Non-operating room anesthesia cases are projected to account for more than half of all anesthesia cases within the next decade, according to a joint report by the American Hospital Association and the American Society of Anesthesiologists.
Procedures are undeniably moving into the outpatient setting. But training, by some accounts, has not.
The gap surfaces in everything from pain management philosophy to how nurses approach a patient in recovery, ASC leaders said during a panel at Becker’s Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference in Chicago from June 11-13.
“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,” said Martin Jenter, MD, an orthopedic surgeon at Henry Ford Providence Novi (Mich.) Hospital and Michigan Outpatient Surgical Solutions . “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.”
That philosophy — minimize sedation, lean on regional anesthesia, move patients through recovery quickly — is built into ASC operations by necessity. The economics of ambulatory surgery depend on throughput. But Dr. Jenter said it also produces meaningfully better patient experiences, and the contrast with hospital post-anaesthesia care unit culture is stark.
“The anesthesia and the nurses on the hospital recovery side are always taught to treat a pain score, a number, and everyone gets heavily sedated and no one feels good and no one wants to go home,” he said. “In my surgery center, it’s rare that the patient I operate on before is still there when I come out from the next one.”
The behavioral difference, leaders say, is a product of the medical training landscape more than individual aptitude. Allyn Wilcock, CRNA, owner of Advanced Anesthesia Services and Northwest Healing and Wellness in Snoqualmie, Wash., said that independent clinical decision-making develops slowly in hospital-centric programs.
“It’s just that level of decision-making and independence that comes with time and with practice — the ability to make difficult decisions on the fly that maybe new grads or younger ASC providers aren’t used to making,” Mr. Wilcock told Becker’s. “Knowing what’s appropriate in those outpatient areas from an anesthetic standpoint versus what should be brought into the main operating room is a hard decision for newer people who don’t have the experience to make sometimes.”
He suggested that medical schools rotate trainees through independent, freestanding ASCs rather than only hospital-based or hospital-affiliated centers.
“It seems like most of the training programs are centered around hospital training and even hospital-based ASCs, as opposed to freestanding, independent ASCs,” Mr. Wilcock said. “A lot of people who are training in hospital systems and are training in surgery centers that are attached to those systems, they still have a lot of the resources that come with the larger organizations, whereas smaller facilities don’t have those resources.”
Roy Davidovitch, MD, an orthopedic hip surgeon at NYU Langone and managing partner of a standalone all-orthopedic spine ASC in New York City, said his practice eventually stopped trying to convert hospital-trained nurses and started sourcing directly from other ASCs instead.
“After a while of banging our heads against the wall, we decided our strategy is to look at nurses that are already in ASCs, other ASCs, because it’s a cultural mindset,” Dr. Davidovitch said. “An ASC-based nurse is very different than a hospital PACU nurse — they think differently.”
Some institutions are beginning to build training programs that reflect the shift. Johns Hopkins Medicine in Baltimore recently received a $10 million gift to endow a new division focused on minimally invasive surgery at its Brady Urological Institute. The investment supports robotic surgery training, advanced imaging technology and surgical simulation — all with the explicit aim of helping patients recover faster.
“Our goal is to continue to make surgeries more precise and help patients recover faster,” said Mohammad Allaf, MD, director of the institute, in a June 15 news release. “This gift will help advance more than a century of innovation at Johns Hopkins Medicine that has helped patients live better and longer, while improving the practice of urological surgical care.”
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.