Doug Yunker, MD, an anesthesiologist and medical director of Upper Arlington Surgery Center in Columbus, Ohio, discusses four ways ASCs can improve profitability.
1. Improve turnover time. Dr. Yunker says techniques to improve turnover time are well known and he has nothing to add, but he would like to make a point. In the drive for turnover time to be as low as possible, ASCs should not skimp on safety. He advises taking the minute or two necessary for a time-out to check for "right patient, right surgery" and to go over the checklist for material needed for surgery, such as implants and other components. "Doing it wrong will be much more costly than the time needed to make sure you are doing it right," he says.
2. Improve patient flow. At Dr. Yunker's ASC, one anesthesiologist — often Dr. Yunker himself — is stationed in the pre-op area to get patients ready for surgery. At the same time, he supervises CRNAs in the ORs, so he has two jobs in one. In the pre-op area, "I'm in there at the start, doing blocks on patients," Dr. Yunker says. "I'm talking to them and giving them a little sedation."
3. Have the right equipment. Certain pieces of equipment make it easier for anesthesiologists to do their job and thus improve ASC efficiency, while other equipment is not as essential. Here are some examples:
* Ultrasound. Use an ultrasound for regional blocks. The ultrasound system costs $40,000 but it provides a more accurate reading.
* Intubating device. The Gliderscope, which costs about $9,000-$10,000, helps the anesthesiologist intubate patients. Without this device, intubation can take a while for some patients, frequent attempts can make them hypoxic, and in some cases intubation is not possible and surgery must be called off.
* BIS monitor. On the other hand, a BIS monitor for brain waves may not be needed. "We've used it at the hospital and not found it to be helpful on a routine basis," Dr. Yunker says.
4. Select the right patients. The ASC should evaluate patients several days ahead of the operation to make sure they are good candidates for surgery, including anesthesia. Patients with certain conditions may not take well to the anesthesia needed in certain kinds of surgery. When issues are discovered on the day of surgery, Dr. Yunker says, there is no time to explore the issue. The literature shows there are fewer cancellations when patients are screened several days in advance. Here are some issues in patient selection:
* Dealing with cardiac patients. For cardiac issues such as angina, the physician might want to order a stress test or EKG. For patients with uncontrolled hypertension, the physician needs to know the extent of the problem and then get blood pressure under control before surgery.
* Patients with sleep apnea. Dr. Yunker says patients with sleep apnea fare well in carpel tunnel and cataract surgery because there is not a lot of pain, but not in adominoplasty because it requires more potent anesthesia. And
* Hard and soft guidelines. "We have hard guidelines that cannot be changed and soft guidelines where there is some wiggle-room," Dr Yunker says. "It depends on the condition and the type of surgery." For example, there would be a hard guideline for an obese patient with a certain body mass index who is going into major surgery and a soft guideline for a patient with a certain blood sugar level in minor surgery.
Read more guidance about anesthesia in ASCs: