6 Qualities Anesthesiologists Look for in Ambulatory Surgery Centers
James Cottrell, MD, is 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.
With nearly 40 years of anesthesia experience, Dr. Cottrell knows what anesthesiologists look for in an ASC. Here Dr. Cottrell gives his six tips on how to make anesthesiologists happy in a surgery center.
1. Convenience and appearance. When anesthesiologists look for a surgery center to partner with, they often look at the non-surgical aspects of a facility.
Dr. Cottrell prefers centers with convenient locations and ease of accessibility, including close parking spaces or public transportation stops. The center should be in located in a safe area with plenty of parking so coming to work every day is convenient for physicians and staff.
Not all locations are perfect, but simple solutions can be devised to meet the anesthesiologist's needs. For example, if a center is located in an area with limited parking nearby, the administrator could work to make valet available.
Dr. Cottrell also says he prefers to work with ASCs with attractive inner and outer appearances and warm greeters upon entrance. "We have to be concerned about what the patients see when they first walk in," he says.
2. High operating standards. Anesthesiologists look for surgery centers with high standards of care, Dr. Cottrell says, and that includes additional accreditation and safety.
Being safe and accredited not only gives anesthesiologists a better work environment, it also leaves patients with a positive perception of the center and confidence in its ability.
Dr. Cottrell also looks at accredited centers as a sign of better reimbursement rates since many payors require or look more kindly upon centers with accreditation other than Medicare.
Most anesthesiologists also will only work in safe ASCs, he says, and that includes clean facilities and equipment. "The cleanliness of an ambulatory surgery unit is important for the patient and for the physicians that work there," he says. "The equipment also has to be up-to-date with safety contracts updated as the equipment ages."
3. 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, Dr. Cottrell says.
Basic pre-operative screenings will often suffice, or more detailed conversations can 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. 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," he says. "Knowing the patient and procedure is critical for the success of the endeavor."
Good HIT systems help anesthesiologists prepare for the procedures and help the ASC scheduler allow the appropriate amount of time for a case. Information systems often let healthcare providers track how long each provider takes for a certain procedure so they can can schedule the right amount of time for the job. This keeps cases from getting backed up and slowing the entire day down.
4. Medication management. Especially since they deal with large quantities of drugs, anesthesiologists look for medication management programs at ASCs, Dr. Cottrell says.
If staff members don't properly manage the center's medications, they can end up with a surplus or shortage and consequences from both. "Too many supplies on hand can increase expenses," he says. Supply shortages, on the other hand, render the specialists unable to properly care for patients.
Post-operative medication management is also crucial for producing satisfied customers. "If one procedure is more painful than another, you need different medication for the patient to take home," he says. He prefers programs which call for long-lasting local anesthesia to be administered before a patient leaves along with the proper home medications.
Centers are often graded on pain after a procedure, he says. "Word gets around that a patient did or did not have pain."
5. Transfer policy. Dr. Cottrell always looks to see an ASC has a transfer policy in place with a local hospital in case any complications arise, including puncturing a vessel or colon perforation.
Most surgery centers are not equipped to deal with these potentially life-threatening cases. Transfer policies make sure a center's patients can access proper emergency treatment if necessary.
Surgery center leadership also needs to detail how to transport a patient to the emergency room, how to assess the stability of a patient and who will care for the remaining patients in case of emergency.
6. Communication. Overall, anesthesiologists are 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 says. "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 the anesthesiologists' equipment and supply needs are adequately met. It also makes sure 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.
Solid relationships will bring in more patients and more business.
"The better the experience, the better the outcome for patients than the more likely the ASC is to thrive and grow," Dr. Cottrell says.
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