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REGIONAL ANESTHESIA Anesthesia Care Teams and Block Areas. NAPAN Conference Sue Belo MD PhD FRCPC May 23rd, 2009. HOLLAND CENTRE. The Holland Centre. AMALGAMATION 1998. Orthopedic and Arthritic Hospital. Sunnybrook Hospital. Orthopedic and Arthritic Institute SWCHCS.
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Sue Belo MD PhD FRCPC
May 23rd, 2009
Orthopedic and Arthritic Institute
Holland Centre 2005
Convert the Holland Centre to Regional Anesthesia
Regional Anesthesia requires time
Regional Anesthesia requires expertise
Regional Anesthesia requires co-operation
Regional Anesthesia requires a team effort
Investment for Improvement
Same Day Admission
Approached surgeons individually and as a group
Provided relevant literature (including surgical literature)
Involved Pre-Assessment Clinic nursing staff, ward nurses, OR nurses
Provided with literature, in-services
Invited to Block Area and PACU
educational sessions for Physiotherapy
feedback from Physiotherapy on issues in regards to rehab
revision of practice and protocols to address concerns with hypotension, prolonged motor block, etc.
consultation with Pharmacy re pre-op medications, pre-printed orders
established an Acute Pain Service under the direction of Nurse Practitioner and a dedicated anesthesiologist (Nov 2005)
developed best practices for post-op pain management (epidural analgesia, PCEA, oral analgesia protocols for THR, multi-modal analgesia regimens)
Developed protocols and standardization for selected procedures initially and introduced new procedures slowly
17% decrease in time for patient-in to patient-out from 2004 to 2007 in total knee arthroplasties
18.6% decrease in time required from patient-in to patient-out for total hip arthroplasties
Average LOS 4.8 days
67% discharged home (day 5)
24% short term in-pt rehab- 5 days (day 3)
9% longer in-pt rehab
Improved patient care
Retainment and Recruitment
(Anesthesiologists, Block RNs, Anesthesia Assistants)
Documenting improved outcomes
Expansion of program to Sunnybrook site
Maintaining expertise at 2 sites