Efficient, effective anesthesia providers are necessary to keep quality of care high at a busy ambulatory surgery center. Mark Casner, president and CEO of anesthesia provider aisthesis, discusses 10 ways surgery center leaders can evaluate their current anesthesia group.
1. Track on-time arrivals. Late arrivals from anesthesiologists can affect surgery center finances as well as patient, staff and physician satisfaction. Mr. Casner recommends surgery center leaders track on-time arrivals to determine if anesthesia is delaying cases and diminishing surgery center efficiency. "Showing up to work on time doesn't mean arriving at 7:20 if it's a 7:30 start," he says. "It should mean you're there 30 minutes ahead of time, you're prepared and you've introduced yourself to staff if you're new." He says anesthesia providers should be expected to talk to staff and physicians prior to the procedure, participate in the pre-operative exam and speak to patients about their anesthesia.
To ensure timely case starts, Mr. Casner says new anesthesia providers should be oriented to the facility prior to their first case. "Providers should orient to a facility before their official first day," he says. "This means determining out how long it takes to drive to their assigned facility, locating the equipment and medications in the center, and meeting the nurse manager."
2. Look at interactions with physicians and staff. Because the surgery center is a smaller, more close-knit environment than the hospital, anesthesiologists must be friendly and respectful, Mr. Casner says. “Anesthesia providers are guests in a physician and nurse manager’s home and they should behave accordingly.” At the hospital, distant or rude anesthesiologists may be able to get away with poor behavior, but a hostile relationship between a surgery center physician and an anesthesiologist will soon sour the contract between the anesthesia provider and the ASC. "Outpatient centers are typically owned by the surgeons, and you have to [behave well] in those centers or you get fired," Mr. Casner says.
He recommends the administrator take note of the relationship between surgeons, staff and anesthesiologists to make sure everything is running smoothly. If the ASC physician-owners hold a regular meeting with the administrator, he or she can use that time to check in on the anesthesiologists' performance and the relationship between the two groups. This is especially important because disagreements between anesthesia providers and physicians can endanger patient safety if the two parties cannot communicate properly.
3. Follow up with patients after discharge. Mr. Casner says aisthesis performs follow-up calls with every patient that has been discharged from a surgery center to check in on their progress after surgery. While most surgery centers perform follow-up calls to remind patients of post-surgical directives, Mr. Casner recommends checking in on the patient's experience with anesthesia and progress after surgery. Centers should know when a patient has experienced untreated pain or postoperative complications, including nausea or vomiting. Patient experience and postoperative complications can greatly influence a patient’s satisfaction and their overall memory of a procedure. Mr. Casner says that aisthesis works with the centers they serve to follow up with discharged patients and collect post-procedure data.
Given the influence patient experience and postoperative complications can have on patient satisfaction, anesthesiologists should be kept aware of their track record in preventing postoperative discomfort. The patient may also feel that the anesthesia provider did not spend enough time explaining the anesthesia process or that the anesthesiologist seemed rushed or rude. Make sure to catch these issues before they become a pattern and affect your surgery center's reputation in the community.
4. Collect information on specific clinical outcomes. Mr. Casner says surgery center leaders should collect information on clinical outcomes, in addition to patient experience, and regurgitate that data back to providers to demonstrate where problem areas exist. The information does not have to be broken down by anesthesiologist — especially in a small ASC because anesthesia providers should be expected to act as a team to prevent adverse clinical outcomes. Mr. Casner also recommends recording any untoward events that occur in the post-anesthesia care unit and in the first 24 hours after discharge.
"We use clinical outcome data as an opportunity to educate or congratulate our providers. In the event that a provider had an excessive amount of [untoward events], such as a longer time to recover from anesthesia or too many cases of intubation, we would assess whether the anesthesia provider has a problem with their clinical skills or just a string of bad luck." Over time, you will get a sense for the most common anesthesia issues in your ASC and can work with anesthesiologists to fix those problems.
5. Analyze hospital transfers. A high number of hospital transfers can be a sign that your ASC is experiencing too many adverse outcomes due to anesthesia, according to Mr. Casner. Track hospital transports per anesthesia provider and discuss those events during quarterly clinical meetings. "This includes any transport to the hospital for whatever reason," he says. While anesthesiologists may not always be to blame for hospital transports, they may be able to offer insight into pre-surgical or surgical problems that are causing the increase.
6. Perform regular chart reviews. Mr. Casner says his company mandates chart review every month for all its anesthesiologists. The first thing they look for is completeness of the record — in other words, whether the anesthesiologist documented everything necessary.
"If the rule is documenting vital signs every five minutes, is there demonstration of that on the clinical chart and have they filled in all the boxes?" he says. "When they discharged the patient to the PACU, did they do a post-op assessment and note the vital signs?" If the charts are frequently incomplete, remind anesthesiologists that the information is important and mandatory.
7. Conduct customer satisfaction surveys. For Mr. Casner, "customer satisfaction surveys" mean asking the surgery center for feedback on their anesthesia provider — but tracking satisfaction scores is just as important for the ASC leaders themselves. When you send out physician, patient and staff satisfaction surveys (which should happen on at least an annual basis), make sure to ask questions about the anesthesiologists at your facility.
For patients, these questions could sound something like, "Did the anesthesia provider explain the anesthesia process adequately prior to surgery?" For physicians and staff, the question could be phrased, "Does the anesthesia provider introduce him/herself prior to surgery?" Leave room on the surveys for your "customers" to expand on their thoughts.
8. Expect anesthesia to contribute to quality improvement. Anesthesiologists should be expected to contribute to projects that improve efficiency, cut costs or emphasize patient safety, Mr. Casner says. That doesn't mean anesthesia providers should spend every waking minute at the center, but they should be expected to attend meetings and provide feedback. The level of involvement in these projects will demonstrate how committed the group is to your center.
In addition, anesthesiologist feedback is essential to many projects that improve ASC operations. Especially in centers that perform a majority of ophthalmology or endoscopy cases, quick room turnover is extremely important to efficiency and profitability, Mr. Casner says. "We have very busy centers where you've just got to be hopping," he says. "Anesthesiologists have to be part of that process."
9. Track case cancellations due to anesthesia. If a case is cancelled because an anesthesia provider arrives late to the surgery center or cancels a patient at the last minute, make a note of the cancellation and track the number over time, Mr. Casner says. He says surgery center anesthesia providers should be committed to the ASC — one reason that finding a group that specializes in surgery center anesthesia can be so beneficial.
"We have found that ASCs with hospital-based anesthesia groups, have experienced delays in coverage and cancellations because the group pulls the doctor or CRNA back into the hospital," he says. Groups that specialize in ASC anesthesia never have to post call or delay cases to serve other centers, Mr. Casner says. Additionally, providers from specialized ASC anesthesia groups never show up to procedures exhausted from a night at the hospital.
10. Select a liaison from the anesthesia group. Surgery center leaders should ask their anesthesia groups to select a go-to provider to answer questions, report anesthesia provider feedback, and head quality improvement initiatives for the team, according to Mr. Casner. Anesthesia liaisons allow ASCs to collect feedback and information in a more efficient fashion. Every few months, ASCs should sit down with their anesthesia liaison and review the relationship between the surgery center and the anesthesia provider. There may be issues on the anesthesia group's end that you have no idea about — and vice versa.
Learn more about aisthesis.
Related Articles on Anesthesia:
Heat, Extreme Exercise Can Trigger Malignant Hyperthermia
Local Anesthesia Effective for Oculofacial Surgery
Anesthesia in ASCs
1. Track on-time arrivals. Late arrivals from anesthesiologists can affect surgery center finances as well as patient, staff and physician satisfaction. Mr. Casner recommends surgery center leaders track on-time arrivals to determine if anesthesia is delaying cases and diminishing surgery center efficiency. "Showing up to work on time doesn't mean arriving at 7:20 if it's a 7:30 start," he says. "It should mean you're there 30 minutes ahead of time, you're prepared and you've introduced yourself to staff if you're new." He says anesthesia providers should be expected to talk to staff and physicians prior to the procedure, participate in the pre-operative exam and speak to patients about their anesthesia.
To ensure timely case starts, Mr. Casner says new anesthesia providers should be oriented to the facility prior to their first case. "Providers should orient to a facility before their official first day," he says. "This means determining out how long it takes to drive to their assigned facility, locating the equipment and medications in the center, and meeting the nurse manager."
2. Look at interactions with physicians and staff. Because the surgery center is a smaller, more close-knit environment than the hospital, anesthesiologists must be friendly and respectful, Mr. Casner says. “Anesthesia providers are guests in a physician and nurse manager’s home and they should behave accordingly.” At the hospital, distant or rude anesthesiologists may be able to get away with poor behavior, but a hostile relationship between a surgery center physician and an anesthesiologist will soon sour the contract between the anesthesia provider and the ASC. "Outpatient centers are typically owned by the surgeons, and you have to [behave well] in those centers or you get fired," Mr. Casner says.
He recommends the administrator take note of the relationship between surgeons, staff and anesthesiologists to make sure everything is running smoothly. If the ASC physician-owners hold a regular meeting with the administrator, he or she can use that time to check in on the anesthesiologists' performance and the relationship between the two groups. This is especially important because disagreements between anesthesia providers and physicians can endanger patient safety if the two parties cannot communicate properly.
3. Follow up with patients after discharge. Mr. Casner says aisthesis performs follow-up calls with every patient that has been discharged from a surgery center to check in on their progress after surgery. While most surgery centers perform follow-up calls to remind patients of post-surgical directives, Mr. Casner recommends checking in on the patient's experience with anesthesia and progress after surgery. Centers should know when a patient has experienced untreated pain or postoperative complications, including nausea or vomiting. Patient experience and postoperative complications can greatly influence a patient’s satisfaction and their overall memory of a procedure. Mr. Casner says that aisthesis works with the centers they serve to follow up with discharged patients and collect post-procedure data.
Given the influence patient experience and postoperative complications can have on patient satisfaction, anesthesiologists should be kept aware of their track record in preventing postoperative discomfort. The patient may also feel that the anesthesia provider did not spend enough time explaining the anesthesia process or that the anesthesiologist seemed rushed or rude. Make sure to catch these issues before they become a pattern and affect your surgery center's reputation in the community.
4. Collect information on specific clinical outcomes. Mr. Casner says surgery center leaders should collect information on clinical outcomes, in addition to patient experience, and regurgitate that data back to providers to demonstrate where problem areas exist. The information does not have to be broken down by anesthesiologist — especially in a small ASC because anesthesia providers should be expected to act as a team to prevent adverse clinical outcomes. Mr. Casner also recommends recording any untoward events that occur in the post-anesthesia care unit and in the first 24 hours after discharge.
"We use clinical outcome data as an opportunity to educate or congratulate our providers. In the event that a provider had an excessive amount of [untoward events], such as a longer time to recover from anesthesia or too many cases of intubation, we would assess whether the anesthesia provider has a problem with their clinical skills or just a string of bad luck." Over time, you will get a sense for the most common anesthesia issues in your ASC and can work with anesthesiologists to fix those problems.
5. Analyze hospital transfers. A high number of hospital transfers can be a sign that your ASC is experiencing too many adverse outcomes due to anesthesia, according to Mr. Casner. Track hospital transports per anesthesia provider and discuss those events during quarterly clinical meetings. "This includes any transport to the hospital for whatever reason," he says. While anesthesiologists may not always be to blame for hospital transports, they may be able to offer insight into pre-surgical or surgical problems that are causing the increase.
6. Perform regular chart reviews. Mr. Casner says his company mandates chart review every month for all its anesthesiologists. The first thing they look for is completeness of the record — in other words, whether the anesthesiologist documented everything necessary.
"If the rule is documenting vital signs every five minutes, is there demonstration of that on the clinical chart and have they filled in all the boxes?" he says. "When they discharged the patient to the PACU, did they do a post-op assessment and note the vital signs?" If the charts are frequently incomplete, remind anesthesiologists that the information is important and mandatory.
7. Conduct customer satisfaction surveys. For Mr. Casner, "customer satisfaction surveys" mean asking the surgery center for feedback on their anesthesia provider — but tracking satisfaction scores is just as important for the ASC leaders themselves. When you send out physician, patient and staff satisfaction surveys (which should happen on at least an annual basis), make sure to ask questions about the anesthesiologists at your facility.
For patients, these questions could sound something like, "Did the anesthesia provider explain the anesthesia process adequately prior to surgery?" For physicians and staff, the question could be phrased, "Does the anesthesia provider introduce him/herself prior to surgery?" Leave room on the surveys for your "customers" to expand on their thoughts.
8. Expect anesthesia to contribute to quality improvement. Anesthesiologists should be expected to contribute to projects that improve efficiency, cut costs or emphasize patient safety, Mr. Casner says. That doesn't mean anesthesia providers should spend every waking minute at the center, but they should be expected to attend meetings and provide feedback. The level of involvement in these projects will demonstrate how committed the group is to your center.
In addition, anesthesiologist feedback is essential to many projects that improve ASC operations. Especially in centers that perform a majority of ophthalmology or endoscopy cases, quick room turnover is extremely important to efficiency and profitability, Mr. Casner says. "We have very busy centers where you've just got to be hopping," he says. "Anesthesiologists have to be part of that process."
9. Track case cancellations due to anesthesia. If a case is cancelled because an anesthesia provider arrives late to the surgery center or cancels a patient at the last minute, make a note of the cancellation and track the number over time, Mr. Casner says. He says surgery center anesthesia providers should be committed to the ASC — one reason that finding a group that specializes in surgery center anesthesia can be so beneficial.
"We have found that ASCs with hospital-based anesthesia groups, have experienced delays in coverage and cancellations because the group pulls the doctor or CRNA back into the hospital," he says. Groups that specialize in ASC anesthesia never have to post call or delay cases to serve other centers, Mr. Casner says. Additionally, providers from specialized ASC anesthesia groups never show up to procedures exhausted from a night at the hospital.
10. Select a liaison from the anesthesia group. Surgery center leaders should ask their anesthesia groups to select a go-to provider to answer questions, report anesthesia provider feedback, and head quality improvement initiatives for the team, according to Mr. Casner. Anesthesia liaisons allow ASCs to collect feedback and information in a more efficient fashion. Every few months, ASCs should sit down with their anesthesia liaison and review the relationship between the surgery center and the anesthesia provider. There may be issues on the anesthesia group's end that you have no idea about — and vice versa.
Learn more about aisthesis.
Related Articles on Anesthesia:
Heat, Extreme Exercise Can Trigger Malignant Hyperthermia
Local Anesthesia Effective for Oculofacial Surgery
Anesthesia in ASCs