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“Certain cases are appropriate for the ASC setting and others are not,” Asher says. “We have to be par- ticularly careful when screening patients be - cause present regula- tions require patients to be discharged with in a 23-hour window. In that regard, patients hav ing surgery in an ASC need to meet specific crite- ria related to medical co-morbidities, anti- cipated pain control needs and the extent of planned surgery.” To make an ambula-


tory surgery successful, Asher’s team counsels patients preoperatively and creates realis- tic expectations about every aspect of their anticipated experience in the ASC.


Sohrab Gollogly, MD, Monterey Spine and Joint and Monterey Peninsula Surgery Cen- ter in Monterey, Cali- fornia, also consid- ers managing patient expectations to be a critical part of perform- ing a high-acuity sur- gery successfully in the inpatient setting. Before surgery, a


nurse educator on Gollo- gly’s team does one-on- one teaching sessions


with each patient. “The nurse educator is the first step of patient education in the preop stage,” he says. “Ninety-nine percent of that session is education and setting expectations.”


Gollogly and his team have devel- oped a preoperative assessment tool to determine who can have a successful


outpatient operation. “It is a 10-point scoring system with six preop ques- tions, BMI and ASA category deter- mination and


expected tourniquet


time,” he says. He presented a descrip- tion of this protocol and the results of 100 consecutive hip and knee replace- ments using it as a screening tool at


the American Academy of Orthopae- dic Surgeons (AAOS) annual meeting last year. “This paper found that 100 percent of patients who were selected for outpatient joint replacement using this protocol were able to leave the center within 24 hours and had high patient satisfaction rates and minimal


ASC FOCUS FEBRUARY 2018 |www.ascfocus.org 9


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