Thomas Wherry, MD, principal for Total Anesthesia Solutions and consulting medical director for Health Inventures, discusses six ways surgery center administrators can ensure clinical quality during a transition between anesthesia providers.
1. Educate your staff about the transition. Anesthesia groups and surgery centers part ways for a number of reasons, but chances are, the transition will not be entirely amicable, Dr. Wherry says. Whether the group is leaving for financial or clinical quality reasons, there may be more tension in the surgery center in the 30-90 days between the group's decision to leave and its actual departure. For this reason, Dr. Wherry recommends that administrators communicate with surgery center staff about the transition. "These transitions don't occur over night, and in that period of time, it's important to do your best to educate your staff on the fact that a new group is coming," he says. "I see so many centers that don't clue the staff in and give them all the details."
This doesn't mean the administrator needs to communicate the exact reasons for the anesthesia group's departure, Dr. Wherry says. Just make sure that staff know the dates of the transition and can come to center leadership with any problems. "The staff may feel kind of put in the middle of this," he says. "Especially if these [providers] are their friends and they've worked with them for years, they need to understand that the surgeons have signed off on the change and it's being done for the right reasons."
2. Meet a few weeks before the start date to go over policies and procedures. Dr. Wherry says the center administrator should meet with the new anesthesia group a few weeks in advance to discuss the center's policies and procedures. This particularly applies to pre-op screening processes and post-operative care processes. "If you've had trouble with the old group around pre-op screening processes, this is the opportunity to make changes," Dr. Wherry says. "For example, the old group may have been too stringent on a type of patient or required too much information." He says some surgery center leaders feel that their anesthesia group is not involved enough in the pre-op screening process, so this is a perfect opportunity to lay out expectations for the new providers.
The same is true for recovery care in the PACU, Dr. Wherry says. "Anesthesiologists need to clarify how patient discharge works," he says. "What is their expectation of the recovery room, and what is their willingness to participate in helping to define the standards?" He says in the past, there may not have been clarity around when patients were ready to be discharged from the PACU. Those standards should be decided in this initial meeting.
3. Make sure the group is comfortable with all equipment, medication and disposables. Go over all the anesthesia equipment in the surgery center to make sure the new group is happy with the equipment. He says the two "big-ticket items" for anesthesia in a surgery center — the anesthesia machine and the monitors — will probably not be of concern to the anesthesiologists. "Most centers today that are fully licensed and certified have adequate equipment," he says. He says while the anesthesia group may not be used to the monitors the surgery center uses, the providers will probably be able to adapt easily as long as the monitors have been checked and calibrated properly.
The new anesthesia group may have more requests when it comes to difficult airway equipment and equipment for peripheral nerve blocks, Dr. Wherry says. "You may have to invest in the difficult airway department," he says. "The new group may have an expectation that a GlideScope is the standard of care, while the old group was comfortable with something a little less expensive." Similarly, if your center performs a lot of orthopedic procedures, the new group may prefer an ultrasound technique.
The center should be confident that the group is comfortable with the anesthesia supplies on-hand and that the pharmacy formulary will meet their needs. "The center and the group should go through the anesthesia carts the evening before the transition," Dr. Wherry says. "Avoiding any confusion the first day is of paramount importance."
4. Do a comprehensive equipment and medication check the weekend before the start date. Dr. Wherry recommends asking your biomed provider to visit the surgery center the weekend before the group's start date to perform a comprehensive equipment check. "That's the time to go over everything and make sure nothing is broken, especially things that the old group was used to that [may not have been] working properly," he says. "You want to make sure that everything is in proper working condition."
Additionally, all open medications should be discarded and outdates checked. Dr Wherry highly recommends that tight controls on medications and processes to avoid 'look-alike' drugs be in place prior to the new group's arrival.
5. Ask anesthesia to review the first week's schedule. Prior to starting at the surgery center, the anesthesia group should review the first week's schedule, Dr. Wherry says. At that point, go over how you will communicate about add-on cases and cancellations, and assign a point person from the group to answer any last-minute scheduling questions. You can also go over when the anesthesia providers are expected to arrive at the surgery center for each case.
6. Identify a lead anesthesiologist who can serve as a liaison. The anesthesia group should appoint one anesthesiologist to serve as a go-between for the group and the surgery center. "It would be really nice to identify a lead anesthesiologist who will be on-site most of the time and who would be willing to go with the administrator to surgeons' offices and answer any questions they have," Dr. Wherry says. The surgeons may have had problems with the previous anesthesia group's techniques, and the anesthesiologist can address those concerns during the office visits.
Learn more about Health Inventures.
Learn more about Total Anesthesia Solutions.
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1. Educate your staff about the transition. Anesthesia groups and surgery centers part ways for a number of reasons, but chances are, the transition will not be entirely amicable, Dr. Wherry says. Whether the group is leaving for financial or clinical quality reasons, there may be more tension in the surgery center in the 30-90 days between the group's decision to leave and its actual departure. For this reason, Dr. Wherry recommends that administrators communicate with surgery center staff about the transition. "These transitions don't occur over night, and in that period of time, it's important to do your best to educate your staff on the fact that a new group is coming," he says. "I see so many centers that don't clue the staff in and give them all the details."
This doesn't mean the administrator needs to communicate the exact reasons for the anesthesia group's departure, Dr. Wherry says. Just make sure that staff know the dates of the transition and can come to center leadership with any problems. "The staff may feel kind of put in the middle of this," he says. "Especially if these [providers] are their friends and they've worked with them for years, they need to understand that the surgeons have signed off on the change and it's being done for the right reasons."
2. Meet a few weeks before the start date to go over policies and procedures. Dr. Wherry says the center administrator should meet with the new anesthesia group a few weeks in advance to discuss the center's policies and procedures. This particularly applies to pre-op screening processes and post-operative care processes. "If you've had trouble with the old group around pre-op screening processes, this is the opportunity to make changes," Dr. Wherry says. "For example, the old group may have been too stringent on a type of patient or required too much information." He says some surgery center leaders feel that their anesthesia group is not involved enough in the pre-op screening process, so this is a perfect opportunity to lay out expectations for the new providers.
The same is true for recovery care in the PACU, Dr. Wherry says. "Anesthesiologists need to clarify how patient discharge works," he says. "What is their expectation of the recovery room, and what is their willingness to participate in helping to define the standards?" He says in the past, there may not have been clarity around when patients were ready to be discharged from the PACU. Those standards should be decided in this initial meeting.
3. Make sure the group is comfortable with all equipment, medication and disposables. Go over all the anesthesia equipment in the surgery center to make sure the new group is happy with the equipment. He says the two "big-ticket items" for anesthesia in a surgery center — the anesthesia machine and the monitors — will probably not be of concern to the anesthesiologists. "Most centers today that are fully licensed and certified have adequate equipment," he says. He says while the anesthesia group may not be used to the monitors the surgery center uses, the providers will probably be able to adapt easily as long as the monitors have been checked and calibrated properly.
The new anesthesia group may have more requests when it comes to difficult airway equipment and equipment for peripheral nerve blocks, Dr. Wherry says. "You may have to invest in the difficult airway department," he says. "The new group may have an expectation that a GlideScope is the standard of care, while the old group was comfortable with something a little less expensive." Similarly, if your center performs a lot of orthopedic procedures, the new group may prefer an ultrasound technique.
The center should be confident that the group is comfortable with the anesthesia supplies on-hand and that the pharmacy formulary will meet their needs. "The center and the group should go through the anesthesia carts the evening before the transition," Dr. Wherry says. "Avoiding any confusion the first day is of paramount importance."
4. Do a comprehensive equipment and medication check the weekend before the start date. Dr. Wherry recommends asking your biomed provider to visit the surgery center the weekend before the group's start date to perform a comprehensive equipment check. "That's the time to go over everything and make sure nothing is broken, especially things that the old group was used to that [may not have been] working properly," he says. "You want to make sure that everything is in proper working condition."
Additionally, all open medications should be discarded and outdates checked. Dr Wherry highly recommends that tight controls on medications and processes to avoid 'look-alike' drugs be in place prior to the new group's arrival.
5. Ask anesthesia to review the first week's schedule. Prior to starting at the surgery center, the anesthesia group should review the first week's schedule, Dr. Wherry says. At that point, go over how you will communicate about add-on cases and cancellations, and assign a point person from the group to answer any last-minute scheduling questions. You can also go over when the anesthesia providers are expected to arrive at the surgery center for each case.
6. Identify a lead anesthesiologist who can serve as a liaison. The anesthesia group should appoint one anesthesiologist to serve as a go-between for the group and the surgery center. "It would be really nice to identify a lead anesthesiologist who will be on-site most of the time and who would be willing to go with the administrator to surgeons' offices and answer any questions they have," Dr. Wherry says. The surgeons may have had problems with the previous anesthesia group's techniques, and the anesthesiologist can address those concerns during the office visits.
Learn more about Health Inventures.
Learn more about Total Anesthesia Solutions.
Related Articles on Anesthesia:
Fear of Blame by Colleagues May Stop Anesthesiologists From Reporting Adverse Events
Biomarkers Indicate General Anesthesia Could Speed Up Cognitive Decline
Lawyer: Teva, Baxter Could Have Prevented Hep C Outbreaks by Selling Smaller Propofol Vials