Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/1316512
That needs to change — and soon. When used in all phases of the perioperative continuum of care, ERAS protocols result in faster discharges, acceler- ated recoveries, fewer readmissions and happier patients. Post-op pain is controlled with fewer nar- cotics, meaning patients are at less risk of addic- tion from surgery-induced opioid use. The model's clinical efficiencies make for more profitable facili- ties as well. Here are the key elements to a suc- cessful multimodal and coordinated ERAS-based clinical care pathway. • Pre-op practices. Patients should meet with the surgical and anesthesia teams several weeks in advance of their procedures to discuss expectations for realistic and timely recoveries. Your facility should also conduct pre-op education sessions with patients to explain the details and purpose of their surgeries, and to address commonly asked questions. Some patients have consid- erable anxiety and stress before undergoing joint replacement surgery, particularly if they have a history of depression or no fam- ily support. Work with them to set achiev- able goals with respect to when they'll be mobile again, and always make sure to tell them they will be experiencing a certain level of post-op discomfort no matter what form of pain-control regimen they receive. Ortho centers with pre-op teams that include physical therapists, occupational therapists, care coordinators and nurses have a high level of success in meeting patients' pre-surgery needs. Scheduling pre-op meetings several weeks in advance of procedures allows the medical team to screen patients for organ dysfunction and conditions such as heart disease or diabetes that could put them at high risk of postoperative complications. The advance sessions also allow time for patients to begin alcohol and nicotine cessa- tion if necessary. Pre-op nutrition should be addressed as well. Our ERAS protocols include recommendations for patients to load up on carbohydrates with a specially formulated drink two or three hours before their procedures. The opioid crisis that killed almost 72,000 peo- ple in the United States last year has triggered a multimodal pain management approach during the entire surgical episode of care. NSAIDs, acetamin- ophen, preoperative bupivacaine and gabapentin can all be effective non-opioid analgesics before surgeries. Midazolam, a sedative, is part of the standard pre-op cocktail as well. Taking measures to prevent thrombosis should also be part of any orthopedic ERAS protocol. • In the OR. Using minimally invasive surgical and anesthesia techniques is the best way to reduce the physical stress on the body that takes place dur- ing procedures. Neuraxial anesthesia, for example, causes less of a stress hormone release than general 3 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 2 0 QUICK RECOVERIES Ultrasound-guided regional blocks have revolutionized post-op pain management and help patients ambulate soon after surgery. Pamela Bevelhymer