Thomas Wherry, MD, an anesthesiologist, medical director of Health Inventures and principal for Total Anesthesia Solutions, a company dedicated to finding strategic solutions for issues relating to anesthesia care, discusses four ways ASCs can make improve anesthesia provision more efficient.
1. Deal with patient's concerns in the preoperative stage. Successful ASCs should have an organized and comprehensive pre-op triage system that coordinates well with the anesthesia service. If the patient has a unique anesthesia concern or medical issue, there must be a mechanism for anesthesiologist or CRNA to review these patients. You don't want that conversation at 7:00 in the morning when the patient is waiting for surgery.
2. Agree on anesthesia guidelines. Anesthesiologists and CRNAs working in the ASC should agree on consistent guidelines for such issues as weight limits and medical condition of patients. Inconsistent guidelines can cause problems when one anesthesiologist approves an obese patient for surgery but is not there for the surgery. Arbitrary or inconsistent guidelines will undermine the pre-operative system.
3. Build a regional anesthesia program. Using a peripheral nerve block can improve efficiency but it requires changes in the ASC to be efficient. There needs to be a space in the pre-op area to administer the nerve block, carts need to be set up with supplies and a nurse needs to be trained to help with block administration. The ASC should also work hard in assisting the anesthesia group with patient education. Additionally, centers may want to invest in an ultrasound machine. It is less expensive to use a "twitch" monitor to place the nerve block; however, within five years the use of ultrasound will most likely be the standard of care. This is especially true with the placement of continuous peripheral nerve catheters. Currently, ASCs have been able to capture an additional facility fee when the ultrasound is used.
4. Help between cases. When the anesthesiologist finishes the case and takes the patient to recovery, ASC staff can move things along by getting the anesthesia equipment ready for the next case. Preparing the breathing circuit, placing monitors on the operating table and using the appropriate pillow will make it possible for the anesthesiologist to start the next procedure as soon as they complete the preoperative interview. Additionally, an organized pre-op admitting process with streamlined paperwork will help facilitate room turn over. The anesthesia provider has a finite time to complete a full anesthesia assessment, as well as turn the room over (prepare the anesthetics and equipment). Any assistance the ASC can provide to the provider will certainly go a long way in reducing turnover time.
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