6 ASC Characteristics That Matter to Anesthesiologists
1. Information technology. Proper pre-operative screening is important to anesthesiologists yet is often overlooked by surgery centers. This problem can be avoided by installing adequate health information technology systems.
HIT can save time and headaches for both the center and the contracted anesthesia group and allow anesthesiologists to provide more efficient care, said James Cottrell, MD, a board-certified anesthesiologist, professor and chairman of the department of anesthesiology at the State University of New York Downstate. He also provides anesthesia for one freestanding ambulatory surgery center.
Basic pre-operative screenings will often suffice, but more detailed conversations can also take place, as long as both happen prior to the day of the patient's procedure.
"We won't have to waste time when the patient comes in," he said. "Nothing is worse than when a patient shows up the morning of a procedure and you find out the patient has a history of a recent myocardial infarction. Knowing the patient and procedure is critical for the success of the endeavor."
Good HIT systems keep cases from getting backed up and slowing the entire day down.
2. Proper patient screening. While ASCs must maintain a steady patient volume to be successful, certain patients cannot be as easily anesthetized as others. Sleep apnea, for example, is becoming a more common condition for patients and requires a risk assessment prior to administering anesthesia.
Not all patients with the condition are good candidates for outpatient surgery, said Peter Glass, MD. It depends on several factors, including the severity of the sleep apnea, the procedure being done and how long a center is willing to keep a patient in the recovery room.
Dr. Glass is the immediate past president of the Society for Ambulatory Anesthesia. He is also the chair of the department of anesthesiology at Stony Brook Medicine in New York.
"Each ASC needs to determine what level of risk they are willing to take from any given patient," he said.
Sleep apnea can be problematic during the procedure, but it also poses a risk to patients the day after surgery while they are recovering at home.
When performing anesthesia on a patient with sleep apnea, anesthesiologists could consider using regional anesthesia, rather than general, if the procedure permits. They could also opt for non-opioid narcotics for pain management and short-lasting sedatives.
3. Open communication. Overall, anesthesiologists are also looking for a surgery center whose staff is willing to engage in strong and consistent dialogue.
"Having everybody on the same page is extremely important," Dr. Cottrell said. "Team effort and communication are key to any successful unit in terms of patient outcomes."
He recommends monthly meetings to review statistics and quality issues. Open communication ensures everyone's needs are adequately met. It also makes ensures anesthesia providers are able to handle the surgery center's case load and specialty mix.
For example, if a surgery center wants to treat pediatric patients, the anesthesia providers must be involved in the discussion. Anesthesia machines and dosages are different for pediatrics, and only pediatric-experienced anesthesiologists can perform the procedures. Unnecessary friction and expenses can be avoided by open conversations.
4. Pleasant patient experience. Prioritizing patient experience can help set ASCs apart from hospitals and other healthcare facilities and draw in anesthesiology providers.
ASCs should promote their friendly, convenient patient environments. Freestanding ASCs, which are usually compact facilities, are less likely to frustrate patients with long wait times.
"The whole experience for patients is more efficient and pleasant," Dr. Glass said.
5. Equipment compromises. Anesthesia equipment prices are rising, which can be a challenge for cost-conscious ASCs. Two of the most common tools — an ultrasound for regional anesthesia and a glide scope — are practically standard, making it difficult for anesthesiologists to perform jobs without them, said Thomas Wherry, MD, the principal for Total Anesthesia Solutions in Ellicott City, Md., and a consulting medical director for Health Inventures.
Surgery centers should be mindful of the anesthesia market and accommodate their center as much as possible. "If you want to secure your service, provide your group with superior technology," he said.
However, anesthesia providers used to working with hospitals may have unrealistic expectations for what the center can afford to provide. Anesthesia machines can range from $20,000 to $100,000. While a hospital with a larger capital budget may be able to afford the more expensive machine, it is not crucial for proper patient care.
"What they have at the hospital may be overkill," he said. "You don't necessarily need to replicate it at the surgery level."
Anesthesia groups should be encouraged to consider the ASC's budget before requesting unnecessary high-end machines.
6. Appropriate cost-cutting measures. While cost-effectiveness remains important, major anesthesia equipment savings are often hard to come by without compromising safety.
Rather than looking to cut costs that could jeopardize patient care, focus on moving more cases through the center each day, said Neil Kirschen, MD, the chief of pain management in the department of anesthesiology at South Nassau Communities Hospital in Oceanside, N.Y., and the medical director for the Pain Management Center of Long Island in New York.
He encountered an ASC that wanted to use less oxygen tubing to save money, but he put his foot down because the supply is necessary for proper care.
"Patient safety is never compromised," he said. "Make up for it by working faster and allowing more cases through. Never compromise patient safety."
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