6 Critical Anesthesia Protocols and Procedures to Improve Efficiency

Many managers and administrators of ASCs are reluctant to adjust anesthesia protocols and procedures to reduce costs. Too often, a facility maintains a negative status quo for fear of disrupting its coverage needs at the facility. Therefore, it is imperative for a facility to maximize the opportunities available without sacrificing patient care.

With good coordination, an effective anesthesia team can help drive improvements in patient flow by increasing the operating room (OR) turnover ratio and improving patient satisfaction. The following is six critical protocols and procedures your anesthesia department should incorporate into its daily routines.

1. Create a more efficient OR. If not careful, your anesthesia team can become a limiting factor to improving OR turnover time. However, this does not need to be the case. By planning ahead, an efficient anesthesia team can play a critical role in facilitating faster OR turnover times. For example, the anesthesia provider can gather and prepare syringes, medications and equipment for all of their cases at the beginning of the day. The anesthesia team should also review the patient's charts prior to the day of surgery. This can significantly decrease the amount of time required to pre-op the patient on the day of surgery and also prevent cancellations on the day of surgery due to previously unidentified medical issues.

In addition to involving your anesthesia provider in turnover time, you may want to regularly ask for constructive feedback from your anesthesiologists about the scheduling order of certain procedures. They may be able spot inefficiencies in the schedule and offer suggestions for improvement for future scheduling.

2. Leverage the director of anesthesia for difficult conversations with surgeons. Sometimes changing surgeon behavior requires a candid conversation with a particular surgeon to improve performance at the facility. The medical director of anesthesia can often serve as an effective conduct for this discussion. For example, the director should feel comfortable communicating to a habitually late surgeon by talking to him/her on a personal level. After all, if a surgeon is late, the anesthesiologist has to stay late with the rest of the clinical staff overseeing the facility. The late surgeon may also delay the use of the OR by other surgeons. These face-to-face interactions between peers are critical to keep a facility moving in the right direction on a day-to-day basis.

3. Ensure patient readiness for surgery. By establishing clear criteria for requisite preoperative testing, nurses and surgeons can often identify potential obstacles to timely surgery start times early in the process. Careful consideration of a patient’s physical status prior to his or her arrival at the ASC decreases the likelihood of postponement of the surgery due to inadequate preoperative evaluation. This requires close cooperation and guidance from the anesthesia team with preoperative and triage nurses to ensure patient readiness for surgery. If a problem persists, the anesthesia director may need to hold a discussion or provide a presentation at investor or board meetings to communicate proper protocols.

4. Implement patient fast-tracking. Whenever possible, identifying patients that can bypass the PACU will reduce Phase I recovery time and expedite time required to discharge. For example, most IV sedation cases (e.g., colonoscopies and minor hand surgeries) can often move directly to Phase II after surgery. Moving lower-risk sedated patients through the post-op recovery period will allow nurses to focus their time on higher risk patients.

5. Use pain management services to improve outcomes. The use of regional/peripheral nerve blocks for postoperative pain can enhance the throughput of patients during the recovery period. An anesthesiologist can perform long-acting peripheral nerve blocks for postoperative pain management in advance of the actual procedure in a designated block area. Preoperative peripheral nerve blocks can decrease a patient’s operative anesthetic requirement, thereby aiding in enhanced fitness for discharge. Decreased overall recovery room time reduces expensive PACU and labor costs.

In addition, patient satisfaction is increased because — compared to treatment of postoperative pain to narcotic pain medications — patients are more comfortable and less likely to experience side effects such as nausea, vomiting, grogginess and constipation.

6. Preemptive post-operative nausea and vomiting (PONV) therapy. The use of cost effective pharmacologic and non-pharmacologic therapies can dramatically reduce the incidence of PONV and greatly improve patient satisfaction. For example, administering fluid therapy and anti-PONV pharmacologic therapies to all patients at high risk of nausea, particularly for certain procedures and specialties (e.g., GYN and ENT) can help reduce PONV incident rate to less than 5 percent of total procedures.

-- Mr. Ribaudo (aribaudo@surgicalanesthesia.net) is executive vice president of business development and Ms. Scherbenske is vice president of clinical operations for Surgical Anesthesia Services, a provider of comprehensive anesthesia services for ASCs nationally. Learn more about Surgical Anesthesia Services at www.surgicalanesthesia.net.

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