Here Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, discusses 12 anesthesia processes to consider benchmarking in your ASC. He recommends choosing five or six of these processes and creating a neat, easy-to-understand report card for your anesthesia providers, rather than trying to benchmark too much.
1. Same-day cancellation rate. According to Dr. Wherry, same-day cancellation rates should be close to zero. Once you know your same-day cancellation rate compared to other centers, you can work with surgeons and anesthesiologist to determine the cause of cancellations. The pre-op phone call screening process is often the root cause.
2. Average phone call length. "Benchmarking the average phone call length is important because phone calls made by nurses should be short and succinct," Dr. Wherry says. While this may not be a direct anesthesia benchmark, he says anesthesiologists can work with nurses to go over necessary information for the call. If the anesthesiologist explains what anesthesia needs to know prior to the case, the nurses should be able to cut the pre-op phone call down to 10 minutes or less.
3. Supply costs per case. Benchmark supply costs per case against other facilities to determine where you waste money on supplies, Dr. Wherry says. He identifies top supply money-wasters as expensive IV tubing and breathing circuits and inhalation agents that are allowed to flow into the atmosphere.
4. Late arrivals. "A lot of centers complain about the anesthesiologist showing up late," Dr. Wherry says. He says tracking arrival times can give you leverage when speaking to your anesthesia providers about lateness problems, as well as give you an idea of where time is wasted during the pre-op process. He says as a general rule, anesthesiologists or CRNAs working in an ASC should be at the center 15-30 minutes before the first schedule case.
5. Time in the procedure room before and after surgery. According to Dr. Wherry, your ASC should benchmark the time the anesthesia provider spends in the room before surgical prep and after surgery ends. These are typically referred to as induction time and emergence time. "Both those times should be under five minutes," he says.
6. Narcotic documentation and compliance. Dr. Wherry says your ASC should ensure anesthesiologists are recording narcotic documentation according to CMS and accreditation regulations. Compare what was recorded on the anesthesia record to what was signed out.
7. ASA physical class of patients. Dr. Wherry recommends benchmarking American Society of Anesthesiologists Physical Status of patients, which (for an ASC) will typically fall on a scale of 1 (normal, healthy patient) through 3 (patient with severe systemic disease). This will give you an idea of how healthy your patient population is and could alter the precautions you take with anesthesia or surgery.
8. Recovery time. Be careful about tasking your anesthesiologists with lowering recovery times, as they are not the only people responsible for the process. However, ASCs can still benchmark recovery times to involve anesthesiologists in promoting efficiency. "If they're benchmarked for [recovery time] and they see that, they may take some ownership to decrease that benchmark," he says. "It's not necessarily fair because they don't have 100 percent impact on recovery times, but you can certainly get them to participate."
9. Type of anesthesia provided. Dr. Wherry recommends benchmarking how much regional and general anesthesia your surgery center performs. "It's an easy benchmark, and most scheduling modules can track it without any extra effort," he says.
10. Patient satisfaction. While patients might not always feel well after anesthesia — no matter how well the anesthesiologist performed — centers can track patient satisfaction based on other factors, such as the level of comfort going into surgery. "You can ask, 'Did the anesthesiologist address your concerns in the pre-op area? Were you satisfied with your care? Did you have concerns for your recovery?'" Dr. Wherry says. "Things aren't going to be 100 percent perfect, but patients will mostly be satisfied if the anesthesiologist listened to their concerns and took them seriously."
11. Post-operative nausea and vomiting rates. Dr. Wherry says your ASC should track nausea and vomiting separately, as in feeling sick versus actual vomiting. "With today's anesthetic techniques, those rates should be low," he says. "It's worth measuring and comparing if you're in a network of 10 centers because you know there's a problem if you're the highest."
12. Surgeon satisfaction. Dr. Wherry says surgeon satisfaction with anesthesia can be measured when the ASC distributes surveys on surgeon satisfaction with the overall ASC. Because surgeons and anesthesiologists sometimes butt heads over patient eligibility for surgery and other issues, benchmarking surgeon satisfaction on a regular basis will help you understand when you need to step in and talk to both parties about regular disputes.
Learn more about Total Anesthesia Solutions.
Learn more about Health Inventures.
1. Same-day cancellation rate. According to Dr. Wherry, same-day cancellation rates should be close to zero. Once you know your same-day cancellation rate compared to other centers, you can work with surgeons and anesthesiologist to determine the cause of cancellations. The pre-op phone call screening process is often the root cause.
2. Average phone call length. "Benchmarking the average phone call length is important because phone calls made by nurses should be short and succinct," Dr. Wherry says. While this may not be a direct anesthesia benchmark, he says anesthesiologists can work with nurses to go over necessary information for the call. If the anesthesiologist explains what anesthesia needs to know prior to the case, the nurses should be able to cut the pre-op phone call down to 10 minutes or less.
3. Supply costs per case. Benchmark supply costs per case against other facilities to determine where you waste money on supplies, Dr. Wherry says. He identifies top supply money-wasters as expensive IV tubing and breathing circuits and inhalation agents that are allowed to flow into the atmosphere.
4. Late arrivals. "A lot of centers complain about the anesthesiologist showing up late," Dr. Wherry says. He says tracking arrival times can give you leverage when speaking to your anesthesia providers about lateness problems, as well as give you an idea of where time is wasted during the pre-op process. He says as a general rule, anesthesiologists or CRNAs working in an ASC should be at the center 15-30 minutes before the first schedule case.
5. Time in the procedure room before and after surgery. According to Dr. Wherry, your ASC should benchmark the time the anesthesia provider spends in the room before surgical prep and after surgery ends. These are typically referred to as induction time and emergence time. "Both those times should be under five minutes," he says.
6. Narcotic documentation and compliance. Dr. Wherry says your ASC should ensure anesthesiologists are recording narcotic documentation according to CMS and accreditation regulations. Compare what was recorded on the anesthesia record to what was signed out.
7. ASA physical class of patients. Dr. Wherry recommends benchmarking American Society of Anesthesiologists Physical Status of patients, which (for an ASC) will typically fall on a scale of 1 (normal, healthy patient) through 3 (patient with severe systemic disease). This will give you an idea of how healthy your patient population is and could alter the precautions you take with anesthesia or surgery.
8. Recovery time. Be careful about tasking your anesthesiologists with lowering recovery times, as they are not the only people responsible for the process. However, ASCs can still benchmark recovery times to involve anesthesiologists in promoting efficiency. "If they're benchmarked for [recovery time] and they see that, they may take some ownership to decrease that benchmark," he says. "It's not necessarily fair because they don't have 100 percent impact on recovery times, but you can certainly get them to participate."
9. Type of anesthesia provided. Dr. Wherry recommends benchmarking how much regional and general anesthesia your surgery center performs. "It's an easy benchmark, and most scheduling modules can track it without any extra effort," he says.
10. Patient satisfaction. While patients might not always feel well after anesthesia — no matter how well the anesthesiologist performed — centers can track patient satisfaction based on other factors, such as the level of comfort going into surgery. "You can ask, 'Did the anesthesiologist address your concerns in the pre-op area? Were you satisfied with your care? Did you have concerns for your recovery?'" Dr. Wherry says. "Things aren't going to be 100 percent perfect, but patients will mostly be satisfied if the anesthesiologist listened to their concerns and took them seriously."
11. Post-operative nausea and vomiting rates. Dr. Wherry says your ASC should track nausea and vomiting separately, as in feeling sick versus actual vomiting. "With today's anesthetic techniques, those rates should be low," he says. "It's worth measuring and comparing if you're in a network of 10 centers because you know there's a problem if you're the highest."
12. Surgeon satisfaction. Dr. Wherry says surgeon satisfaction with anesthesia can be measured when the ASC distributes surveys on surgeon satisfaction with the overall ASC. Because surgeons and anesthesiologists sometimes butt heads over patient eligibility for surgery and other issues, benchmarking surgeon satisfaction on a regular basis will help you understand when you need to step in and talk to both parties about regular disputes.
Learn more about Total Anesthesia Solutions.
Learn more about Health Inventures.