Up,Up,and Away:Early Ambulation Initiative Positively Impacts Patient Outcomes in Laparoscopic Cholecystectomy Patients

Purpose:
Relief of post surgical pain is a major medical challenge, and unrelieved pain is one of the strongest predictors of prolonged post operative stay.Administration of preemptive pain medication and innovative practices can minimize negative pain related outcomes and increase patient satisfaction

Significance:
In 2007,during the months of April,May and June,11 % of our total volume of patients having Laparoscopic Cholecystectomy procedures were admitted for 23 hour stays for uncontrolled pain management.Our goal was to improve patient's overall experience through innovative best practice interventions.

Strategy and Implementation:
In the first phase of this multidisciplinary project lead by nursing, analysis,utilizing Six Sigma (DMAIC ) and Lean processes house wide inconsistencies in the management of pain were identified.In the second phase of the project, the team leveraged data from random sampling of cases from 2007 through 2008,focus groups, and practice reviews from Anesthesiology and Nursing teams. As a result of the data,a new pain management delivery protocol was initiated and launched in 2008 based on best practices and modeled after our top performing Anesthesiologists. New ambulatory chairs were introduced into the PACU IN 2008 through the combined efforts of the Day Surgery and PACU Nursing teams initiating an "Early Ambulation " program that significantly promoted faster post operative recovery and reduced overnight admission stays for these patients.

Evaluation:
Scores for patient satisfaction relative to the degree pain was controlled increased from 90.4% in 2007 to 97.1% in 2010.The introduction of better pain control practices and early ambulation also resulted in declining patient admission rates from 11 % in 2007 to 1.6% in 2010.

Implications for Practice:
While there are many factors that affect patient outcomes,we found the following to be intergral to our success: Early Ambulation demonstrated through the chair initiative. Improved preemptive analgesia administration through the new pain assessment and medication delivery protocol