Postoperative Practice Management
When it comes to surgery, each phase is important in different ways. Preoperatively, it’s all about choosing the appropriate procedure in the appropriate patient and a thorough consent process. Intraoperatively, it comes down to executing the procedure effectively and efficiently.
The postoperative time period is unique in its own way. With all of the potential headaches and complications comes a significant practice building opportunity. In my short time as a podiatric physician, I’ve had the opportunity to witness a large variety of postoperative care regimens from other physicians. I’ve also had the chance to experiment with different postop methods myself and found some that have been successful and others that have failed miserably. The postop time period is the physician’s chance to provide value-added service that elevates the practice from typical to unique and high quality.
Obviously, good postoperative care requires excellent performance of the pre- and intraoperative phases, so let’s focus on the postoperative phase. Listed below are some successful postoperative practice management methods that I’ve either witnessed or tried myself over the past10 years. Write in with your tips and suggestions so we may all provide that high quality postoperative care.
Successful Postoperative Patient Management Methods
- Patient counseling. A smooth postoperative period starts with a well-educated patient. The surgeons I’ve observed who have the calmest patients are those that thoroughly educated them about the major steps in the surgical process. Additionally, this eliminates any potential surprises for the patient and reduces anxiety.
- Pre-prescribe postop meds. This one has to be considered with caution and should only be done with patients who you know and trust. If the patient has already filled the Rx, then they don’t have to worry about filling it postop. This makes for a smooth immediate postop period.
- Popliteal block. All of us are aware of the various anesthetic choices available for foot and ankle surgery. However, the popliteal/saphenous block is particularly effective for postoperative management. Typically administered by the anesthesiologist preoperatively this block achieves up to 30 hours of complete postoperative analgesia (average around 24 hours). I’ve found myself increasingly requesting this block because almost 100% of my patients who’ve undergone this have had a long term postop decrease in pain, even beyond the initial anesthetic period, as well as decreased use of narcotics. If your patients have less postop pain, they’re going to relate an improved overall experience. A couple of important notes here. First, this block takes an experienced doctor about 20-30 minutes and up to an hour by a novice. Take the extra time into consideration. Second, a saphenous block must accompany it (if you want to block the medial foot) since the saphenous nerve comes directly off of the femoral nerve, rather than the sciatic. Third, your patient should not bear weight on the limb until full sensation has returned (about 24 hours).
- Patient called by physician. I’ve done this one since the first surgery I performed in practice, and universally patients greatly appreciate a simple phone call the day after surgery. It’s also a good opportunity to do a review of systems and screen for medical complications like DVT, pulmonary embolism, and infection. I was initially surprised to find out how few physicians actually do this.
- Card/flowers/gift. While practicing in Michigan, one of the surgery centers I worked at would have everyone involved in the surgery sign a get well soon card. I found that to be a very caring and humanistic thing to do. On that note, I’ve always wanted to dispense a personalized gift pack that would be given to the patient upon hospital discharge. This gift pack could contain a pair of scrubs specific to your practice (especially useful for patients with casts), flowers, contact information, and various paraphernalia to keep the bedbound patient occupied. I’ve never actually tried this one, for the obvious reason that this would have a considerable cost.
- Expedited postop appointments. I was very impressed by one surgeon who had special expedited appointments for his postoperative patients. His patients had essentially no time in the waiting room. They went straight back into an exam room, radiographs were taken, the foot was elevated, and treatment administered quickly. Patients were in and out of the office in a matter of minutes.
- Long term follow-up. This may be more for the surgeon, but having the patient follow-up at 6 months and 1 year (if not longer) helps determine how successful the surgery actually was. It’s great if the patient can walk immediately after surgery, but if they have a recurrent bunion 1 year postop, then something went wrong.
- Leave your pager. This one is likely to be controversial, but I give my postop patients my pager number and tell them to call me whenever necessary. Now, most doctors would probably shy away from this one, wanting to avoid being bothered by frivolous questions. However, in my time as a surgeon thus far, I’ve only rarely had a patient abuse this. The benefit is simple: my patients have an open line of communication with me. If there’s a complication, the last thing I want is to get a phone call from the ER. Instead, I’ll have more control of the situation and can mitigate issues before they become emergencies.
The postoperative period is another opportunity to build a superior practice, and it is always the best businessmen that have such a strong grasp of this. With a little effort and creativity, many of the most successful practitioners manage to provide high quality postoperative care benefiting their practice and, most importantly, their patients.
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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