 90 days 6 months 12 months 18 monthsPre-procedure

30 days 90 days 6 months 12 months 18 monthsPre-procedure

30 days

30 days

90 days

90 days

6 months

6 months

12 months

12 months

18 months

18 months

24 months

24 months

Pre-procedure

Pre-procedure

67

68

CRANIAL MAXILLOFACIAL PROGRAM

Following the same objectives, concepts

and the flow of the Spine Program, the

Cranial Maxillofacial Surgery Program

provides to patients a second opinion

about orthognathic, temporomandibular

joint (TMJ) and sleep apnea treatment.

The second opinion is based on the best

evidence and focused on multiprofessional

opinions of at least two surgeons of the

specialty.

As opinions are not individualized, the

indications (to surgery or conservative

treatment) are transparent and supported by the best literature evidence and

professional ethics. The project has been created to serve patients who normally

would not have access to Einstein services. Once the diagnosis and correct treatment

are defined, the patient may choose to undergo it or not. Einstein provides both

conservative and surgical treatment and patients are monitored before, during and

after the surgery.

Between February and December 2016, 687 patients were referred. Out of the total,

395 had diagnosis of temporomandibular joint dysfunction, 262 of orthognathic

surgery due to facial deformity, and 26 had sleep apnea. The program concluded the

assessment of 304 patients and the results were astonishing: 90% of the cases were

defined as non-surgical.

Patient Referrals - General

Jan/

16

0

Jul/

16

56

Feb/1

6

26

Mar

/16

85

Sep/1

6

49

Apr/

16

60

Oct

/16

43

Mai

/16

98

Nov/

16

68

Jun/1

6

78

Dec

/16

64

Aug/1

6

56

Diagnosis at Referral

Orthognathic

ATM

Sleep apnea

n=3,933

262 (38%)

395 (58%)

26 (4%)

The pilot program was run in June 2013. There were 34 patients and 17 were fully assessed.

According to Einstein assessment, 71% of the cases had no indication for surgery. The five

patients who had surgical indication were operated at Einstein. In 2014, we expanded the

scope of our services to patients with sleep apnea and temporomandibular joint diseases.

In February 2016, Einstein restarted to provide the service to patients referred by the

healthcare management companies.

There has been improvement in quality of life of patients who decided for conservative

treatment at Einstein.

Utility - EuroQol

As mentioned already, this questionnaire measures quality of life.

Quality of Life (EQ-5D)

(Ranging from 0 to 1, being 0 inappropriate quality of life and 1 appropriate quality of life)

0.46

0.62 0.660.75

0.640.60 0.58

30 days 90 days 6 months 12 months 18 months 24 monthsPre-procedure

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70

Definition of Einstein Management

Definition of Einstein Management - Orthognathic

Definition of Einstein Management - TMJ

Definition of Einstein Management - Apnea

Follow up of surgical cases

31 (10%)

19 (49%)

250 (98%)

4 (44%)

21 (68%)

273 (90%)

20 (51%)

6 (2%)

5 (56%)

7 (22%)

3 (10%)

Conservative Treatment

Surgical Treatment

Conservative Treatment

Surgical Treatment

Conservative Treatment

Surgical Treatment

Operated patients

Patients being prepared for surgery

Patients who refused surgery

n=304

n=39

n=256

n=9

n=31

Out of 31 patients with surgical indication, 21 were operated at Einstein and 7 were

being prepared to the surgery at the end of 2016.

INDICATION OF TREATMENT BY DISEASE

Conservative Treatment

Surgical Treatment

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Patient Experience

The strategy to place patients in the center of care and making them the key players in topics of their own interest has become an important route for improving medical and clinical practice. Patients are free to express their feelings about the experience at Einstein, using the following communication means: e-mails, social media, fax, telephone, letter or in person. Moreover, we run satisfaction surveys to measure their satisfaction levels and willingness to recommend Einstein to other people.

Year after year, the survey indicates that the promoters of Einstein brand are

far more frequent than the detractors. In 2016, Orthopedics reached 81% of

promoters, against only 3% of detractors. The performance portrays the joint

actions of the Surgical Clinical Practice, Inpatient Management, Locomotor

Program and Training area, which focused on adapting the behavioral skills and

team work practices to all professionals providing services to orthopedic patients.

In addition to these actions, Einstein has been employing other initiatives to provide

warm and humanized care. Some of the highlights are:

• Implementation of a concierge service, someone who goes to patients’ rooms to ask

about the quality of care.

• Creation of a Patient Advisory Board, which has been in existence for 4 years. Formed

by patients and family members invited by the organization, the committee meets

periodically with the directors, managers and representatives of different areas of the

organization to discuss topics related to services provided by the hospital.

813Locomotor

Values in %

17

Detractor

0 - 6

Promoter

9 - 10

Passive

7 - 8

Promoters = recommendation score equal or greater than 9 (% of respondents)

Passives = recommendation score equal to 7 and 8 (% of respondents)

Detractors = recommendation score equal or lower than 6 (% of respondents)

Question: In a scale ranging from 0 to 10, how would you score your

willingness to recommend Hospital Israelita Albert Einstein to a

friend or family member?

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• Opening of Einstein Lounge to accompanying people. The area offers many resources and information

to ensure that people are comfortable and calm.

• Because of patients’ requests and the awareness that the relationships with pets are beneficial to

patients, Einstein has created a flow to provide pet visits, according to the necessary health conditions.

All these actions are initiatives aligned with the aspiration of patients, adopted by Einstein to provide a

humanized and welcoming experience to people.

PLANETREE: CARE AND RESPECT TOWARDS PATIENTS AND FAMILY MEMBERS

Planetree is a North-American not-for-profit organization that acknowledges

healthcare organizations that are patient-centered providers, in healthy

environments and prone to cure patients. In Latin America, Einstein was the first

organization recognized by Planetree (in December 2011).

In this model, active participation of the patient and the family member is

encouraged through information and education. The partnership with the clinical

team is also encouraged, to provide a more humanized and seamless experience

of treatment.

Einstein Lounge

MAGNET RECOGNITION PROGRAM

Magnet Recognition Program was developed by ANCC

(American Nurses Credentialing Center) to acknowledge

the healthcare organizations that have nursing services of

excellence and contribute to the dissemination of successful

practices and strategies in nursing.

This program provides to consumers the best reference about the quality of

care that they can expect to receive in a health care organization. It is based on

quality indicators and best practice standards of the American Nurses Association

(ANA) and the Scope and Standards for Nurses Administrators, whose criteria

are: transformational leadership, exemplary professional practice, empowerment

structure, new knowledge, innovation and improvement, and empirical results.

Patient Satisfaction Score

2014

90 90

2015

8992

2016

88 89

General

Locomotor

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Education and Scientific Events MEDICAL RESIDENCY IN ORTHOPEDICS AND TRAUMA

The Medical Residency Program in Orthopedics and Trauma started in March 2013, after

its approval by the Ministry of Education, the National Board of Medical Residency and

Brazilian Society of Orthopedics and Trauma (SBOT). There are three seats for each of

the three regular years of the program.

The resident physicians have theory classes and take turns in eight-week internships,

dividing their time between Unit Morumbi and Hospital Municipal Dr. Moyses Deutsch

-M’Boi Mirim. In 2015, the resident physicians joined Programa Cuidar, which provides

outpatient supervised care to employees of the organization and their dependents,

comprising different areas of orthopedics (pediatric orthopedics, upper limb affections,

lower limb affections and spinal diseases).

In 2016, the second class of Orthopedics and Trauma resident physicians was

graduated. The dedication and commitment of the resident physicians and the team

involved in their training was rewarded by having all applicants of the hospital pass the

test for Specialists in Orthopedics and Trauma (TEOT 2016). In order to further deepen

knowledge and skills acquired in their areas of interest, our three resident physicians

were included in the improvement program of the organization. These programs are still

pending acknowledgement by the subspecialties’ boards in Orthopedics and Trauma.

GRADUATE STUDIES

The non-degree graduate studies in Multidisciplinary Orthopedics and the degree

graduate course in Health Sciences contribute to the dissemination of knowledge to

the orthopedic team.

The proposal of the graduate studies in Multidisciplinary Orthopedics is to prepare

and update the members of the multiprofessional team to work in treatment and

rehabilitation of the main lesions related to the locomotor system. In 2016, two more

classes completed the course, which has already trained 100 new specialists since its

beginning.

The degree graduate program in Health Sciences is comprised of one major

area, dedicated to Medical Sciences research, with research lines and projects in

basic, physiological and physiopathological studies or those related to diagnostic,

treatment and prevention aspects of communicable and non-communicable

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diseases. In orthopedics, there are three faculty members who are focused on the research line

of Aging, studying clinical and experimental aspects of aging. In 2016, two new master degree

applicants and one PhD applicant joined the program.

FORUMS

Interdisciplinary Forums of Orthopedics and Rheumatology are monthly meetings that gather

physicians from the open clinical staff and the main leaders of Einstein. The objectives of these

forums are to strengthen the ties between the Clinical Staff and the Organization, providing a

channel for free expression of opinions, criticisms and suggestions, and to treat topics of interest

in medical practice. This is all focused on improving the workplace and the provided services. In

the meetings, we also address clinical guidelines based on the best scientific evidence.

The events normally take place at lunchtime, in meeting rooms at Einstein. They are joined by

members of the Clinical Staff and representatives of the Clinical Director Office, Medical Practice

Office and Clinical Practice. In 2016, there were three meetings to discuss topics related to

orthopedics and trauma.

Key topics discussed in 2016 were:

• Pre, peri and postoperative care in orthopedic and

spine surgery

CLINICAL MEETINGS

In partnership with the Imaging/ Radiology team, the Locomotor Program carries out

weekly meetings to discuss clinical cases and relevant topics. The meeting receives

orthopedists, orthopedics and radiology resident physicians, rheumatologists,

radiologists and physiatrists, to encourage the production of future scientific projects

and continuing medical education.

• Osteoporosis – care with

the vertebral spine

• Postoperative pain

management in children

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TRAINING SESSIONS

• Training on Hip and Knee Managed Protocols

The purpose of the session was to update the multiprofessional teams in areas of general medicine

and severely-ill patients when caring for patients submitted to hip or knee arthroplasty. The training

program was directed to standardizing patient care, creating a specific team to provide care to severe

patients.

• Home Care Project Training

To better serve our clients submitted to knee and hip arthroplasty, we have trained the teams of Home

Care, which make home visits before and after the surgery. The objective was to prepare the team to

provide specific care and make residential adaptations.

• Training on preventing orthopedic infections

The training program was focused on giving a preoperative bath of chlorhexidine at home and using

intra-hospital CHG-soaked towels to prevent surgical site infections in orthopedic patients.

SPINE BOARD

Every week, orthopedists, neurosurgeons and the multidisciplinary team gather for the Spine Board

to discuss cases referred to the Spine Project. The team of Radiology supports the discussions and

clarifies the questions. The meeting is opened to the whole Clinical Staff and it is based on exchange of

experiences, trying to identify the best approach for each patient.

XVI EXPOSIÇÃO DA QUALIDADE E SEGURANCA 2016 (QUALITY AND SAFETY EXHIBIT)The Quality and Safety Exhibit is an annual event that promotes exchange of

experiences among the different areas of the organization, opening opportunities to

adopt continuous improvement practices and to disseminate to internal and external

clients what the areas do.

The Orthopedics Program submitted two papers in 2016:

• Bacterial resistance prevention by interrupting prophylactic antibiotic within 24

hours in managed orthopedic surgeries (Magnet category);

• Experience of Spine Project (Planetree category).

COURSES

• 1º Diálogos entre a Pediatria e a

Ortopedia Pediátrica (1st Forum of

Pediatrics and Pediatric Orthopedics)

Held on July 16, 2016, at Auditorium

Kleinberger, at Einstein. The event

addressed osteoarticular infection,

equine gait, lower limb pain, newborn

hip and postoperative pain. The target

audience included orthopedists,

pediatricians, anesthesiologists,

physiatrists and multiprofessional team

members (physical therapists, physical

educators, pharmacists and nurses).

• 1º Simpósio de Coluna (1st Spine Symposium)

Held on August 5-6, 2016, the event focused on degenerative diseases of the

lumbar spine, approached by multidisciplinary and multiprofessional clinical case

discussions with the specialists and the audience, also counting on the presence of

Edward Covington, from Cleveland Clinic.

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Research and Scientific Production

RESULTS OF SCIENTIFIC ACTIVITY AT EINSTEIN ORTHOPEDICS

In 2016, the Orthopedics staff participated in the following projects:

• 20 research projects submitted to the Research Project Management System

(SGPP – Sistema de Gerenciamento de Projeto de Pesquisa);

• 16 approved research projects;

• 10 completed research projects;

• 33 ongoing research projects.

PUBLICATION IN SCIENTIFIC JOURNALS

In 2016, there were 25 studies on orthopedics published, ten of them in journals with

impact factor > 1 (IF>1). These numbers represent a relevant increase compared

to previous years. The complete list of publications from 2016 can be access on

the internet at: http://www.einstein.br/especialidades/ortopedia/ensino-pesquisa/

publicacoes-cientificas.

The table below represents the scientific production of the Orthopedics area:

Evolution of Research Projects

11

15 16 16

22

33

7

1310

14

2320

Submitted Approved Ongoing Completed

2014 2015 2016

IF 2012 2013 2014 2015 2016 Total

>5 2 0 2 2 4 10

>1 and < 5 7 3 6 10 10 36

<1 0 2 3 0 1 6

No IF 6 10 4 7 10 37

Total 15 15 15 19 25 89

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NATIONAL AND INTERNATIONAL FUNDING

The Locomotor Program has created a scientific structure that has provided more

funding opportunities.

In 2016, there were two projects funded by Fundação de Amparo a Pesquisa do Estado

de São Paulo (Fapesp – Research Funding Institution for the State of Sao Paulo),

amounting to approximately R$800,000.

Einstein has also taken part in a special funding process by Fapesp and Instituto de

Estudos de Saude Suplementar (IESS – Private Health Study Institute) that selected

four research projects on Sustainability of Private Healthcare Sector. One of them

was Einstein project – Second opinion of spine surgical indications: cost-effectiveness

assessment. The project is carried out by the area of orthopedics, supported by the

Rehabilitation Center.

2013

2013

2

152,740.00

2014

2014

1

209,740.00

2015

2015

1

237,987.50

2016

2016

2

571,019.56

Total funded projects (overall)

Total funded amount (overall)Publications by Impact Factor

>5

<1 and > 5

einstein (Sao Paulo)

<1

No IF

2014

313

6

2

2015

250

10

2

2016

7

31

10

4

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Concerning international funding, a funded project of approximately R$150,000 as a

partnership between Fapesp and Ohio University has also been approved.

RESEARCH LINES

Research lines may be represented as specific topics, which gather projects whose results are

closely related. The scientific production of Einstein Orthopedics has adopted the research

line “Aging”, comprising investigations in four major areas:

• Cell therapy – experimental studies;

• Managed protocols of the Orthopedics Program;

• Evidence-based Orthopedics and Rheumatology;

• Bone tumors: Early imaging diagnosis.

2013

1

0 0

1

0 0

2014 2015

1

2016

1

Total submitted x approved projects (international funding)

Submitted

Approved

2013

45,000.00 45,000.00

0.00

2014 2015 2016

147,001.50

Funded Amount (international)

As to Cell Therapy, there are the following ongoing projects:

1. ALTERNATIVE THERAPIES FOR CARTILAGE REPAIR: IN VITRO STUDIES

Team: Eliane Antonioli, Felipe B. D. de Oliveira, Anna Carla Goldberg, Mario Ferretti

External collaborator: Helena B. Nader (Full Professor of Unifesp and Director of the

Brazilian Society for Progress of Science - Sociedade Brasileira para o Progresso da

Ciência). Funding: Fapesp #2012/00831-7 – PI: Mario Ferretti

2. APPLICATION OF PCL/ CNT NANOFIBERS ALIGNED IN DIFFERENT ORIENTATIONS

AS FRAMEWORK FOR MENISCAL REGENERATION

Team: Eliane Antonioli, Felipe B. D. de Oliveira, Mario Ferretti Filho

External collaborators: Anderson de Oliveira Lobo (Coordinator, Laboratorio de

Nanotecnologia Biomedica – Laboratory of Biomedical Nanotechnology /Instituto de

Pesquisa e Desenvolvimento - Universidade do Vale do Paraiba), Thiago Domingues

Stocco (Ongoing PhD. Student , Engenharia Biomedica, UNIVAP).

3. ANALYSIS OF CELL AGING IN MESENCHYMAL STEM CELLS (REPLICATIVE

SENESCENCE) AND ITS APPLICABILITY IN CELL THERAPY

Team: Eliane Antonioli, Andrea Sertié, Carla Piccinato, Natalia Torres, Mario Ferretti

4. IN VITRO ANALYSIS OF THE CHRONDROPROTECTIVE ACTION OF LOSAC AND

LOPAP MOLECULES

Team: Eliane Antonioli, Edgard S. Pereira Junior, Moises Cohen, Mario Ferretti

External collaborators: Dr. Ana Marisa Chudzinski-Tavassi (Coordinator of Laboratório

de Inovação e Desenvolvimento no Instituto Butantan – Laboratory of Innovation and

Development), Miryam P. A. Flores (researcher, Instituto Butantan).

5. RESPONSE OF OSTEOARTHRITIS BIOMARKERS AFTER A REHABILITATION PROGRAM

– PARTNERSHIP WITH OHIO STATE UNIVERSITY (OSU)

Team: Eliane Antonioli, Felipe B. D. de Oliveira, Sudha Agarwal, Mario Ferretti

Funding: Fapesp #2015/50274-5 PI: Mario Ferretti

6. REGENERATIVE CAPACITY OF MESENCHYMAL CELLS ADMINISTERED LOCALLY AND

SYSTEMATICALLY IN OSTEOPOROSIS ANIMAL MODEL

Team: Eliane Antonioli, Felipe B. D. de Oliveira, Mario Ferretti

Funding: Fapesp #2015/16606-0 PI: Mario Ferretti

7. SECOND OPINION IN INDICATIONS OF SPINE SURGERY: COST-EFFECTIVENESS

ASSESSMENT

Team: Mario Lenza, Miguel Cendoroglo Neto, Eliane Antonioli, Mario Ferretti

External collaborators: Wilson Mello Alves Junior, Rodrigo A. Vasconcelos,

Leonardo Oliveira Pena Costa, Paulo Portes Teixeira Funding: Fapesp #2015/50352-6

PI: Mario Ferretti

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Social Responsibility Opened in April 2008, the hospital resulted from a long time request of the local population

and provides support and strengthens the primary healthcare system of the region M’Boi

Mirim, including the districts of Jardim Angela and Jardim Sao Luiz, which add up to 600,000

inhabitants. Operating as a reference to 43 primary healthcare centers (31 UBSs, 9 AMAs,

2 Specialty AMAs and 1 specialty outpatient unit), the Hospital is primarily focused on

urgencies, emergencies and deliveries.

In 2013, when Einstein started its medical residency program in Orthopedics and Trauma,

Hospital Municipal M´Boi Mirim was chosen to be a partner in the training and development

of resident physicians.

To present, seven resident physicians are part of the team of orthopedists credentialed by

Sociedade Brasileira de Ortopedia e Traumatologia (SBOT). There they learn about the

Universal Public Healthcare System (SUS) care and can study, discuss and follow up different

cases of orthopedic emergencies.

The first, second and third year residents rotate in their internships every two months, but

throughout the year they all maintain contact with the municipal hospital, working on night

and weekend ED shifts.

Part of their training includes workshops with partnering organizations about synthetic bone,

bringing better clinical practice to the population at M’Boi Mirim.

ORTHOPEDICS INDICATORS FOR HOSPITAL MUNICIPAL DR MOYSES DEUTSCH (M’BOI MIRIM)

The Locomotor Program is engaged in two important social

responsibility actions.

One of them is orthopedic care provided to patients in the Organ

Transplant Program (liver and kidney). Some patients may present

orthopedic complications such as pyoarthritis, osteomyelitis and

skin infections which, in most cases, require surgeries.

Another social responsibility action of the program is orthopedic

care provided at Hospital Municipal Dr. Moyses Deutsch - M’Boi

Mirim, which is administered by Einstein.

Number of Orthopedic Outpatient Visits

1st sem 2014

3,494 4,534

2nd sem 2014

3,8975,323

1st sem 2015

3,4485,507

2nd sem 2015

3,710

7,581

1st sem 2016

4,067

16,199

2nd sem 2016

4,386

17,085

Orthopedic Visits

Total Visits

One of the highlights of the social activities

of Einstein orthopedics is

service provision at Hospital Municipal

do M’Boi Mirim. In 2016, the orthopedics at Hospital M’Boi Mirim totaled 8,453 outpatient orthopedic

visits, which amounts to 25% of the entire volume of outpatient visits.

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Brand Dissemination and Management

Through its website, which brings detailed information about the specialty activities, and media coverage in different channels, Orthopedics used communication as an instrument to disseminate information to the public and strengthen Einstein brand.

INSTITUTIONAL WEBSITE

In 2016, the new institutional website was launched. It has led to a drop in number of

visits due to three main reasons:

• Previous content, which was over two years old, did not migrate to the new version;

• Separation between the Teaching website and the main portal;

• Expected decrease in visits due to the inclusion of new Google pages.

In 2016, Orthopedics had fewer visits to the website than in 2015. Despite that, over

110,000 people visited it and the number of pageviews per visit increased compared

to the two previous years (2.3 pages per visit as opposed to 1.2 in 2015).

MEDIA PARTICIPATION

Considering printed media, radio and TV, the Orthopedics area stood out in over 40

coverages throughout 2016.

Number of visits

436,731

600,981

113,905

Number of pageviews

617,754723,977

260,504

Institutional website

2014

2015

2016

2014 2015 2016

81

114

44

Media appearance

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LOCOMOTOR PROGRAM

Dr. Mario Ferretti Filho

Medical Manager

ferretti@einstein.br

+55(11) 2151-1444

Dr. Mario Lenza

Medical Coordinator

mario.lenza@einstein.br

+55(11) 2151-1444

Dr. Rodrigo Junqueira Nicolau

Physician

rodrigo.nicolau@einstein.br

+55(11) 2151-1444

Dr. Eliane Antonioli

Researcher I

eliane.antonioli@einstein.br

+55(11) 2151-2265

Isabela Dias Paião

Nurse

isabela.paiao@einstein.br

+55(11) 2151-1443

Luciana Pereira de Magalhães

Machado

Nurse

luciana.machado@einstein.br

+55(11) 2151-5248

Renata Alves Lima

Administrative Technical Assistant

renata.alima@einstein.br

+55(11) 2151-4585

Gerusa Leandro de Souza Silva

Administrative Technical Assistant

gerusa.silva@einstein.br

+55(11) 2151-5249

Thais Rosa de Oliveira

Conceição

Administrative Technical Assistant

thais.conceicao@einstein.br

+55(11) 2151-3045

Vanuza de Oliveira Silva

Administrative Technical Assistant

vanuza.oliveira@einstein.br

+55(11) 2151-4586

Staff and Contact InformationREHABILITATION CENTER

+55(11) 2151-1100

ORTHOPEDIC RADIOLOGY

+55(11) 2151-2487

INPATIENT UNIT – 11TH FLOOR

ORTHOPEDICS

+55(11) 2151-1168

MEDICAL OFFICES BUILDING A1

+55(11) 2151-1233

EMERGENCY DEPARTMENT UNIT

+55(11) 2151-1233

HOME CARE

+55(11) 2151-2944

ORTHOPEDIC MEDICAL RESIDENCY

PROGRAM

Dr. Mario Ferretti Filho

Supervisor, Orthopedics and Trauma

Medical Residency Program

ferretti@einstein.br

+55(11) 2151-1444

Dr. Mario Lenza

Coordinator, Orthopedics and Trauma

Medical Residency Program

mario.lenza@einstein.br

+55(11) 2151-1444

Dr. Francesco Camara Blumetti

Physician Preceptor of Orthopedics and

Trauma Medical Residency Program

francesco.blumetti@einstein.br

+55(11) 2151-1444

Dr. Luiz Fabiano Taniguchi

Coordinator of the Orthopedic team at

Hospital do M’Boi Mirim

Physician Preceptor of Orthopedics and

Trauma Medical Residency Program

luiz.taniguchi@einstein.br

+55(11) 2151-1444

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