Q: As an anesthesia quality assurance officer and former anesthesia practice manager, how do you define quality in anesthesia?
Hugh Morgan: Defining quality in anesthesia delivery is really no different from defining quality in other aspects of life; we tend to know what it looks like when we see it or experience it, and it’s very much an individual preference or expectation. The challenge for defining the concept in anesthesia is that there are numerous “quality” stakeholders — patients, surgeons, nurses and hospital administrators — all of whom tend to have varying expectations of anesthesia performance and outcomes underlying their definition of quality.
Although it’s become somewhat commonplace for the healthcare industry to simplistically define anesthesia quality by a handful of regulatory (PQRI) requirements and accreditation measures (SCIP), in my opinion, the fundamental source of anesthesia quality rests with each and every patient’s anesthetic experience.
Q: So how then do you go about achieving clinical quality excellence in anesthesia?
HM: The key is to build a solid clinical quality program infrastructure that truly values each patient’s anesthetic experience, and then to dedicate to it the appropriate quality resources. It should begin with your most valued resource: your clinical staff. To borrow from Jim Collins, who stated in his book “Good to Great,” it really is “first who, then what”. To achieve excellence in anesthesia, you must first develop a team of clinicians who appreciate and are fully engaged in the concept that quality is defined by a patient’s anesthetic experience. Developing a culture of clinical quality, and patient safety, is paramount to achieving clinical quality excellence.
Clinicians should not view quality processes and procedures as obligatory, but rather as part of their daily duties and responsibilities and, always, as the right thing to do. They must subscribe to clinical care standards that are founded in evidence-based medicine and guided by policies, procedures and protocols intended to reduce or eliminate performance and outcome variation. As medical professionals, they must continually strive to improve their personal performance and outcomes by utilizing tools and resources that prompt and ensure compliance with evidence-based medicine, and capture information and data on each patient experience. In the end, clinical quality excellence is predicated on a clinician’s acceptance of personal responsibility and accountability for his or her performance and outcomes as they pertain to every patient in the clinician’s care.
While we may objectively know that a patient’s anesthesia care was with good outcome and without incident, the key to quality lies in the collection of the subjective feedback that comes from patients and other anesthesia stakeholders. Doing so enables anesthesia clinicians to continually learn from and improve upon their performance and outcomes which, in the end, benefits patients in the future.
Q: What is the value of an anesthesia quality program?
HM: A good anesthesia quality program meets and, perhaps, exceeds basic “check-box” PQRI and SCIP requirements; a great anesthesia quality program transcends basic requirements and focuses on how to improve a patient’s anesthetic experience. The latter measure the often overlooked or undervalued areas of anesthesia performance, outcomes and satisfaction: post-op pain management, post-op nausea and vomiting, or failed regional anesthesia.
Achieving clinical quality excellence in anesthesia doesn’t happen overnight, it certainly doesn’t happen by chance. However, once realized, it can and does add tremendous value to both the anesthesia group and the hospital. As with successful hospital-wide quality programs, quality programs around anesthesia require dedicated resources and a step-wise, comprehensive and systematic approach. It’s also critical that any anesthesia quality program be fully integrated with a hospital’s existing quality program to deliver collaborative results. Valuable anesthesia quality programs capture and analyze data around every patient experience. They prompt and ensure regulatory and accreditation compliance and they ensure and maintain 100 percent survey readiness. They also comply with The Joint Commission’s National Patient Safety Goals and contribute to the overall efficiency and productivity of the operating room.
Q: How does an anesthesia quality program impact a hospital’s bottom line?
HM: Anesthesia is not immune to the evolving world of pay-for-performance policies and related outcomes. And because anesthesia is involved in so many different areas of care, the impact of an anesthesia quality program on the bottom line is significant.
It begins with maintaining 100 percent regulatory and accreditation survey readiness. It includes processes that avoid unreimbursed hospital-associated infections such as central line blood stream infections. It includes documenting compliance with the CMS (AHRQ) patient safety indicators, which, when combined with Hospital Consumer Assessment of Providers and Systems (HCAPS) patient survey data, impacts a hospital’s annual CMS reimbursement percentage. By recognizing how anesthesia quality relates directly to OR efficiency and productivity, it measurably impacts a hospital’s bottom line. For example, it can be argued that OR turnover is affected by the appropriate, efficient anesthetic recovery of surgical patients in between cases, and also that on-time first-case starts are often related to appropriate pre-op evaluations and preparation by the anesthesia department. By making sure the care episode runs smoothly, the anesthesia team can reduce surgical schedule delays that often result in unnecessary overtime costs.
Hospitals simply can no longer afford to allow their anesthesia groups to show up and “pass gas.” They must require the staff to have a comprehensive and continually developing quality program in place, one that achieves desired levels of performance and outcomes and supports a hospital’s mission, vision and values. To do otherwise will erode bottom lines and may compromise patient safety.
Learn more about Somnia Anesthesia Services at www.somniaanesthesiaservices.com.
Read more insight from Somnia Anesthesia Services leadership:
– 5 Observations on Anesthesia in ASCs From Syed Ishaq of Somnia Anesthesia
– Overcoming the Anesthesia Provider Shortage: Q & A with Marc Koch of Somnia Anesthesia
– Anesthesiologist Dr. Marc Koch Comments on Anesthesia Cost-Containment Study
