Archive Ambulatory Anesthesia 2015

A New Way to Manage Post-op Pain

The Perioperative Surgical Home model is revolutionizing patient care with preset clinical pathways for specific cases.

Zeev Kain, MD, MBA


patient-centered care INTEGRATED APPROACH It's time for anesthesiologists to adapt to patient-centered care.

Should you wait until patients enter the PACU to administer pain medications? Of course not, but many surgical facilities still fail to fight pain proactively. With the Perioperative Surgical Home (PSH) model, that won't happen. The buzz-worthy coordinated care program is based on a standardized clinical pathway created with input from all stakeholders in surgery. For example, they agree in advance on pain and nausea control regimens for each type of procedure, put the protocols in writing and implement them during every case. Launching a PSH program will put your facility on the cutting edge of care and ensure you successfully manage post-op pain and PONV, two of the biggest factors in patient satisfaction and timely discharges.

Preset plans
At most facilities, there is variability in the overall system of care. I'm suggesting you establish a comprehensive order set for every surgery, and change it based on the needs of individual patients. For example, if a patient developed a peptic ulcer after taking a non-steroidal, you uncheck that box on the preset order and avoid giving that medication. It makes sense to do it that way; very few patients are sensitive to the drug, so shouldn't the default involve administering a non-steroidal and changing plans if the patient has a comorbid condition that prevents its use? The PSH model is not a cookie-cutter approach to surgery. In fact, it's very much in line with individualized care.

Typically, all aspects of perioperative care work in silos for the benefit of the patient. But why shouldn't anesthesiologists and surgeons agree on how cases will be performed, including how pain will be controlled? By reducing variability among providers, you're reducing the likelihood of oversights occurring. The order set is standardized regardless of which surgeon will perform the case or which anesthesia provider will work the room.

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