Patient satisfaction can make or break the success of your ASC. As an anesthesiologist, I broke down 5 changes you can implement to keep your patients happy without costing you anything!  Here are my thoughts:

1. Carb Loading – If you’re still saying “NPO after midnight” reflexively to all of your patients, it’s time to change that. Abundant evidence, including revised guidelines from the ASA Taskforce on Preoperative Fasting that were issued in 2017, state that patients can safely ingest clear liquids up to 2 hours before surgery. Additional studies have shown that there may be benefits to carbohydrate loading before elective surgery, which can be accomplished by ingesting sport nutrition drinks such as Gatorade. The advantage to sports drinks is that they are more readily available and cheaper than drinks that are specifically made for preop consumption. Anecdotal evidence from scores of preop and PACU nurses suggest that patients feel better before and after surgery and have a lower incidence of post-op nausea and vomiting. Note – these guidelines apply to healthy patients. Check with your anesthesia staff about considerations for patients who are prone to delayed gastric emptying such as diabetics, patients who have had a gastric sleeve or bypass, etc. An added benefit is that well hydrated patients are easier to start IVs on.

2.  Local for IV Starts – It’s amazing what a little lido can do! Painful iv starts are a major dissatisfier of surgical patients, but it doesn’t have to be that way. Get some small gauge 1ml TB syringes and some 1% or 2% lidocaine. Make a skin wheal after cleansing the area with chlorhexidine or alcohol, and then pop the iv in through the skin wheal. For those of you who are saying “yes, but it’s 2 sticks vs just 1”, the patient doesn’t feel the second stick when the iv goes in. If I had a nickel for every patient who told me “that’s the best iv start I’ve ever had…” I’d be rich… Your patients will be happier, and your nurses will feel better about not causing pain with iv starts.

 

3. Preop Tylenol – For adult patients who don’t have a known contraindication to taking acetaminophen, a single 1,000mg PO dose preoperatively can have significant benefits in reducing post-op pain. In fact, preop acetaminophen is a cornerstone of almost every ERAS (Enhanced Recovery After Surgery) protocol. Although IV Tylenol has become popular in recent years, studies have thus far been inconclusive if IV administration is better than PO. The cost difference is significant however, so stick with PO if possible.

 

4. Family and Friends – Patient satisfaction is influenced by those around them. Yes, it’s more convenient for YOU if every patient’s ride home stays in the waiting room. But is it really convenient for that friend or family member? Is it really necessary? Ok, we all remember that one patient 4 years ago whose ride left and then didn’t return, but we need to stop punishing everyone else. Is there a coffee shop right next door? A shopping center? As long as you have the cell phone number of the friend or family member and they are close by, why not give them the option of leaving?

 

5. Direct to PACU Phase 2 – This requires coordination with your anesthesia providers, but it is definitely worth it. Have criteria in place for this option (is this the default for all uncomplicated MAC cases?). On average, patients will spend significantly less time at your facility if there is an option for direct to Phase 2 admission.

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