Here are five points about successful anesthesia at orthopedic practices.
1. Rely on several core anesthesiologists to streamline OR processes. To save money on intra-operative processes, Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, says ASCs must focus on recruiting anesthesiologists who are willing to perfect their technique and make the OR more efficient. "The skill level of a provider can really impact the flow of the room, and if they're doing eight or nine cases in a day and the anesthesia provider is really slow, that could add an hour to the day easily," he says. "A provider that can get the patient prepared and under anesthesia more efficiently can be a huge cost-savings."
In order to make the OR more efficient, Dr. Wherry says anesthesiologists must build relationships with nursing staff and help them address inefficiencies. This can only be accomplished if an anesthesiologist spends a good amount of time at the center, he says. "A lot of centers will insist that out of a group of 20 anesthesiologists, they use a few core providers and one provider that's there on a regular basis," he says. "Without that consistency, you don't get any traction on some of these initiatives." He says the facility should take responsibility for encouraging the core anesthesiologists to identify problems and work with nursing staff and surgeons to fix them.
From "6 Ways to cut Anesthesia Costs in Your ASC."
2. Encourage surgeons and anesthesia staff to coordinate their efforts. Ensuring that blocks and other anesthetics are administered at times that make the surgeon most efficient is also very important to success for an orthopedic service line.
"Work with anesthesia to help them understand how [surgeons] want to coordinate their blocks," says Timothy Kremchek, MD, medical director at Beacon Orthopedics and Sports Medicine and a physician-owner of the clinic's surgery center. "This is very important for ensuring that procedures can begin in a timely manner. Otherwise, you may be waiting in a room before a procedure can start."
From "8 Best Practices to Make Orthopedics Profitable in Surgery Centers."
3. Conscious sedation and local anesthesia works. A clear benefit of The Bonati Spine Procedures is that they are performed under IV sedation or local anesthesia instead of general anesthesia. "This allows the patient to communicate during the procedure, providing real-time feedback," saysJohn Grossmith, MD, a board certified neurosurgeon at The Bonati Spine Institute in Hudson, Fla. Before ending the procedure, he asks the patient to move on the operating room table in ways to ensure that the preoperative pain complaints have been eliminated. This is a real boost to the patient's confidence and would not be possible under general anesthesia.
From "7 Key Elements for Achieving High Patient Satisfaction and Better Outcomes in Orthopedic and Spine Surgery."
4. Use twighlight anesthesia for older patients undergoing minimally invasive surgery. It is recommended that endoscopic spine procedures be done under twilight anesthesia, not general anesthesia, which is especially important when treating older patients, says Bryan Massoud, MD, a spine surgeon with Spine Centers of America in Fair Lawn, N.J. Older patients often have co-morbidities which would make them poor candidates for open surgery. However, going in endoscopically without general anesthesia will limit the complication rate, decrease the infection rate and allow patients to have surgery who otherwise wouldn't be able to handle the procedure.
From "The Trend toward Minimally Invasive Spine Surgery: Q&A With Dr. Bryan Massoud of Spine Centers of America."
5. Examine the last year of transfers by anesthesia provider. Once David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, understood that his center treated a higher percentage of sick patients than the average ASC, his committee decided to look more closely at transfer data based on different categories. "We looked at transfers for the past year by surgeon, by anesthesia provider, by the nurses that cared for the patient, by how long the patient was in the PACU, by time of day in the PACU, by the patient's co-morbidities and by what kind of procedure it was," he says.
By examining this data, he says his center discovered several surprising trends. The staff had expected more cases to be transferred on Thursdays and Fridays, but the data showed more Monday transfers than any other day. Similarly, the staff expected shoulder surgeries to prompt the most transfers, when in fact urology cases were the highest.
From "6 Steps to Reduce Transfer Rates Through Benchmarking."
1. Rely on several core anesthesiologists to streamline OR processes. To save money on intra-operative processes, Thomas Wherry, MD, principal of Total Anesthesia Solutions and medical director for Health Inventures, says ASCs must focus on recruiting anesthesiologists who are willing to perfect their technique and make the OR more efficient. "The skill level of a provider can really impact the flow of the room, and if they're doing eight or nine cases in a day and the anesthesia provider is really slow, that could add an hour to the day easily," he says. "A provider that can get the patient prepared and under anesthesia more efficiently can be a huge cost-savings."
In order to make the OR more efficient, Dr. Wherry says anesthesiologists must build relationships with nursing staff and help them address inefficiencies. This can only be accomplished if an anesthesiologist spends a good amount of time at the center, he says. "A lot of centers will insist that out of a group of 20 anesthesiologists, they use a few core providers and one provider that's there on a regular basis," he says. "Without that consistency, you don't get any traction on some of these initiatives." He says the facility should take responsibility for encouraging the core anesthesiologists to identify problems and work with nursing staff and surgeons to fix them.
From "6 Ways to cut Anesthesia Costs in Your ASC."
2. Encourage surgeons and anesthesia staff to coordinate their efforts. Ensuring that blocks and other anesthetics are administered at times that make the surgeon most efficient is also very important to success for an orthopedic service line.
"Work with anesthesia to help them understand how [surgeons] want to coordinate their blocks," says Timothy Kremchek, MD, medical director at Beacon Orthopedics and Sports Medicine and a physician-owner of the clinic's surgery center. "This is very important for ensuring that procedures can begin in a timely manner. Otherwise, you may be waiting in a room before a procedure can start."
From "8 Best Practices to Make Orthopedics Profitable in Surgery Centers."
3. Conscious sedation and local anesthesia works. A clear benefit of The Bonati Spine Procedures is that they are performed under IV sedation or local anesthesia instead of general anesthesia. "This allows the patient to communicate during the procedure, providing real-time feedback," saysJohn Grossmith, MD, a board certified neurosurgeon at The Bonati Spine Institute in Hudson, Fla. Before ending the procedure, he asks the patient to move on the operating room table in ways to ensure that the preoperative pain complaints have been eliminated. This is a real boost to the patient's confidence and would not be possible under general anesthesia.
From "7 Key Elements for Achieving High Patient Satisfaction and Better Outcomes in Orthopedic and Spine Surgery."
4. Use twighlight anesthesia for older patients undergoing minimally invasive surgery. It is recommended that endoscopic spine procedures be done under twilight anesthesia, not general anesthesia, which is especially important when treating older patients, says Bryan Massoud, MD, a spine surgeon with Spine Centers of America in Fair Lawn, N.J. Older patients often have co-morbidities which would make them poor candidates for open surgery. However, going in endoscopically without general anesthesia will limit the complication rate, decrease the infection rate and allow patients to have surgery who otherwise wouldn't be able to handle the procedure.
From "The Trend toward Minimally Invasive Spine Surgery: Q&A With Dr. Bryan Massoud of Spine Centers of America."
5. Examine the last year of transfers by anesthesia provider. Once David Kelly, administrator of Samaritan North Surgery Center in Dayton, Ohio, understood that his center treated a higher percentage of sick patients than the average ASC, his committee decided to look more closely at transfer data based on different categories. "We looked at transfers for the past year by surgeon, by anesthesia provider, by the nurses that cared for the patient, by how long the patient was in the PACU, by time of day in the PACU, by the patient's co-morbidities and by what kind of procedure it was," he says.
By examining this data, he says his center discovered several surprising trends. The staff had expected more cases to be transferred on Thursdays and Fridays, but the data showed more Monday transfers than any other day. Similarly, the staff expected shoulder surgeries to prompt the most transfers, when in fact urology cases were the highest.
From "6 Steps to Reduce Transfer Rates Through Benchmarking."