5 Changes for Outpatient Anesthesia in 2012: Thoughts From Dr. Gilbert Drozdow

Gilbert Drozdow, MD, MBA, is president of the anesthesiology division of Sheridan Healthcare, one of the nation's largest providers of hospital-based physician services, including over 1,200 anesthesiology providers and more than 800 providers in emergency medicine, radiology, neonatology and hospitalist services in 142 hospitals and outpatient facilities in 21 states. He discusses five ways outpatient anesthesia will change over the next year.

1. Movement of procedures into outpatient settings. According to Dr. Drozdow, one of the most significant trends occurring within outpatient anesthesiology is the movement of procedures traditionally performed in hospital facilities into ambulatory surgery centers and physician offices. "This is related to the improved efficiency that ASCs can provide," he says. "There are fewer delays in the outpatient settings because hospitals have to deal with emergency procedures, which can disrupt the daily flow in the surgical theater."

He says the specialization of the ASC environment also gives anesthesiologists the chance to perform procedures more efficiently. The ASC environment is absent the complex processes and equipment that are necessary in a hospital environment because of higher-acuity cases. "The advantages of the ambulatory environment appear to have an impact on both patients and surgeons," he says. "Smoother scheduling allows for faster turnover of cases, which is linked to improving patient and surgeon satisfaction."

2. Increased use of regional anesthesia under ultrasound guidance.
Dr. Drozdow says outpatient anesthesiologists increasingly use regional anesthesia under ultrasound guidance, a procedure which provides for greater post-operative pain control and permits complex cases to be performed in an outpatient environment. The use of regional anesthesia is especially important as more complex orthopedic cases move into the ASC setting. Peripheral nerve blocks especially are popular for orthopedic cases because they allow the provider to isolate and anesthetize a specific area in the arm or leg without putting the patient to sleep.

Dr. Drozdow says regional anesthesia is also useful for patients with a higher risk of complications who might historically have been deemed too risky for the outpatient setting. "For example, sleep apnea patients who run the risk of post-operative respiratory complications can have their procedures done in an outpatient environment, and avoid general anesthesia," he says. "Orthopedic procedures that were traditionally only done in hospitals, such as bone fractures, can now be performed safely."

3. Use of multi-modal pre-emptive anesthesia. In addition to the use of complex regional anesthesia, outpatient anesthesiologists are also using multi-modal preemptive anesthesia, or the use of intravenous and oral medications to reduce the need for post-operative narcotic pain relief and alleviate post-operative nausea and vomiting. PONV can be a major determination of patient satisfaction in a surgery center, as the patient will likely remember the post-operative recovery period better than the actual surgery. By using multi-modal preemptive anesthesia, anesthesiologists can help reduce recovery room time, decrease the risk of readmissions and reduce the patient's risk of developing chronic pain conditions, Dr. Drozdow says.

The benefits are not only clinical: ASCs on a budget should consider multi-modal preemptive anesthesia to prevent delays and clogged PACUs. "There are [also] economic benefits in utilizing these modalities, including greater operating room throughput and faster discharge of patients," he says.

4. Development of outpatient anesthesia as a subspecialty. Dr. Drozdow says outpatient anesthesia has gradually become a subspecialty within the profession, meaning more attention paid to research, clinical best practices and networking for anesthesiologists that work in ASCs.

"The outpatient anesthesiologist … is represented by dedicated professionals committed to strong leadership and clinical expertise in the outpatient setting," Dr. Drozdow says. "For example, there is SAMBA — Society for Ambulatory Anesthesia — that is working assiduously to define best practices, enhance patient safety and establish independent thinking apart from a traditional, hospital-based focus."

Many ambulatory anesthesiologists agree that this focus is necessary because of the inherent differences between the hospital and outpatient setting. For example, outpatient anesthesiologists work in a smaller space with a smaller, more consistent group of staff, generally dealing with high volumes of the same procedures and developing criteria to make sure only appropriate patients are treated in the ASC.

5. Increased emphasis on regulatory environment. Dr. Drozdow says patients will and should be more critical of accreditation achievements when choosing centers in the future. Anesthesiologists should aim to work at accredited centers that follow "the same standards as hospitals, in both credentialing and governance," he says.

Dr. Drozdow adds that anesthesiology practices are under greater pressure from accrediting bodies this year: New requirements from The Joint Commission in demonstrating ongoing professional provider evaluation are forcing anesthesiology practices to identify solutions to meeting these obligations and challenges. "These solutions require leveraging informatics as well as human resources with specific content knowledge," he says. "This forces anesthesiologists to either invest themselves in building this infrastructure support or seek to affiliate with national physician-driven organizations that have the business scale to deliver these critical services."

Related Articles on Anesthesia:
Anesthesiologist Dr. Michael Dellinger Joins Leadership of Hilton Head Hospital in South Carolina
Pioneer Anesthesiologist Dr. Joseph F. Artusio Dies at 94
Hospital Value-Based Purchasing Program: An Introduction to Anesthesiologists

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