Monday, June 18, 2012 - Connecticut Hospital Association Honors Greenwich Hospital

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Connecticut Hospital Association Honors Greenwich Hospital

2012 John D. Thompson Award given for successful outcomes of pain management protocols


Key members of the team that produced the hospital's first John G. Thompson Award are shown in the Helmsley Atrium, from left - Mark Chrostowski, MD, hospital anesthesiologist who headed the team; Tori Kroll, RN, joint replacement program coordinator; and James Duffy, MS, RPh, pharmacy systems manager. Other members of the team included staff from anesthesiology and orthopedics departments.

GREENWICH, Conn. – Greenwich Hospital has been named recipient of the Connecticut Hospital Association’s 2012 John D. Thompson Award for Excellence in the Delivery of Healthcare Through the Use of Data. The award will be given at the organization’s 94th Annual Meeting on June 27, 2012.

The Greenwich Hospital team led by anesthesiologist Mark Chrostowski, MD, is being recognized for A Novel, Comprehensive, Multimodal Analgesic Regimen for Joint Replacement Surgery. Total knee and hip replacement surgeries have become two of the most common surgical procedures performed in the United States; treatment of pain following these surgeries affects a patient’s comfort and compliance with physical therapy required for complete healing.

This new multi-modal approach has shown to reduce both pain and side effects of medication following joint replacement surgery. Chrostowski worked collaboratively with Greenwich Hospital’s joint replacement program coordinator Tori Kroll, RN, and pharmacy systems manager James Duffy, MS, RPh, plus other members of the hospital’s anesthesiology and orthopedics departments.

The results were dramatic:

“Of the 424 patients for whom we collected data between January 2011 and February 2012, patients who received this new protocol, on average, used 40% less opioids during their entire hospital stay, and the average use of patient-controlled analgesia (morphine pump) decreased by 47%,” according to Dr. Chrostowski. Data was collected from medical records and patient surveys.

The approach begins prior to surgery by starting the patient on non-opioid medications to control pain and inflammation. A local anesthetic to numb the joint area is then given either by single injection or a peripheral nerve catheter. The catheter tube is inserted through a needle and placed near nerves associated with anticipated surgical pain.

“The procedure to insert the catheter that dispenses the numbing agent is easy to perform and can be completed in less than five minutes under mild sedation,” explained Dr. Chrostowski, adding, “We use a state-of-the-art ultrasound machine that allows us to see, in real time, the nerves, surrounding muscles, blood vessels and the medication as it spreads around the nerve.”

After surgery, the patient continues to receive non-opioid oral medications as well as the numbing medication through the peripheral nerve catheter, which is attached to a disposable pump.

Because opioid use was reduced, so were the side effects from these potent medications. For instance, nausea and vomiting decreased by 49% (31% vs. 16%) and 54% (17% vs. 8%) respectively. Pruritis (itchiness) decreased by 97% (26% vs. 1%). Urinary retention decreased by 73% (32% vs. 9%), reducing the need for Foley catheters. And because patients felt more comfortable, they reported increased compliance with post-surgery physical therapy.

“The goal is to return each patient back to their regular activities with reduced pain and a better range of motion,” said Chrostowski, who sees potential for using this approach for patients undergoing bariatric, major gynecologic, oncologic and other types of general surgery.

Surveys showed that patients reported increased satisfaction with their overall experience. When compared to 854 other hospitals that participate in a national satisfaction survey, Greenwich Hospital is now ranked in the top 95th percentile.

Winners of the prestigious John D. Thompson Award have achieved excellence in patient care through the use of data, as demonstrated by the improvement of internal operations, procedures, and outcomes.