July 23, 2024
Taking the pain out of reducing hospital length of stay
By Neil Mayer, DO | Chief Medical Officer, Sound Anesthesia
As an anesthesiologist, my life’s work is to keep patients safe and comfortable through all types of medical procedures, often on the most difficult day of their lives. I’m grateful to live in a time when advancements in anesthesia allow clinicians who share that goal to provide better care than ever before. One of the most exciting developments in our field is the use of novel anesthesia techniques to reduce patients’ length of stay (LOS) in the hospital.
Hospital LOS is an ongoing focus across all specialties, as we have learned that more time in the hospital does not necessarily equate to better outcomes. LOS reductions facilitate a positive patient experience, allowing patients to recover in the comfort of their homes. Patients are less likely to suffer from the deleterious effects of prolonged admission including emotional distress, infections, or the myriad consequences of immobility. Shorter LOS benefits the hospital as well by conserving supplies, limiting unnecessary expenses, and permitting better access for all.
How can anesthesia teams make a difference in length of stay? At Sound, we know that when innovation is imbued in the culture and model of anesthesia care, anesthesiologists and certified registered nurse anesthetists (CRNAs) have a major impact on reducing length of stay and facility readmissions. Our teams intentionally champion three key areas to reduce LOS: pain management, collaboration, and workflow efficiency.
Pain management
Persistent pain is an unfortunate, yet common, reason patients remain in the hospital beyond their other medical needs. Through effective pain management, anesthesia clinicians can significantly contribute to reducing a patient’s length of stay. A comfortable patient is a confident patient, and when confident patients leave the hospital, they are more likely to follow discharge instructions that reduce their risk of readmission. Our team utilizes multiple approaches to improving our patients’ conditions, including an emphasis on multimodal analgesia and timely regional nerve blocks. While these concepts are not unique to Sound, their prevalence reflects an industry-leading commitment to patient satisfaction and efficient hospital partnership.
Regional nerve blocks
Regional nerve blocks are especially important in rapidly eliminating pain with minimal downside. This technique blocks the body’s ability to perceive pain from a given area, providing immediate relief for a prolonged duration, without the need for potentially harmful adjuncts like opiate narcotics. Nerve blocks have transformed the realities of pain management for intense procedures like total knee arthroplasties. A patient who used to spend days in the hospital after a joint replacement can now go home the same day as their surgery.
Nerve blocks are used best when anesthesia teams deliberately integrate them into their practice. Our teams use these blocks for all types of cases, and we emphasize consistent training to ensure clinicians work at the top of their licensure. Blocks are performed in the emergency room, as well as immediately before and even after procedures to limit operating room delays. Combined with multiple perioperative opiate-sparing adjuncts, patients go home with less side effects and quicker than ever before.
Collaborative group model
Exceptional pain management requires a comprehensive approach to patient care. As a clinician-led medical group, we create teams who nest into a hospital and take pride in their presence throughout the facility.
Collaboration begins with attentiveness to our hospital partners’ needs. Teams are designed and recruited with patients’ and clinicians’ best interests in mind from the start. Well-chosen teams, well-planned protocols, and recurrent follow-up create the optimal environment for effective groups working together to maximize patient experience.
We empower every anesthesia provider to review patients, cover cases, and perform procedures. Physicians and CRNAs support one another by leveraging each other’s unique training and experience to provide multiple layers of patient oversight. Backups are available, checks and balances are in place, and teams work together to do what’s best for patients at all times. This includes regular touchpoints where we routinely review schedules and look to standardize protocols in the interest of reproducibility and adherence to established best practices.
Efficient workflow and throughput
Our focus on maintaining involvement throughout the hospital, not just in the surgical suite, facilitates throughput and differentiates us from the anonymous anesthesia providers of the past.
We are happy to be involved in patient care during any aspect of their hospital stay. We collaborate with surgeons preoperatively to optimize patients and curate the ideal anesthetic experience for our patients. Evaluating patients early in their hospital stay puts our anesthesia teams ahead of the curve. We put our patients to sleep, wake them up, and follow-up on them later. We look for opportunities to improve our process long after the patient has returned home. At each critical juncture of a patient’s journey, we are there to advocate for their well-being and improve the care they receive.
Whether it’s establishing preoperative testing guidelines or implementing enhanced surgical recovery protocols, our influence on patients leaving the hospital in a timely manner is just as important as the safety we provide in the operating room. Our patients feel seen, fellow clinicians feel supported, and we all benefit from the best care possible.
Overall, reducing length of stay comes down to consistent intentionality. Intentional pain management, group models, and workflows combine to create an ecosystem of efficiency. When anesthesia team culture is rooted in collaboration, innovation, and clinical excellence, the results speak for themselves.