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November 16, 2018 12:00 AM

Geisinger tackles post-op pain management without opioids

Steven Ross Johnson
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    Geisinger Health system this week plans to "redesign" its surgical program with a goal of improving pain management and reducing opioid prescribing after surgical procedures.

    The Pennsylvania-based health system Thursday announced a new program that will implement best practices developed over a yearlong pilot project across 42 of its surgical procedures. The goal of ProvenRecovery is to expand to 100 procedures by the end of 2019.

    Results of the pilot, which kicked off in June 2017, led to an 18% decline in opioid use across the system and $1.5 million in cost savings among neurosurgery and colon surgery patients in reduced hospitals stays.

    "In my 35 years in surgery, this is the innovation with the greatest potential to improve the patient experience, save lives, reduce complications and be less disruptive to patients," said Dr. Neil Martin, chief quality officer at Geisinger and chair of the system's neuroscience institute.

    The program focuses on nutrition, managing pain without the use of opioids and promoting the post-surgery mobility of patients.

    For example, patients prior to surgery would receive immunonutrition drinks as opposed to fasting in order to help boost their nutrition levels and reduce the risk of infection and accelerate healing after their procedure.

    Patient pain is managed through a combination of two or more different methods or medications as alternatives to using opioids. The program also prompts patients to move around and walk a few steps as soon as they wake up in the recovery room to expedite the return home.

    The program is one of a handful of efforts by healthcare providers to reduce clinician dependence on prescribing opioids after surgery, which has been found to put patients at higher risk for developing an opioid use disorder after a procedure.

    Recent studies have found that surgeons accounted for 60% of opioid prescriptions written three months following a surgical procedure, and that surgeons prescribe opioids at nearly four times the rate patients actually used them, leading to increased risk of misuse.

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