Follow these steps to enhanced recovery
When seeking enhanced patient recovery in ambulatory surgery, being prepared is key, according to sources interviewed by Same-Day Surgery.
Selecting the right patient, then preparing them with calls and, in some cases, visits to the home to assess for safety are important, says Terri Link, MPH, BSN, CNOR, CIC, ambulatory education specialist in the Ambulatory Surgery Division of the Association of periOperative Registered Nurses (AORN).
"Clear discharge criteria using evidence-based practice along with follow-up after discharge, including postop phone calls and surgeon office visits, are necessary to intervene and prevent complications," Link says. A plan/pathway of care can ensure the patient recovers at home rather than a longer stay that might put the patient at risk for a hospital-acquired infection, she says.
Consider these specific suggestions:
• Use of electronic medical records (EMRs).
When fast-tracking patients began several years ago, patients might have felt hurried because nurses hadn’t finished the paperwork, says Rebecca S. Twersky, MD, MPH, professor and vice-chair for research, Department of Anesthesiology, State University of New York (SUNY) Downstate, and medical director, Ambulatory Surgery Unit, SUNY Downstate Medical Center and at Bay Ridge, both in Brooklyn.
"Now with electronic records, it’s not as cumbersome for document milestones to be met to be discharge-ready," Twersky says. "I think with the nursing staff’s continued commitment to patient education and to the families, the overall experience will be reviewed as favorable and positive."
• Nurses’ comfort with using clinical-based discharge criteria.
Nurses have accepted the move away from time-based discharge criteria, Twersky says. Much of the success falls to having excellent nurses in the postop care unit (PACU) and the step-down areas, she says. "If everyone is on board with treating common side effects, engaging patients and family in the recovery, that would be a path for a successful recovery protocol without increasing complications or readmissions," Twersky says.
