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Pain management
The other factor that lets us have patients mobile so quickly is
our approach to pain management. Each of our anesthesia
providers is board-certified in pain management, and the protocols
they've created are targeted toward not letting patients get into pain.
Intra- and post-operatively, we use nerve blocks where appropriate.
Even then, we numb the skin so blocks generate as little pain as pos-
sible. Post-op, our approach consists of microdosing, or administering
smaller doses more often. For example, the nurses won't give 2 to
3mg of Dilaudid; instead, they'll administer 25mcq of fentanyl or a
similarly tiny bit of IV Valium, and then reassess 15 to 20 minutes
later, administering again as necessary. Microdosing gets patients sit-
ting up, doing deep-breathing exercises, and eating crackers and soup
in no time, which lets us move to larger PO doses. We also get a mus-
cle relaxant in early, so patients don't freeze up.
It's a smooth transition from there to mobilization. In addition, get-
ting the patient comfortable early increases trust and decreases the
psychological stress that can delay patient recovery. Remem-ber, the
goal isn't just to knock the patient out, then wake him up — the goal
is to move the patient toward wellness.
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Infection prevention
We started thinking about infection control before we'd even
built the facility, spending nearly $1 million extra during con-
struction to install a 100% HEPA-filtered, UV-treating, high-flow HVAC
system throughout. And our protocols are equally proactive. Some
examples:
• Scrubs aren't to be worn outside — they're strictly for in-facility use,
and laundered by a third-party service.
• Cell phones don't go in the OR unless they've been cleaned with
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