Geisinger surgical redesign seeks to reduce opioid use

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On the heels of a successful pilot test last year, Geisinger Health in Pennsylvania is implementing an enterprise-wide surgical redesign program to decrease the use of opioids.

In June 2017, Geisinger launched a pilot test called ProvenRecovery, a surgical redesign initiative to expedite healing, improve pain management and reduce opioid use.

During the pilot, Geisinger achieved an 18 percent decrease in opioid use across the organization, while at the same time neurosurgery and colorectal surgery patients had their hospital stays cut in half, which drove $1.5 million in savings.

Now, the program is being implemented across 42 surgical procedures with the goal of reaching 100 surgical specialties by the end of 2019, while surgeons are working toward standardizing care processes to eliminate unnecessary variation in care, says Neil Martin, MD., chief quality officer and chair of Geisinger’s Neuroscience Institute.

“In my 35 years in surgery, this is the innovation with the greatest potential to improve the patient experience, save lives, reduce complications and be less disruptive to patients,” Martin explains. “With ProvenRecovery, we are empowering patients to be healthier before surgery, leading to fewer surgical complications and patients returning to their lives sooner.”

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Among the benefits of the program are that patients are coming in for surgery with a proper nutrition level that will help reduce infection and accelerate healing after the surgery.

In the pre-surgery consultation, patients get a kit with care instructions, mobility instructions, as well as fortified nutrition drinks to reach a proper nutrition level before surgery.

To avoid opioid use, patients are given non-opioid medications such as local anesthesia, acetaminophen, ibuprofen, gabapentin, ketamine and lidocaine. During surgery, pain is controlled by targeting only the surgical area, supplemented with the medications taken before the procedure starts.

To police use of opioids, hardwired protocols have been inserted in order sets within Geisinger’s Epic electronic health record system, with template order sets tied to each phrase of care. For example, there is a proven recovery order set for post-operative pain appropriate for the surgical procedure that was performed.

“Getting the right balance and providing the right drugs and dosages are guided by electronic order entry,” Martin says. “This is surgical care redesign at a level not previously seen and information technology is a key to that.”

Geisinger also is looking at using artificial intelligence technology to process data streams and identify high-risk patients who should be moved to a high-risk protocol.

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