Georgia Hospital Engagement Network

Hospital Acquired Condition Affinity Webinar Series

3/19/2014

Dr. Roy Soto

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Dr. Soto is an anesthesiologist at William Beaumont Hospital in Royal Oak Michigan. Following his residency training at UCLA, he joined the faculty of the University of South Florida in Tampa, and then the State University of New York at Stony Brook. In 2007 he was recruited to Beaumont Hospital to start an anesthesiology training program, and he currently is the Residency Program Director. He also serves as a Professor of Anesthesiology at the hospital's affiliated medical school, and his research interests include patient safety, enhanced recovery after surgery, care standardization, and service excellence/patient satisfaction

Re-evaluating Safe Perioperative Pain Management

National Procedural NO Harm Affinity Group

Roy Soto, M.D.

Case Presentation

• 52yo s/p posterior cervical fusion• BMI 34

• OR pain meds: 0.5mg hydromorphone• PACU pain meds: 2.5mg hydromorphone

• Hospital course: dead within 2hr of arrival on ward

Overview

• Assumptions• MHA pain management toolkit• MHA data measures

0

10

20

30

40

50

60

70

80

90

100

Any Pain Slight Moderate Severe Extreme

Pate

ints

(%)

1993 1999 2012

6

Pain is Poorly Controlled

2001

2012

Opioids Cause Harm

Hospital X

Pain Control Drives Satisfaction

HCAHPS/Hospital Compare

Pain Control Enhances Recovery

• ↓opioids/↑multimodal analgesia leads to– Earlier return of gut motility– Earlier enteral feedings– Earlier mobilization– Earlier removal of drains/catheters

Implementation

• Baseline data collection– Gap analysis– Outcome and process data

• Implementation of MOSS tool• Education

– Physician– Nursing– Patient

• Reassessment and refinement

Implementation

Implementation

Patient Education

Gap Analysis Tool

Michigan Opioid Safety Score

Process & Outcome Measures

A. MHA Derived measures (numerator/denominator)1. % pts readmitted within 30d/total number surg proc2. HCAHPS q13

B. Process Measures (numerator/denominator)3. # surg pts receiving opioids/total number surg proc4. # pts eval with MOSS/total number surg proc

C. Outcome Measures(numerator/denominator)5. # surg pts rec Narcan/# surg pts receiving opioids6. # RRT opioid calls/# surg pts receiving opioids

Process & Outcome Measures

Educational Product

• Powerpoint with voiceover– Surgeon– Anesthesia– Nursing

• Live presentations• +/- CME/CE• Patient print product

Dynamic Processes

Contact Information

• Michelle Norcross, MSA – Michigan Health & Hospital Association Keystone

Center Project Manager– 517-886-8357– mnorcross@mha.org

• Roy Soto, MD– Beaumont Health System– roy.soto@beaumont.edu