Nonoperating room anesthesia cases are expected to account for more than 50% of all anesthesia cases in the next decade, according to a report by the American Hospital Association and the American Society of Anesthesiologists, which means anesthesia providers may increasingly find themselves working in outpatient settings including ASCs.
Some ASC leaders have said that the current workforce’s skillset lags behind the demands of the outpatient migration, with many providers having been trained to work in more traditional inpatient operating room settings.
“From the pre-op nurse to the anesthesiologist to the recovery room nurse, they know not to give this person drugs they don’t need,” Martin Jenter, MD, an orthopedic surgeon at Henry Ford Providence Novi (Mich.) Hospital and Michigan Outpatient Surgical Solutions, said on a July 12 panel at Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago. “We rely on the blocks, we rely on everything else to treat their pain, rather than just these hard narcotics. If you’re not on the surgery center side and you don’t see it, you just might not know it and trust it.”
While ambulatory anesthesia holds no board certification in the same way that cardiac or pediatric anesthesia do, Becker’s has reported on nine medical school schools that have begun offering residencies and fellowships specific to outpatient anesthesia.
Two ASC leaders recently joined Becker’s to discuss whether they are observing the same trend in their markets and how they’re aligning their anesthesia teams with the needs of their facilities.
Editor’s note: Responses have been lightly edited for clarity and length,
Question: Some say that many anesthesiologists and certified registered nurse anesthetists are trained for inpatient settings or HOPDs, creating a gap as procedures shift increasingly towards ASCs. Is this something you’re seeing in your market? What’s your process for ensuring your anesthesia team is fully aligned with ASC workflows?
Jarrett Heard, MD. Associate Professor of Clinical Anesthesiology and Medical Director of Perioperative Services at Ohio State University Wexner Medical Center (Dublin): In our market, we are not seeing training gaps in the anesthesia workforce in ASCs. With respect to anesthesia APPs there is a growing demand/preference for working in ASCs. Leaner coverage models at ASCs means many anesthesia APPs enjoy potential opportunities to practice in a collaborative environment with more “independence” while not necessarily practicing under QZ billing, in addition to the stable case mix and predictable hours compared to hospital/inpatient settings. There was a time where our efforts to shift more cases to the ASCs meant that anesthesia residents were not receiving exposure to certain cases (sitting shoulder arthroplasties for instance). We quickly pivoted to incorporating more ambulatory focused rotations to ensure that they were competent and competitive after residency training, including a regional rotation away from our main hospital and an additional month of ambulatory anesthesia during their CA-2 year.
Ken Hammer. Administrator of Bronson Orthopedic Surgery Center (Kalamazoo, Mich.): We are fortunate and have some excellent providers. They provide excellent care and work efficiently and as a team. We work closely with our anesthesia group (CRNA only) and they provide us with a select group, a group that works at our facility primarily, and collaborates with our team daily, to maximize efficiency. The CRNAs we have, want to be in an ASC setting, and understand how we work through the daily schedule. They have wonderful bedside manner and it shows in our top-notch Press Ganey scores.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.