A U G U S T 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 3 9
Why? Because the more aggressive the physical therapy is, the more range of
motion they're going to have in those initial therapy sessions, which, in theory,
can reduce the chance that adhesions will re-form down the road. So we're
working together. The therapists can be more aggressive, because patients are
relatively comfortable with their regional nerve blocks, but they also have to
understand that patients aren't going to be at full strength, because our protocol
allows patients to go home with ambulatory catheters.
• Starting slow is best. As we've been implementing our protocols, we've also
learned that change often involves overcoming some resistance. That's why we
always start each protocol with a pilot program involving 20 or 30 patients, and
we set parameters and desired outcomes ahead of time. In addition to opioid
reduction, we measure length of stay, pain scores, readmissions and any other
complications that happen within 30 days. Positive outcomes help get buy-in from
everyone involved as we move forward with implementing the protocols.
The big payoff
The beauty of creating multimodal protocols is that once they're up and running,
all you have to do is plug patients in. We've created tools in our EMR that allow
patients to answer simple yes-or-no questions in the surgeon's office, and thereby
establish whether a given patient is a candidate for a given protocol.
Once the protocols are established, every provider knows exactly what's
expected, and anybody who opens that patient's chart will have all the needed
documents and information in hand to be able to follow the proper steps.
Fine-tuning your protocols takes effort and time, but after that, it's just a mat-
ter of having all the parties involved touch base every few months, review the
data and talk about how well the clinical pathways are working and whether
any tweaks might be appropriate.
OSM
Dr. Elkassabany (nabil.elkassabany@uphs.upenn.edu)
is the director of orthopaedic anesthesia at the Hospital of
the University of Pennsylvania.
