Hello, everyone. This is Erica Spicer Mason with
the Becker's Healthcare Podcast Series. Thank you all
so much for tuning in today.
I'm thrilled to be joined by Doctor. Greg
Colbath, an orthopedic surgeon with Spartanburg Regional Healthcare
System.
He's also fellowship trained in sports medicine and
shoulder reconstruction.
Today, doctor Colbath and I will talk about
how ASCs can enhance at home care and
increase patient satisfaction
after surgeries.
Doctor Colbath, welcome to the podcast. Thank you
so much for joining us today. Thank you
for having me aboard, Erica. Appreciate it. Yeah.
We're thrilled to have you with us. And
before we get into our conversation,
can you share just a little bit more
about yourself,
any detail, anything about yourself that you think
would be helpful for our audience to know?
Certainly. I've, been practicing for about 15 years
now. I'm based in Spartanburg, South Carolina.
One of the things that I've,
you know, focused on primarily after my fellowship
was sports medicine shoulder reconstruction. And,
despite all these surgeries that we do, shoulder
surgery can be painful. We found that to
be
that patients come with the notion
that it can be painful, but we've
been able to come up with better ways
to treat pain following surgery before surgery.
And I think that's allowed us to have
the shift to,
be able to take care of patients,
treat them,
with less pain, faster recovery.
And, ultimately, that's that's kind of the the
the whole goal is to get these patients
back to their prior level of function.
So that's what I find challenging anytime we
have, new technology and new strategies in order
to, try to maintain that, and, that's our
goal. That's what we're always striving for.
Yeah. Doctor Colbatch, thanks so much for sharing
a bit more about yourself. And you kind
of touched on something that was top of
mind for me as we're diving into this
conversation, and that's, you know, you're trying to
get patients
back home and back to their regular life
after their surgeries as quickly as possible.
And we know that that's something that's really
driving that rapid growth in the ASC space
right now. Patients really appreciate that ability to
return to normal, so to speak,
quickly as possible.
So can you explain the challenges
that patients face with medication management,
especially disposing medications
once they leave an ASC after their procedure?
Certainly.
The last 10 years, that's really been my
goal is to try to reduce the amount
of opioids that we're prescribing to our patients.
And not because I'm trying to be a
nihilist or not understand
they're having pain, but
we know that we can do a better
job for the patients and their recovery
if we can limit that. And we don't
always do it completely
opioid free, but if we can limit that,
then the patients do better afterwards. And study
after study has shown that. And we no
longer have the issues
with the side effects, whether it's constipation, nausea,
vomiting,
secondary,
or unintentional falls. I mean, all those things
we'd see with our patients after coming in
for a routine
outpatient surgery
and,
felt like it's that we we could do
a better job. And so
by being able to provide patients with what
we call multimodal treatment,
and that can entail everything from
anti inflammatories,
ice, compression,
early physical therapy,
general range of motion, compression.
All of these things can can help,
provide that pain care afterwards and including some
of the regional blocks we have now. So
we've really come a long way, I think,
in the last 10 years of of being
able to do this, effectively
with a safe discharge to home. That's always
our goal, safe discharge to home for these
patients
and ultimately get them back where they need
to be sooner and with less complications and
less side effects.
Yeah. Thanks so much, doctor Colbath. And, you
know, as patients are
going home more quickly, which is something that
they appreciate
about,
you know, what ASCs are enabling them to
do in terms of their recovery.
Where does medication management fall
fall in there? You know, are there particular
considerations,
maybe safety considerations, other things like that when
it comes to medication disposal that that need
to be top of mind, not just for
patients, but providers as well.
Right. I think,
the biggest thing for me and the biggest
wholesale shift was
about 8 years ago, really involved in this
opioid reduction strategy. How can we do a
better job? And one of the things, that
I was
fortunate to to be a part of was
a task force here in our local community
to through our medical society
to
try to look at some strategies. How can
we do a better job? Is it, drug
take backs? Is it,
decreasing the, prescriptions that we're giving?
And one of the tools that came to
the that kinda bubbled up to the top
was,
the simple
strategy. It's a disposal bag from Deterra.
And,
what it allows us to do is it's
basically a a pouch with charcoal,
kind of a formulated
charcoal. You can add any of the unwanted
pills
after the patients have finished using the medications
postoperatively
and add a little bit of water and
then shake it up, so like a ziplock
bag.
And then that allows for the medications to
be neutralized
and then also safely disposed. You can then
put this in the trash. It goes in
the the waste system rather than flushing it
down the toilet
or leaving it in your medicine cabinet or,
you know, for a rainy day. And that's
that's where diversion and misuse
comes into play. And these patients,
you know, keep the medications unfortunately around,
and it can fall into unwanted hands. And
so
this is a a a good strategy. We
felt this was,
very effective. And one thing I I found
was even more effective was having this discussion
at the beginning
of their surgical planning. So not after
surgery, 1 week later,
but within their preoperative discussion,
we would provide all of our patients with
these the tear bags. And it really allowed
us to have that conversation early,
and recognize it and start the discussion then
with a very non threatening manner
and get some patient buy in. You know,
put the impetus on the patient
to be,
you know, part of their their own pain
control
afterwards.
So I think it's very effective.
We are very fortunate enough to get a
grant through our foundation, our
our Spartanburg Regional Hospital Foundation.
We were able to purchase about 5,000 bags
to, start this this program.
And it's been very well received in the
community. Initially, I thought it was gonna have
a
lot of pushback from patients, saying I'm not
treating their pain well. But we found that
most patients didn't need all the pain meds
that we were giving them. And I've ratcheted
it down from when I started
my practice 10 years ago from maybe 30,
40 pills to now we're only giving 10
or 15.
And even then, most of the patients are
saying they still have pills left over. The
average,
number of pills that our patients are taking
are 5 or 6
after any given shoulder surgery, whether it's rotator
cuff repair
or a total shoulder replacement.
And, we're we're having good success, and the
patients are are participating with it. So it's
been really one of the easiest things we've
been able to implement,
beyond all this other innovative technology that can
be pricey and expensive.
This is simple, effective, and it allows a
patient to have some control of their own
perioperative
or postoperative pain management.
So that's but nothing but a win for
us.
Yeah. Doctor Culbeth, I I really appreciate you
sharing all these details. It it's great to
hear that you were able to secure that
that grant to purchase 5,000 bags. And to
say that this was a really easy to
implement and kind of an easy win for
your organization,
that that's huge.
And, the fact that patients are feeling more
involved in their care sounds like a big
win as well.
So for other leaders who are kind of
intrigued by this idea and who maybe have
considered,
safe medication disposal as part of a safer
medication practice and protocol.
What are other what are effective ways that
you would recommend that they kind of start
to implement these practices
within their patient base. Can you share any
best practices or next steps?
Certainly. And part of it, I may have
touched on some of those multimodal pain regimens.
So, the ice, the compression,
and then the anti inflammatories, and that's actually
been shown to have better pain relief than
narcotics.
So that's part of it. We've been very
fortunate to have dedicated anesthesiologists
who are fellowship trained in regional blocks with
ultrasound.
So there's a lot of advancement
on that end.
And then for a system,
some of the, I guess, the the drug
control or the medication disposal
options are to to engage
your systems and make sure we have drug
take backs. Also,
drug disposal
boxes are very common now. So back when
we started this kind of crusade, if you
would, 8 years ago,
the pharmacies
were more than happy to fill the prescriptions
for you. But they did not want you
to bring any unwanted medications back to them
in a brown paper bag because they felt
it was liability, and,
they didn't want to have that chain of
custody. But now just about every
major retailer and and even local pharmacies,
will be happy to take those back for
you. We have some drug disposal boxes,
at our facilities at, not only in our
hospital, but also at the fire stations and
police stations. But not everyone's wanting to take
their day out to go to swing by
the police station to do that. So we
try to make it a little bit more
easy,
for them, a little bit more accessible.
And one of the things I found in
some of our discussions in the community is
that this is actually a green measure. So
we talked to the wastewater management managers, and
they don't want these things being flushed down
the toilet. It seems like an easy solution,
but, it contaminates the the water supply. It,
is very costly for them to have to
process that. So the the safest way is
this disposal
mechanism,
whether it's a drug disposal or whether it's,
through the the tear vacs.
So those are all,
sort of multi pronged approach in order to
to get this engagement and and, hopefully, get
some of these pills, unwanted pills, off the
streets.
Yeah. It's fascinating how something as small as,
you know, a few leftover
pills in a prescription could go so far
as to contaminate
any water waste, as you mentioned, doctor Colbath.
And then, of course, there are other
ramifications for the home and for patients and
their family members. So it's a really important
issue that you're touching on here.
And kind of as we close our discussion,
I'd love to know if there's any innovations
or trends in this space that you're particularly
excited about that you'd like to highlight for
listeners?
Certainly. I would say that, you know, 8
years ago, this is a very hard discussion
to have with patients.
If you told them, hey. We're in the
middle of a drug crisis or an opioid
epidemic,
most patients said, well, I don't
see it. But luckily,
the press and multiple organizations have have been
very effective as far as getting the word
out. And I think the the general public
is is well aware that we are facing
this, and there's so many ramifications,
not only in the medical community, but also
in just our our general community. And so
that has been very helpful. So that conversation
is a lot easier to have on the
front end now.
Moving forward next year and, January 1,
the no pain act will now mandate that
Medicare reimburse,
for qualified
non opioid options, at all outpatient surgical
facilities and procedures. So now allowing for some
reimbursement for,
some of the innovative technology that's available. So
long acting injections
for your regional blocks
There's 1. Another is, for other modalities
as far as long acting non narcotic pain
medications.
So these reimbursement strategies that are now gonna
be covered by Medicare
and accepted,
I think are are very exciting that we
now have these tools available for us and
that, even our legislation is is getting behind
us. So that's that's exciting for us.
Physicians here in our own community have looked
into, some other,
I call it,
you know, other non opioid options such as
laser treatment,
physical therapy. All of these are are good
options,
to help in that postoperative pain period to,
make sure that we're reducing and minimizing
the amounts of opioids we're needing to use.
I have several patients who now come to
me because they know that I'm I'm opioid
sparing
surgeon,
with a sole intent purposes. Let's get through
the surgery without doing any opioids as well
at all. And I think that is, is
encouraging. That tells me that we've we've,
we're making some strides.
And I get it. I know this is
this is we we're surgeons. We, we we
we can put some some hurt on patients
with, we're not careful. And so, I've gone
through it myself. I had back surgery about
4 years ago, and I was determined to
go through it without having any opioids. And
I was able to do it with,
anti inflammatories, ice, compression.
And I was early moving, got back to
the office pretty soon. So within a couple
of days, I was
back to, I'd say, 90% normal. And so
it's all about getting through that storm of
surgery,
having a good support group, and knowing that
you can do this without opioids. And I
think that's the key.
Yeah. Doctor Culbeth, really appreciate how you've highlighted
kind of the current state and how the
public is seeing this topic, kind of some
best practices in prescribing and the multimodal pain
management,
and then also how you're
encouraging your community to safely dispose of their
medications. It's it's been a really interesting conversation,
and I appreciate it so much.
Before we we end our time together, were
there any other final thoughts you wanted to
share with listeners?
I think the biggest thing is have this
discussion even with your younger patients or even
with patients who you think may not be,
you know, exhibiting the drug seeking behavior. The
the more you discuss this and the more
that you provide some awareness about it, everybody
is going to have somebody, either a family
member or a coworker,
who has been affected by this. And
it's something that I think is probably the
most impactful
way that I've changed my practice in the
the 10 years that I've I've been in
practice is to be more aware of this
and to be proactive. And, again, that's that
discussion needs to start before you even consider
surgery. And so,
Plan For Pain is, one of the other
sites you can go to,
but awareness and then just being vigilant. So
it's amazing how many patients I think we
have saved
by implementing these things. So it's it's, it's
probably the most impactful thing for my my
practice. So I'm very thankful for all of
these organizations
coming together and, providing this because it's we
can all get behind this. Right? It doesn't
matter what side of the political aisle you're
on. Everybody can get behind this and say
this is this is worthwhile for our communities
and our patients.
Absolutely. Doctor Colbath, fantastic insights. Thank you so
much again for your time and the great
discussion today. It was great having you here.
Thank you for the opportunity, and appreciate all
the work you guys are doing.
And we'd also like to thank our podcast
sponsor for today's episode, Deterra.
You can tune into more podcasts from Becker's
Healthcare by visiting our podcast page at beckershospitalreview.com.