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important, incidentally, because it also sets the right expectation for
them and puts pressure back on us to deliver. And of course, no
patient wants to stay one minute longer than necessary.
We also dug deeper and talked to the different groups at our facility
— Ob/Gyn, orthopedics, general surgery, plastics and urology — to try
to determine which factors were most likely to be significant for
them. In fact, we've made it a point to talk and brainstorm regularly.
Every Tuesday we come in a half hour early and we start the OR a
half hour later.
It's working. We've managed to find and address a lot of other
issues. For example:
• Ease up on the opioids. Excessive opioids were making patients
groggy and leading to other unwanted side effects. So we started pre-
medicating patients orally and using a multimodal pain-management
approach. And we got all of our orthopedic surgeons to agree to use
regional blocks whenever possible.
• Mitigate voiding issues. When hysterectomy patients come out of
surgery, the sensation to void builds quickly because our surgeons
now place 100cc of saline in their bladders. Surgeons were already
checking bladders to make sure ureters were intact after surgery, so it
was a no-brainer to start placing some fluid.
• Do away with scopolamine patches. We discovered that for hys-
terectomy patients, our practitioners often used scopolamine patches.
But it came to our attention that the patches can cause urinary reten-
tion, so we stopped using them.
The effort has paid off. We still hope to do better, but our success
rate has gone from 13% to about 65%, and we hit 69% in our best
month.
Eswar Sundar, MD
Beth Israel Deaconess Medical Center
Boston, Mass.
esundar@bidmc.harvard.edu
