Strategies to cut time for spinal injections
Save money by reducing OR time
The first study of low back injection for pain management by the AAAHC Institute for Quality Improvement, a not-for-profit subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC), found eight common factors among organizations with shortest procedure times:
- following a strict schedule for patient appointments, physicians and other staff avoid over-scheduling to decrease patient pre-procedure wait times;
- calling patients the day before the procedure to confirm their appointments;
- doing telephone pre-assessment and registration prior to the patient's appointment date;
- having staff members who are familiar with each physician's preferences and how they perform their procedures;
- having preoperative staff work together so at least two patients are ready for the procedure at any time;
- using an electronic health record so physicians can complete their procedure reports at a computer station in the procedure room;
- having all available staff help with turnover, including nurses, radiation technologists, and physicians.
About 80% of patients were contacted within 7-10 days of the procedure to obtain information on outcomes.
Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute, said, "More than 1.5 million spinal injections as a treatment for pain and other back problems are performed each year, and that number is expected to rise as the population ages. Nearly two-thirds of these procedures are performed in the outpatient setting. As the leader in ambulatory care accreditation, AAAHC believed it was important to gather data and benchmark results for low back injection, which is increasing in prevalence and associated costs."
More than three-fourths (78%) of patients reported their pain had improved, and 82% said they were able to perform their daily activities after undergoing spinal injections for back pain. However, only about half (53%) said they were able to reduce their pain medications after the procedure.
Girish P. Joshi, MBBS, MD, FFARCSI, who was a member of the AAAHC Institute work group that designed the study, said, "Low back injection was very effective in managing pain in this patient population. Although only about half of the patients were able to reduce their pain medications, more than eight out of 10 were able to return to their normal activities. That increase in physical activity may account for the need to continue the medications." Joshi is professor of anesthesiology and pain management and director of perioperative medicine, University of Texas Southwestern Medical Center, Dallas.
Additional findings include:
- The most frequent symptoms for which the procedure was performed were pain (96%), limited range of motion (47%), spinal tenderness (28%), weakness (28%), a positive straight-leg test (21%), a test in which the leg is raised upward with the knee unbent (the test is positive if there is pain down the back of the leg), and numbness (5%). Some patients reported more than one symptom.
- 53 percent of patients rated the severity of their symptoms as greater than "5" on a scale of 0-10, with "10" being the most severe.
- 91% of patients received three or fewer injections.
- 89% of injections included local anesthetics, and 95% included corticosteroids.
- 63% of patients received intravenous sedation.
- 98% of injections were guided by X-ray imaging.
The 107 ambulatory organizations that participated in the study perform approximately 139,000 low back injections annually. The organizations submitted data on a total of 2,227 routine, uncomplicated procedures for inclusion in the study. Not every organization and/or every patient was included in every measure. (The benchmarks from this study were published in the Dec. 3, 2010, issue of Same-Day Surgery Weekly Alert. To subscribe to this free weekly ezine, contact customer service at [email protected]. To order copies of the report or for more information, visit www.aaahciqi.org. On the left side of the page, select "Order Products." At the bottom of the page, under "Pain Management Low Back Injection January June 2010," select "purchase product" for the PDF or CD-ROM product. The price is $85 for the PDF and $110 plus $15 shipping for the CD-ROM.)
The first study of low back injection for pain management by the AAAHC Institute for Quality Improvement, a not-for-profit subsidiary of the Accreditation Association for Ambulatory Health Care (AAAHC), found eight common factors among organizations with shortest procedure times:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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