Compared with hospitals, relationships between anesthesiologists and surgeons at ASCs are excellent, but there is also an elevated level of expectation at ASCs, says Thomas Wherry, MD, medical director of Health Inventures and principal for Total Anesthesia Solutions, a company dedicated to finding strategic solutions for issues relating to anesthesia care.
"The surgeon expects a low same-day cancellation rate in an ASC," he says. "Additionally, unlike the hospital, they expect the ASC to be a well-oiled machine. The cases should start on time, turnaround should be efficient and the patient should recover easily from the anesthesia." The anesthesiologist also expects the patients to be well-prepared, relatively healthy and to have the required medications and equipment to safely provide care.
Here are four ways Dr. Wherry suggests surgeons and ASCs can improve relations with anesthesiologists.
1. Approve appropriate patients for surgery. Surgeons should not decide to operate on patients inappropriate for anesthesia in an ASC, such as extremely obese patients with severe obstructive sleep apnea. "Anesthesiologists will feel resentful if surgeons are pushing them to do cases they don't feel comfortable with." There needs to be an agreed-upon methodology on choosing and screening patients.
2. Get to the OR on time. Anesthesiologists must arrive early to get the patient ready for the case, but they may end up waiting for a late surgeon. "This is a big problem with certain ASCs and is a big dissatisfier for the patient, nurses and anesthesia," Dr. Wherry says. ASCs must be more proactive in dealing with the chronically late surgeon.
3. Be truthful about scheduling. When a surgeon says a case should last two hours, it shouldn't then take four hours. "There needs to be truth in scheduling," Dr. Wherry says. The chronically late or under-posted surgeon will have a significant impact on morale. Anesthesia groups tend to run tight schedules and will often travel to several locations. Running past the posted time for preventable reasons will certainly minimize their ability to cover other locations.
4. Consult on decisions. Consult with anesthesiologists on important decisions such as opening an additional operating room or introducing a new service line. "It's a mistake not to include the anesthesiologists because you're counting on them to make the new plans a success," Dr. Wherry says. He also suggests inviting anesthesiologists to medical executive or board meetings. By including them in the process, you will more likely to get their buy-in. An anesthesiologist who is included will be more engaged and be more likely to go the extra mile for the ASC.
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