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An electronic surgical order, undertaking patient education, and obtaining informed consent for regional analgesia before the day of surgery reduce block-related delays

Authors Brooks BS, Barman J, Ponce BA, Sides A, Vetter TR

Received 21 June 2016

Accepted for publication 25 July 2016

Published 5 October 2016 Volume 2016:9 Pages 59—64

DOI https://doi.org/10.2147/LRA.S115432

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Dr Stefan Wirz


Brandon S Brooks,1 Joydip Barman,2 Brent A Ponce,3 Alisa Sides,4 Thomas R Vetter1

1Department of Anesthesiology and Perioperative Medicine, 2Department of Health Care Organization and Policy, 3Division of Orthopaedic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 4Community Health Systems, Franklin, TN, USA

Background: Obtaining patient informed consent for a regional analgesia block on the day of surgery can result in surgical case delays. We hypothesized that implementing a preoperative electronic surgical order, undertaking patient education, and obtaining informed consent for a regional block in our preoperative assessment clinic prior to the day of surgery would reduce surgical case delays attributed to our regional anesthesia pain service and increase the percentage of patients for whom our regional anesthesia pain service was requested to provide a block.
Methods: A prospective two-group time-series design, with a nonrandomized, pre- and post-intervention data collection strategy, was applied. Based upon the surgeons’ newly implemented preoperative electronic outpatient orders, patients were identified by our preoperative assessment clinic staff to receive educational materials. The attending anesthesiologist in the preoperative assessment clinic then obtained written informed consent. Block-related delay and utilization data were analyzed with conventional inferential statistics.
Results: We observed a 14.8% (95% CI: 9.4%, 20.1%; P<0.001) decrease in surgical case delays, attributed to the regional nerve block, in the post- vs pre-intervention group. In addition, there was a 9.9% (95% CI: 4.7%, 15.1%); P<0.001) increase in the proportion of patients for whom a regional nerve block was ordered by our three high-volume orthopedic surgeons in the post- vs pre-intervention time periods.
Conclusion: When performed before the day of surgery, a surgeon’s electronic order, patient education, and informed consent for regional postoperative analgesia can improve patient throughput, thereby reducing block-related operating room delays. The preoperative assessment clinic can serve as a venue to achieve this goal, thereby adding value by decreasing downstream delays on the day of surgery.

Keywords:
regional analgesia, peripheral nerve blockade, informed consent, patient education, performance improvement
 

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