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-
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