Anesthesia plays a significant, but often under-appreciated role.
The performance of anesthesia providers directly affects an ASC’s operation – everything from patient outcomes to surgeon satisfaction to case volume. As procedures migrate out of the inpatient setting and into outpatient settings like ASCs, the importance of anesthesia in delivering safe, high-quality care will continue to grow.
The monitoring of appropriate key performance indicators (KPIs) involving anesthesia services can help ensure your anesthesia providers are consistently meeting—if not exceeding—the needs of your ASC and its patients and surgeons. It can also give your ASC a means to identify opportunities for measurable improvement.
METRICS THAT MATTER.
There are numerous anesthesia-related key performance indicators (KPIs) you can choose to measure. If measuring a KPI allows you to effectively assess your operations in some fashion, then you made a good choice. To help you develop or further solidify your ASC’s baseline anesthesia KPIs, here are some areas we recommend you consider monitoring.
PATIENT SELECTION & SAME-DAY CANCELLATIONS.
Nurses at ASCs typically screen patients, but there is an opportunity to involve anesthesia for the benefit of patients and the ASC. Anesthesia can bring additional insight to the screening process, potentially catching issues such as those with a difficult airway that will allow an ASC to appropriately alter the anesthetic plan or, if necessary, cancel the patient prior to the day of surgery.
When working to streamline patient flow, the focus is often on what works best for the clinical support staff or what will start a case quicker. But such mentalities may overlook what is best for the overall patient experience.
Giving patients an opportunity to interact with their anesthesia provider before they are in the OR, hooked up to monitors and staring at the ceiling, can make a big difference in their perception of the overall surgical experience. A meeting with anesthesia can allay patient fears and reduce anxiety. It can also provide the patient with a feeling that the ASC views them as an individual worthy of personalized attention and not just one more case.
Anesthesia should play a significant role in monitoring patient temperature and maintaining normothermia. While always important, this takes on even greater significance during longer and more complex cases.
POST-OPERATIVE NAUSEA & VOMITING (PONV).
PONV should be an area of focus during any case, but, as with temperature monitoring, it is of greater concern during longer cases because of prolonged time under anesthesia. This may contribute to a higher likelihood of patients experiencing PONV.
An ASC’s clinical team, including anesthesia, should make sure PONV prevention efforts are individualized for patients. This includes pre- and post-operative treatments and the anesthetic cocktail administered.
POST-ANESTHESIA CARE UNIT (PACU) RECOVERY TIME.
While many ASCs track PACU recovery time, there can be a tendency to misread the data. When patients are in the PACU longer than expected, the blame often falls on nurses. But if the patient comes out too heavily sedated, there is nothing a PACU nurse can do to accelerate recovery.
Planning for recovery should begin before the surgery starts. An effective pre-op screening involving anesthesia can help identify the most appropriate level of sedation and better ensure patients can be safely brought out of deep sedation as quickly as possible.
When surgeons and anesthesia collaborate on how to approach individual cases, outcomes can improve. Anesthesia’s ability to assess a patient prior to a procedure may influence pain management decisions. For example, if an anesthesia provider learns that a patient experienced post-operative pain when previously undergoing the same scheduled procedure, the provider may determine it is advisable to alter the anesthetic for the procedure to ensure an optimal outcome. A conversation with the surgeon about this patient’s needs prior to surgery can make a significant difference in the overall patient experience, which will reflect well on the surgeon and ASC.
CASES PER PROVIDER.
While adding cases may not seem like a matter tied to improving patient care, an argument can be made for ASCs as a site of service at least as safe, if not safer, than a hospital. Anesthesia can have a direct role in growing the number of cases surgeons bring to the ASC.
Anesthesia providers can speak with surgeons about the procedures they still perform at a hospital and which anesthesia is comfortable supporting in the ASC. Chances are, it will be many of them. Anesthesia providers can explain how they will ensure proper pain management and optimal recovery times and room turnover as well as proper patient selection. These factors may help motivate surgeons to increase their ASC cases.
BUILD COLLABORATION THROUGH DATA SHARING.
We’ve identified just some of the anesthesia-related KPIs you may want to consider tracking, if you are not already, or how to reevaluate the role anesthesia plays in affecting these KPIs. But the KPI data you gather is only as good as what you do with it.
Your anesthesia providers are likely tracking their own KPIs (if they’re not, consider this a red flag). By working more collaboratively with anesthesia, it will become easier to capture the data you want – and more of it. You can coordinate data tracking, which will help reduce redundancy and improve accuracy. By sharing data, you can jointly work to evaluate the information and identify improvement opportunities.
To achieve this synergy, anesthesia must become a true member of your ASC team. When you treat your anesthesia providers like a partner, they will reward your ASC, its surgeons and staff. Anesthesia can play a significant role in evaluating and elevating the performance of your entire operations. In the end, this will ultimately benefit your patients.
If you need help accomplishing these and other performance objectives, please contact Mobile Anesthesiologists.