Outpatient Surgery Magazine

Special Edition: Anesthesia - July 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

Issue link: http://magazine.outpatientsurgery.net/i/1268528

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Page 46 of 54

patient is actually eligible for surgery, thus sparing day-of-surgery can- cellations. With enhanced recovery, your entire approach shifts from "let's just do the case" approach to optimizing the patient ahead of time. I'm a big advocate of this value-based care concept. "Let's just do the case" shouldn't be your status quo, because it can come back and bite you if the patient wasn't really ready for surgery. • Smarter anesthesia. You want to avoid benzodiazepines, especially with older patients, as they cause some confusion in the patient and delay their recovery. That means designing and implementing anesthesia protocols that are straightforward, opioid-sparing and that shy away from benzodiazepines. Depending on the procedure, you should take advantage of some- thing many outpatient facilities have been slow to embrace: regional anesthesia using non-opioid analgesics. This is preferable to general anesthesia in terms of PACU length of stay and PONV. Implementing these enhanced recovery protocols will improve out- comes. Patient satisfaction scores will also increase because patients head home feeling good and prepared for a successful recovery. Selling the benefits It's essential to reduce variability when implementing enhanced recov- ery protocols. Every provider in the episode of care needs to stick to the program. That requires universal buy-in. To implement enhanced recov- ery successfully, your biggest challenge is to change the culture within your organization. Clinicians don't like changing practices, of course, and NPO is one of the oldest protocols in the business. The objection is often a variation of, "I've taken care of patients for 20 years the same way. Don't tell me to change what I'm doing now." A convincing counterargument is that the 30-day postoperative mor- J U L Y 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 4 7

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