Five Essential Ortho-Anesthesia Metrics to Track for Better Outcomes

Improvement begins with measurement. While many orthopedic centers track basic metrics like PACU length of stay and on-time starts, those alone do not capture the full impact of anesthesia on patient outcomes or operational efficiency. Modern orthopedic anesthesia protocols influence infection risk, unplanned admissions, and even patient satisfaction scores. This guide outlines five critical key performance indicators (KPIs) that ambulatory surgery centers and office-based orthopedic practices should monitor to improve both care and business performance. It also explains how CRNA groups such as Advanced Anesthesia Services (AAS) can automate data collection to streamline the process.

1. Peripheral Nerve Block Success and Opioid Reduction

Why It Matters

High block success rates and minimized opioid use are directly tied to patient comfort, reduced side effects, and faster recovery. Lower opioid consumption on the day of surgery has been correlated with higher patient satisfaction scores and decreased incidence of nausea, dizziness, and delayed discharge.

Key Metrics

  • Block success rate: The percentage of patients who do not require conversion to general anesthesia or intra-articular opioids. A success rate of 95 percent or higher should be the standard.
  • Postoperative opioid use (POD 0 MME): The total morphine milligram equivalents consumed within the first 24 hours. A target of less than 50 MME indicates strong multimodal analgesia and effective nerve blocks.

These metrics can be pulled from a combination of electronic health record entries, medication administration records, and post-case CRNA documentation.

2. Same-Day Discharge Rates and Unplanned Admissions

Why It Matters

Timely discharge is essential for efficient PACU operations and bundled payment compliance. Most payers monitor these figures closely, especially in procedures like total knee and shoulder arthroplasty. A reliable discharge by 6:00 PM allows for better use of nursing staff and reduces the risk of overnight admissions that incur financial penalties.

Key Metrics

  • Same-day discharge rate: A target of 95 percent for knees and 97 percent for shoulders helps optimize ASC throughput.
  • Unplanned admission rate: This should be kept below 2 percent to remain compliant with payer guidelines and avoid penalties during audits.

Live dashboards, such as those provided by AAS, allow for real-time tracking so staff can proactively manage potential delays or complications.

3. Incidence of Moderate to Severe Postoperative Nausea and Vomiting (PONV)

Why It Matters

PONV is one of the most common and preventable reasons for unplanned emergency department visits within 24 hours after orthopedic procedures. Effective management significantly improves patient experience and reduces readmissions.

Key Metric

  • PONV incidence, grade 2 or higher: Defined as vomiting or retching that requires rescue antiemetic treatment. A target of less than 10 percent is considered optimal.

This metric can be captured through a simple check-box entry by PACU nurses at the time of discharge.

4. Nerve Block Bay Efficiency

Why It Matters

Measuring how long a patient remains in the block bay from the time the procedure starts to when they are wheeled into the operating room provides insight into staffing adequacy and procedural efficiency. This also helps identify opportunities to increase case volume without compromising care.

Key Metric

  • Median dwell time: A dwell time of 20 minutes or less confirms that block volumes are appropriate and that staffing levels are optimized. Reducing this metric by even seven minutes per case can result in a significant increase in billing opportunities over time.

5. Patient-Reported Quality-of-Recovery Scores (QoR-15)

Why It Matters

Collecting feedback from patients using a validated recovery score provides valuable insight into how patients perceive their surgical experience. The QoR-15 tool offers a standardized way to predict long-term satisfaction and proactively identify patients at risk for negative outcomes or reviews.

Key Metric

  • Median QoR-15 score: A score of 130 out of 150 or higher is associated with a net promoter score above 80 and indicates a positive patient experience.

Automated text messages sent on postoperative day one can streamline the collection of these responses.

Building an Effective Anesthesia Dashboard

Creating a real-time dashboard for these metrics involves integration across anesthesia electronic medical records, PACU notes, and prescription logs. Automated data cleaning and uploads can be managed through scheduled scripts. Visualization tools like Power BI allow for weekly performance snapshots, with team huddles assigning ownership to any underperforming KPIs.

Conclusion

Tracking five key metrics: block success, discharge reliability, PONV incidence, dwell time, and quality-of-recovery scores, offers a comprehensive view of anesthesia’s impact on orthopedic care. These KPIs not only improve patient safety and satisfaction but also enhance operational efficiency and payer compliance. Partnering with an experienced CRNA group that automates data capture and interpretation allows surgical practices to focus on what matters most: delivering exceptional care.

When surgery centers can’t find anesthesiologists, their operating rooms sit empty. We change that by delivering reliable anesthesia services to keep things moving. It leads to better patient care and no lost revenue.
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Thomas Nigro, Jr., Chief CRNA

Tom is a driven individual and supportive teammate. He received a Bachelor of Science degree in Biology from John Carroll University before completing his nursing training, Masters of Science, and Doctor of Nursing Practice degree from DePaul University. Tom’s CRNA training was through NorthShore University Health System School of Nurse Anesthesia. During his time at NorthShore he researched the topic of Substance Use Disorder and his work has subsequently been published. Tom recognizes that each person is unique. His careful examination of patient needs, and willingness to utilize progressive anesthesia practices provide for an individualized and excellent perioperative experience.
Christine Wilcock, Financial Officer

Christine Wilcock

Christine oversees the accounting and business development aspects of Advanced Anesthesia Services. She earned her accounting degree in 2010 and is experienced in all areas of medical accounting and billing. She is dedicated to our customers, ensuring the high-quality care our patients receive in the operating room continues through the billing and insurance payment process. Christine lives in Snoqualmie, Washington and has three children.
Allyn Wilcock, CEO

Allyn Wilcock

Allyn is the owner and oversees clinical operations at Advanced Anesthesia Services as well as Northwest Ketamine Clinics. He has worked in healthcare for over 20 years and earned his Master’s degree and anesthesia training from Texas Wesleyan University in 2004. He is experienced in all types of anesthesia. He is passionate about providing the best patient experience for all patients AAS serves. He was voted top CRNA in Washington State 2013, 2018, 2019, 2020 and 2023. Allyn lives with his wife and children in Snoqualmie, Washington.