Winter 2018


Developing a Successful Regional Block Program By Greg Hickman and Terri Gatton


Hickman


As the opioid epidemic in this country has grown over the past several years, our ASC—the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Florida—set out to achieve a few related goals: reduce opioid administration (and, with it, the likelihood of addiction) without reducing patient satisfaction. Since 2010, the ASC has administered narcotics in the PACU setting to fewer than 11% of its patients while maintaining an overall patient satisfaction rating of 98%.


Gatton


The key to our success: regional blocks. The ASC has placed nearly 30,000 of them since opening in 2008.


Launching and Growing Where do you start when you want to build or enhance a regional block program at your ASC? If you are just beginning a dedicated program, engage your surgeons and, most importantly, your nursing staff.


Think of it like having a private scrub for the surgeon. A dedicated nurse will become proficient with the process, which will increase efficiency. This will increase throughput as well as surgeon satisfaction.


If you are already performing blocks, there are methods to increase engagement with physicians and staff. For example, commit to frontloading blocks in the morning and provide cross training to help ensure consistent coverage. Another important component is patient education and understanding of regional blocks.


Financials As with any new service, you will need to address the financial questions. Can the ASC bill for blocks? If so, how does that work? What is the expected reimbursement across payers? Answering these and other questions is critical for a successful regional block initiative.


In addition, you will want to factor in the cost of supplies, staff and other expenses related to these cases, as well as the expected net margin, into the decision of whether to proceed with a program.


Supply Storage New procedures bring new supplies. Determine the supplies you will need to perform these blocks, then assess storage availability and determine the most effective inventory management.


Staff Competency Carefully consider staff selection. Assess staff ability to multitask and work independently to keep the anesthesiologist on track. Consider using a staff competency checklist to help perform the assessment.


Include annual training for staff related to regional block safety and quality.


2 ASC PHYSICIAN FOCUS


Documentation Forms, either electronic or paper, need to be developed. Involving multiple staff in this phase increases buy-in from staff and can help prevent reformatting the forms repeatedly.


Critical documentation includes consents and policies and procedures. Ensure these are complete and always followed.


Quality Improvement A robust regional block program can be a great source for quality improvement study topics. Examples include patient engagement and tracking outcomes, decrease in opioid use and decrease in pain scores.


Learn More A good regional block program will ultimately enhance your center’s patient care. If you would like to find out more about our regional block program and what makes it successful, we are leading a discussion at the ASCA 2018 annual conference in Boston, Massachusetts. Hear our session, “Regional Block Program Development A–Z,” on Friday, April 13. Access the ASCA 2018 schedule at www.ascassociation.org/asca2018/ schedule. We look forward to seeing you there!


Greg Hickman, MD, is the medical director and anesthesia director, and Terri Gatton, RN, CASC, is administrator at the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Florida. Write Hickman at ghickman@andrewsinstitutesc.com. Write Gatton at tgatton@andrewsinstitutesc.com.


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


4 Reasons to Attend ASCA’s Annual Meeting


ASCA 2018—April 11–14 in Boston—is the can’t-miss meeting of the year for the ASC community. Here are just four of the reasons you and your staff should attend.


1. There’s something for everyone in your ASC. ASCA 2018 is jam-packed with more than 60 sessions. Experienced ASC managers will be talking about robotics, adding specialties, keys to joint venture success, new federal regulatory policies, strategic planning, bundled payments and more.


2. Advanced sessions. These are designed for ASC employees who have the basics in their respective fields covered and are looking to take their skills to the next level.


3. Networking. ASCA 2018 is the largest ASC meeting of the year. There’s no better opportunity to explore new ways to improve your ASC and its bottom line.


4. Exhibit hall. With 200-plus product and service providers, find the partners that can help grow your bottom line.


Learn more and register at www.ascassociation.org/ ASCA2018.


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