News and Views

OR Today

Davinder S. Ramsingh, MD

With the release on May 30, 2019 of the final report from the Federal government’s Pain Management Best Practices Inter-Agency Task Force, anesthesiologists need specific case studies on how to implement recommendations in their hospitals. This OR Today article, published by Davinder S. Ramsingh, MD, Director of Research and Perioperative Ultrasound at Loma Linda University Medical Center, Department of Anesthesiology, shares ten applications of point-of-care ultrasound, a modality mentioned in Perioperative Surgical Home (PSH) and Enhanced Recovery After Surgery (ERAS) clinical practice guidelines. The Task Force’s final report recommends to clinicians the use of multidisciplinary and multimodal approaches for perioperative pain control in selected patients at higher risk for opioid use disorder. Read Dr. Ramsingh’s article to learn more about how anesthesiologists and pain medicine specialties can incorporate point-of-care ultrasound with regional anesthesia or TEE, both potential elements of these multi-modality approaches.

AnesthesiologyNews.com

Theresa Bowling, MD

Enhanced recovery pathways (ERPs) have been shown to reduce costs and improve outcomes in nearly all surgical specialties, including shortening length of stay (LOS) by 30% to 50%, with similar reductions in complications and decreased readmissions. Compared with traditional care, ERPs have resulted in a cost savings of $6,900 to $7,129 per patient. This evidence-based approach to standardizing care of the surgical patient with best practices often includes regional anesthesia techniques, including ultrasound-guided regional anesthesia (UGRA), that result in longer block durations, faster onset times, improved block success, and a reduced need for opioids. In this article from the March 2019 edition of AnesthesiologyNews.com by Dr. Theresa Bowling of Integrated Anesthesia Associates, Fairfield, CT, learn about the results for several UGRA blocks and how to integrate them into your practice.

HealthManagement.org

Nidhi Nikhanj, MD

Obtaining vascular access is one of the most common procedures performed in U.S. hospitals, with more than 5 million central venous catheterizations (CVCs) performed annually (Feller-Klopman 2007). Nearly 80% of critical care patients undergo CVC (Gibbs; Murphy 2006) for administration of fluids, blood products, or vasoactive drugs; hemodynamic monitoring; hemodialysis or transvenous pacing during an inpatient stay (Sisson; Nagdev 2007). To learn how to reduce complications, such as central line associated blood stream infections, with placing a CVC and achieve the one-stick standard, please read the article by Dr. Nidhi Nikhanj from the March 2019 Issue of HealthManagement.org.

Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at Fujifilm SonoSite

HealthCare Business News

While providers continue to adhere to safe, low-dose imaging protocols, we are also seeing a trend toward finding new care pathways that use ionizing-free modalities. For example, more clinicians are opting to use point-of-care ultrasound over CT to diagnose appendicitis in children because it’s safer and has a very high accuracy rate. Many pediatric emergency physicians are an ultrasound-first philosophy because it delivers a speedier diagnosis. It’s less costly, safer, painless, and because children typically have low body fat, it’s easy acquire very clear images with ultrasound. Read this article in the March 2019 edition of Dotmed.com by Dr. Diku Mandavia, Chief Medical Officer, FUJIFILM SonoSite, Inc. to learn more about the future of pediatric imaging.

Becker's Hospital Review

Nishant Shah, MD

During the year 2030, the number of Total Knee Arthroplasty (TKA) surgeries in the U.S. is projected to surpass 1.28 million. A recent study suggests that outpatient TKA can provide a cost savings of approximately $8,527 per patient (as compared to the standard length of stay group). Outpatient TKA also provides faster recovery time and fewer required opioid prescriptions through the use of targeted ultrasound-guided nerve blocks. Dr. Nishant Shah heads the outpatient total joint replacement program at Midwest Anesthesia Partners. In this article, Dr. Shah explains the many benefits of using ultrasound-guided regional anesthesia to enhance ERAS protocols.

ICU Management & Practice

Dr. Gulrukh Zaidi, MD and Prof. Seth Koenig, MD

Physicians have used ultrasonography for more than half a century to aid diagnoses and guide procedures, but the advent of portable ultrasound systems that physicians can use to see and assess physiological function firsthand, and in real time, has revolutionized patient care in the intensive care unit. This shift from traditional ultrasound, in which a technician and/or consulting radiologist obtains and interprets patient ultrasound images, reduces dissociation in patient care and shortens time-to-diagnosis. What goal-directed applications of point-of-care ultrasound are recognized as being among the most valuable in critical care? In this article, Drs. Gulrukh Zaidi and Seth Koenig of Hofstra University present four areas in which intensivists can apply point-of-care ultrasound to improve outcomes in the critically ill.

Clinical Services Journal

Dr. Jim Corcoran, Clinical Director Perioperative Care, Salford Royal Hospital

Ultrasound guidance has proven invaluable for the regional neurosurgical center at the Salford Royal Hospital, outside Manchester, England. In addition to helping to improve patient safety, ultrasound is increasingly being used to guide regional anesthesia, offering a variety of benefits. Jim Corcoran, consultant neuroanesthetist and clinical director for perioperative care at the Salford Royal, says that ultrasound guidance also allows anesthetists to reduce the amount of anesthetic required to effectively block a nerve region (10-20 ml versus 30-40 ml using landmark/nerve stimulation techniques). Another benefit is a significant reduction in the length of stay required for patients who undergo shoulder surgery with regional nerve blocks – shoulder decompression used to require at least an overnight stay in the hospital, and is now regarded as an outpatient procedure with minimal in-hospital recovery time needed. Please read Dr. Corcoran's article to learn more.

Becker's Hospital Review

Jennifer R. Marin, MD, MSc

With the end of summer and children heading back to school and organized athletics, there will inevitably be injuries that may require a trip to the local hospital emergency room and clinicians need to be prepared. This article by Dr. Jennifer Marin discusses ten important applications for ultrasound used at the point-of-care to diagnose medical issues in pediatrics. Dr. Marin also discusses the fact that the American Academy of Pediatrics recently published its first policy statement endorsing the use of ultrasound at the point-of-care by pediatric emergency medicine. Ultrasound is an ideal diagnostic procedure for children whose smaller body size facilitates sound-wave penetration and resolution to generate images. Please read Dr. Marin’s article to learn more.

Anesthesiology News

Alexis LaPietra, DO

With the opioid epidemic ever present in US hospitals, emergency physicians working with anesthesiologists to manage pain in the ED setting are on the front lines of this urgent public health crisis. Alexis LaPietra, DO, a medical director for pain management in the emergency department of St. Joseph’s Healthcare System, shares some key takeaways and lessons learned when developing and implementing a formal program focused on novel alternatives to opioid prescriptions for pain. The ALTOSM (Alternatives To Opioids) program uses alternatives such as nitrous oxide, trigger point injections, Lidoderm patches, anti-inflammatory medications, muscle relaxants and ultrasound-guided nerve blocks, whenever possible, for appropriate patients to manage their pain in the emergency department. Read Dr. LaPietra’s article to learn more about how a program such as ALTOSM can be successful in your hospital.

Axis Imaging News

Diku Mandavia, MD, FACEP, FRCPC, Chief Medical Officer at Fujifilm SonoSite

Vascular access is one of the most commonly performed procedures in U.S. hospitals as up to 70% of patients require a peripheral intravenous (PIV) catheter during their stay. Each year, 200 million PIV catheterizations are performed. The American College of Emergency Physicians (ACEP) recommended in a 2016 policy statement that procedural ultrasound be utilized to facilitate access. In this article, Dr. Mandavia discusses patient safety improvements that are achieved in vascular access with "the one-stick standard."