As ASCs continue to fine-tune pain management, patient selection and the use of technology advancements, more and more high-acuity spine and orthopedic procedures can be successfully shifted to this safe site of care.
During an October webinar hosted by Becker's Hospital Review and sponsored by Surgery Partners, four ASC experts discussed how they have successfully transitioned certain high-acuity patients to the outpatient setting. The panel included:
- Kenneth Nwosu, MD, NeoSpine and Microsurgical Spine Center in Puyallup, Wash.
- David Schall, MD, Valley Bone & Joint Clinic, North Dakota Surgery Center in Grand Forks, ND
- Trent Webb, senior vice president of operations, central region, Surgery Partners
- Nicole Moreland, RN, BSHM, MHA clinical nurse specialist, outpatient total joints, Advanced Surgery Center in Omaha, Neb.
Five insights:
- Hastened by the pandemic, the shift of surgical procedures to the ASC is expected to continue. "COVID really accelerated things," Dr. Schall said. "All of a sudden, I started having many patients come to me and say, 'I don't want to be at a hospital' during the pandemic."
- Selecting the right patients requires baseline measures and experienced, instinctive judgment. Although ASCs follow a strict patient selection criteria that help identify patients as good candidates for outpatient surgery, personal interactions play an important role as well. "Several parameters would exclude a patient, such as a high BMI history of any type of transplantation," Ms. Moreland said. "However, a nurse navigator who can lay eyes on a patient may see other things, like signs of infection or swollen ankles that might contraindicate [a procedure]." Dr. Nwosu added that if he's uncertain about a particular patient, he consults with his anesthesia team. "I think having that system of checks and balances is important."
- Better, more systematic pain management plays a big role in successful surgical migrations. Dr. Nwosu explained that many overnight stays are often due to pain issues. "The question for me, then, is what can we do pre-op, inter-op and post-op to mitigate that pain and allow the patients to have a good outcome and be discharged the same day," he said.
- Technological advances and a trained staff make outpatient procedures safer, easier and more cost effective. Robotics and other technologies have advanced in recent years. "For example, we've started doing endoscopic spine surgeries in our ASC," Dr. Nwosu said. "Instead of stripping the muscle tissue, I'm able to perform an adequate decompression with an incision that's less than one centimeter." In addition, both workflows and support staff care are more consistent throughout the process. "I believe my outcomes are better because we're able to be consistent," Dr. Schall said. "There's definitely a continuity of care you can't get in a hospital."
- Developing a comprehensive vision of resources, costs and payer contracts is important in building or expanding an ASC. According to Mr. Webb, ASCs should "prioritize deployment capital and determine the best use of resources." He advised, "Develop a comprehensive picture of what the program looks like from an intake flow of your total cases, your reimbursement and your cost. Those can certainly make or break a program."
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