manage the process in the hospi-
tal. what makes you think you
can in an outpatient facility?
One nurse, one patient.
Assign a nurse to be solely
responsible for a patient's care
from beginning to end. One nurse takes total control of each
patient: phoning the patient in the days before surgery, admitting
him to the facility, circulating the case, recovering the patient (I
suggest a single-phase recovery process) and discharging him, and
then following up with the patient at home. This way, nurses see
the whole process unfold in front of them (watch their job satisfac-
tion shoot up!). Plus, you eliminate dangerous handoffs.
Accountability is a strong motivation.
Pain management. You can't discharge a patient whose pain is not
controlled. Patient-specific, multimodal pain management protocols
comprising a combination of non-opioid, short-acting analgesics, mus-
cle relaxants and opioids (when pain persists) for rescue are the key to
same-day discharge. Remember, post-op pain control starts before sur-
gical trauma. Stress to your patients that they may have pain, but it will
be well managed. While you want to minimize the use of intraoperative
opioids, chances are that most spinal fusion patients will be on pre-
scription pain medication pre-operatively. So you must be mindful of
and ready to manage opioid-related adverse drug effects in a patient
with a ruptured lumbar disc who's been taking oxycodone for days,
weeks or months. These include nausea, vomiting, respiratory depres-
sion and constipation, all of which can delay discharge. Multiple drugs
that have different analgesic mechanisms of action and multiple meta-
bolic pathways are key.
1 0 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 1 7
Stress to your patients
that they may have
pain, but it will be
well managed.
