Using ambulatory anesthesia to improve the patient experience

This is the fourth and final article in a series written by the Women’s College Hospital. We have chosen to repost these blog posts as they demonstrate how our app, aTouchAway, is being used in their new ambulatory joint replacement program. The program allows patients to recover from surgery from the comfort of home – being discharged the same day as the operation. You can read the firstsecond, and third articles for more background.

May 7, 2018

By Atifa Hamir

Opioids are a vital component of many surgeries, allowing patients to undergo important procedures while minimizing pain during the process. However, they often come with unwanted side effects, such as nausea, which can delay discharge from hospital. Women’s College Hospital’s new ambulatory joint replacement surgery program is addressing this issue by using a unique combination of regional anesthesia, comprised of a local anesthetic-based nerve blockers, to give patients long-lasting pain relief with a reduced risk for adverse effects, allowing them to return home faster and improving their surgical experience.

“A lot of people go through this unfortunate cycle of pain and nausea after surgery, where the anesthetic and the pain medication they are on can cause them to feel nauseated, but stopping the medication causes them to be in pain,” says Dr. Richard Brull, the inaugural Evelyn Bateman Cara Operations Chair in Ambulatory Anesthesia and Women’s Health at WCH. “By moving from opioid-based pain control to local anesthetics, we’re breaking the vicious circle of pain-nausea-pain, and it can be vicious indeed.”

The ambulatory surgery program aims to send patients home within four hours of completing their surgery. This means that patients need to be awake, mobile and comfortable before being discharged. To keep patients comfortable, an anesthesiologist uses a local anesthetic that is administered to the procedure area that lasts for up to 24 hours, giving the patient pain relief well into their first full day of recovery. To do this, the anesthesiologist will use an ultrasound machine to locate the sensory nerves and then use nerve blockers to stop the nerve’s ability to send messages of pain to the brain.

“What makes our method of ambulatory anesthesia unique is the way in which we’re targeting specific types of nerves in a particular area, and essentially tricking the brain into thinking that there’s nothing happening,” notes Dr. Brull. “This puts less strain on a patient’s body in a lot of ways, one them being that the patient doesn’t experience the normal physiological and psychological reactions to pain both during and after the procedure.”

To keep the patient still during the short surgery, the anesthesiologist also gives the patient a spinal anesthetic to freeze the lower half of the body for roughly 75 minutes. Since the surgery is done within an hour, the freezing is completely worn off by the time the patient is ready to go home. This is important for the patient’s recovery process as it allows them to practice walking using their crutches and climbing stairs with the assistance of a physiotherapist in the hospital, giving them the confidence to use them independently at home.

“This transition from traditional inpatient to ambulatory surgery may seem like a small change, but it has really positively impacted our patients in so many ways,” reflects Dr. Brull. “Using regional anesthesia to facilitate an ambulatory procedure with minimal pain, nausea and sedation changes the landscape for joint replacement surgery in Canada and improves the overall patient experience.”

Featured image courtesy of Cleveland Clinic.

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COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
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COPD Education – Continuous Maintenance

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To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

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Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

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The Maintenance Mode
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Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

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Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

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  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
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