Try these nine steps for fast discharges
Patient preparation is one key
The range of time to discharge a patient after arthroscopic knee surgery is a median of 90 minutes, according to a new survey by the Institute for Quality Improvement, a subsidiary of the Accreditation Association for Ambulatory Health Care in Wilmette, IL.
However, one organization was able to discharge patients in about 20 minutes after surgery. Here are nine reasons why the process was so quick:
- The organization used a monitored anesthesia care technique using a bolus of propofol along with Versed and fentanyl. Prior to surgery, the physician assistant also gave patients local anesthetics.
- Patients were well-prepared for surgery. They knew what to expect before, during, and after the procedure.
- Discharge instructions were given to the patient and any responsible family member before the start of the procedure. The patient signed discharge instruction forms during the instruction period.
- Prescriptions for pain medication were provided to the patient at a previous office visit, and patients were instructed to fill these before the day of surgery.
- Patients were instructed to get their crutches before surgery and bring them to the office to use after their procedure.
- As the case ended, the certified registered nurse anesthetist (CRNA) no longer administered any medication.
- The CRNA observed patients in the OR until postoperative vital signs were no more than 20% different than preoperative values, the patient was awake, and the patient was ambulatory.
- The surgeon and CRNA made the discharge decision together.
- Patients were not discharged sooner than 25 minutes after the last dose of IV medication.
In the second-fastest organization, which discharged patients within about 40 minutes, less anesthetic was used. Only intravenous Versed was given, along with a local anesthetic to the knee. Patients were often awake and watching the operation. As with the organization that had the fastest discharge, instructions were given to the patient and accompanying person before the procedure began, patients often had crutches with them, and prescriptions for pain medication were often obtained prior to the procedure.
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