On a rural placement between her second and third year as a medical student in the 1980s, Dr Kelly Mayson got paired with a rural GP who had just completed training in anesthesiology. “It opened my eyes to what it was all about,” she said, and soon after decided to make it her career.
Anesthesiologists usually focus on providing care in the immediate time period before, during and after surgery. But early on in her career, Dr Mayson wanted to see if longer term preparation before surgery might help patients in their recovery.
Now an anesthesiologist and clinical professor at Vancouver General Hospital (VGH), Dr Mayson’s passion is surgical patient optimization, a field of healthcare quality improvement that focuses on optimizing patients’ health before surgery in order to improve their outcomes. Dr Mayson was inspired to take this on after seeing patients experiencing prolonged hospital stays due to poor pain control, nausea, vomiting, hyperglycemia and anemia – and wondered what could be done to prevent these complications.
"Seeing these things made me realize that if we put more time and energy into the patient prior to and during anesthesia we could provide better patient care,” she said. “The whole thrust of patient optimization is to work with the entire patient care team — surgeons, anesthesiologists, GPs, internists — well before the operation to identify and manage any modifiable risk factors for post-operative complications.”
Dr Mayson’s work centers around ensuring patients are as healthy as possible before going into a major surgery in order to optimize their recovery. Before a surgery, patients are checked for pre-existing health conditions, such as diabetes or anemia, and for possible harmful behaviors, such as smoking, drinking or drug use. The waiting time for surgery is then productively used to optimize mental and physical conditions by eliminating harmful behaviors, or taking supplements/medications, or simply exercising.
“We can never reduce the risk of post-operative symptoms to zero, but there are ways to minimize them,” said Dr. Mayson, noting that about 30 percent of patients have significant post-operative symptoms in the first 24 hours after surgery.
Dr Mayson is now the co-lead of the Surgical Patient Optimization Collaborative, a new provincial initiative funded by the Specialist Services Committee (SSC) that has started in six pilot sites in BC, including VGH. The collaborative is an 18-month-long initiative that will explore techniques and collect data on patient optimization and its effectiveness. It is set to expand to other BC hospitals in the fall of 2019.
"Our goal for the project is to improve screening for patients who would benefit from optimization," said Dr. Mayson.
The payoff from the optimization comes in preventing postoperative complications, reducing length of stays, reducing re-admission rates and generally enhancing patients’ health and experience of care.
“We have a really great, enthusiastic team who are all really eager to work on this. It is something that I hope to see in the next few years expand to all hospitals in BC,” said Dr Mayson.
Dr Mayson is one of many BC doctors who are making a difference through innovation, leadership and a commitment to her patients.
Doctors of BC is interested in profiling physicians you know who are making a positive difference for their patients and in their communities. Drop us a line at firstname.lastname@example.org with your suggestions.