The Accreditation Association of Ambulatory Health Care Institute for Quality Improvement recently released the data from a survey on performing low back injections in surgery centers. The survey gathered data from 45 organizations that perform more than 55,000 procedures annually.
"Pain management has been a huge growth industry in the ambulatory setting," says Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute. "Pain management covers several forms of treatment, but we looked at low back injections, which are some of the most frequently performed pain management procedures in the outpatient setting. In the past several years, the shift to the ASC has been huge."
She discusses the survey results and what they mean for ASCs today.
1. Appropriate indications. More than 70 percent of the cases reported an indication of radiating pain from sciatica, which is appropriate based on most guidelines. "Sciatica is a good indication for a low back pain injection since it's one of the most agreed upon indications for success in different guidelines," says Dr. Kuznets. "We'd like to see the proportion of sciatica patients treated with low back injections in the ASC increase."
2. Procedure scheduling. Approximately 95 percent of patients reported scheduling a procedure within a reasonable amount of time after the initial diagnosis. Around 98 percent of patients reported an adequate understanding of the procedure to take place, due to patient education efforts.
3. Pre-procedure time. The median pre-procedure time was 60 minutes, with times ranging from 9-160 minutes. The fastest organizations attributed their quickness to preparations prior to the day of surgery and physician involvement in patient flow.
To avoid wrong-site injections, physicians also take some extra time preoperatively to prepare for the injection appropriately. "For spinal procedures, there is less recognition that marking the site is important because the spine is linear and there aren't two sides of the body to confuse," says Dr. Kuznets. "However, there is a potential for inappropriate sites or wrong levels to be injected."
She referred to national recommendations that physicians take time before the procedure to mark the appropriate sites themselves with the patients or caregivers present and conscious to give feedback, as well as have a pre-procedure pause to check that the physician has the correct patient, site and procedure planned.
4. Procedure time. The average procedure time was seven minutes, ranging from 3-14 minutes per case. About half of the cases included sedation and 99 percent used image-guidance, most often fluoroscopy. "Image guidance is something most guidelines recommend and payors require, so that's good," says Dr. Kuznets. "The injections were center- and patient-specific, and some included corticosteroids for therapeutic purposes."
5. Postoperative time. Dr. Kuznets noted that sedation contributed to lengthening the postoperative procedure time. "If you are using sedation, you will greatly lengthen the postoperative time because the recovery from that can be significant, especially if you aren't using short-acting agents," she says.
6. Discharge time. Discharge time ranged from 7-63 minutes, with a median time of 27 minutes. The organizations with the shortest times attribute their results to avoiding sedation and conducting pre-procedure patient education. "In our studies, we see over and over again that written discharge instructions are especially important for patient satisfaction and flow," says Dr. Kuznets.
7. Outcome satisfaction. There were around 82 percent of patients who reported the ability to perform their daily activities; many patients reported seeing functional improvement postoperatively. 76 percent of patients reported improvement in pain levels.
"With regard to functional issues, most of the patients were able to perform their usual daily activities, which is a good measure of how well an injection is working," says Dr. Kuznets.
8. Pain medication reduction. Around half of the patients reported reducing their pain medications after the injection. "We like to see patients reducing their pain medications, because these medications can cause negative side effects which are not great for daily functioning or productivity," says Dr. Kuznets.
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"Pain management has been a huge growth industry in the ambulatory setting," says Naomi Kuznets, PhD, senior director and general manager of the AAAHC Institute. "Pain management covers several forms of treatment, but we looked at low back injections, which are some of the most frequently performed pain management procedures in the outpatient setting. In the past several years, the shift to the ASC has been huge."
She discusses the survey results and what they mean for ASCs today.
1. Appropriate indications. More than 70 percent of the cases reported an indication of radiating pain from sciatica, which is appropriate based on most guidelines. "Sciatica is a good indication for a low back pain injection since it's one of the most agreed upon indications for success in different guidelines," says Dr. Kuznets. "We'd like to see the proportion of sciatica patients treated with low back injections in the ASC increase."
2. Procedure scheduling. Approximately 95 percent of patients reported scheduling a procedure within a reasonable amount of time after the initial diagnosis. Around 98 percent of patients reported an adequate understanding of the procedure to take place, due to patient education efforts.
3. Pre-procedure time. The median pre-procedure time was 60 minutes, with times ranging from 9-160 minutes. The fastest organizations attributed their quickness to preparations prior to the day of surgery and physician involvement in patient flow.
To avoid wrong-site injections, physicians also take some extra time preoperatively to prepare for the injection appropriately. "For spinal procedures, there is less recognition that marking the site is important because the spine is linear and there aren't two sides of the body to confuse," says Dr. Kuznets. "However, there is a potential for inappropriate sites or wrong levels to be injected."
She referred to national recommendations that physicians take time before the procedure to mark the appropriate sites themselves with the patients or caregivers present and conscious to give feedback, as well as have a pre-procedure pause to check that the physician has the correct patient, site and procedure planned.
4. Procedure time. The average procedure time was seven minutes, ranging from 3-14 minutes per case. About half of the cases included sedation and 99 percent used image-guidance, most often fluoroscopy. "Image guidance is something most guidelines recommend and payors require, so that's good," says Dr. Kuznets. "The injections were center- and patient-specific, and some included corticosteroids for therapeutic purposes."
5. Postoperative time. Dr. Kuznets noted that sedation contributed to lengthening the postoperative procedure time. "If you are using sedation, you will greatly lengthen the postoperative time because the recovery from that can be significant, especially if you aren't using short-acting agents," she says.
6. Discharge time. Discharge time ranged from 7-63 minutes, with a median time of 27 minutes. The organizations with the shortest times attribute their results to avoiding sedation and conducting pre-procedure patient education. "In our studies, we see over and over again that written discharge instructions are especially important for patient satisfaction and flow," says Dr. Kuznets.
7. Outcome satisfaction. There were around 82 percent of patients who reported the ability to perform their daily activities; many patients reported seeing functional improvement postoperatively. 76 percent of patients reported improvement in pain levels.
"With regard to functional issues, most of the patients were able to perform their usual daily activities, which is a good measure of how well an injection is working," says Dr. Kuznets.
8. Pain medication reduction. Around half of the patients reported reducing their pain medications after the injection. "We like to see patients reducing their pain medications, because these medications can cause negative side effects which are not great for daily functioning or productivity," says Dr. Kuznets.
Related Articles on Pain Management:
Pain Management Physician Compensation: 13 Recent Findings
10 Ways to Improve Profitability for Pain Management
Prevalence of Knee Pain, Symptomatic Knee Osteoarthritis Increasing