Creating a Framework Around the Anesthesia Process Improves Clinical Excellence

Anesthesiology is a unique specialty: Each day, patients consent to put their lives into our hands. And with this consent, there is an expectation that the anesthetic will be delivered by a provider, and a department, that actively strives for clinical excellence.

Professors teach clinical excellence in healthcare educational programs. We print it on posters, hang it on walls in our hospitals, place it on agendas in department meetings. Experts tout “clinical excellence” in academic literature, news channels, radio interviews.

Healthcare providers claim to deliver clinical excellence. Patients need to receive clinical excellence. And the government is now attempting to measure clinical excellence.

But what exactly does clinical excellence mean? Defining it requires more than a single sentence. Clinical excellence is multi-faceted and includes:

• Evidence-based integrative practice
• Education, research and policy creation
• Technology development that streamlines data collection
• Team collaboration and leadership

Anesthesia departments are perfectly positioned to contribute to clinical excellence in very meaningful ways. But to do this, we must acknowledge that the “old” ways of practice have to be abandoned. No more

• “That’s the way it’s always been done”
• “You don’t understand; our patients are sicker”
• “The system doesn’t allow for change”
• “It’s someone else’s responsibility”
• “I don’t have time”

Instead, Anesthesiologists and CRNAs can seize this unprecedented moment in healthcare history and decide to be part of the solution to achieving clinical excellence.

As your department begins to think about what clinical excellence looks like in your facility, it may help to create a framework around the anesthesia process:

Pre-anesthesia

Historically, patients received a pre-surgical evaluation without much thought around the complexities of anesthesia. Movement towards a more collaborative relationship between surgery and anesthesia has resulted in a multitude of benefits not only for the patient, but the healthcare system as a whole. A pre-anesthesia clinic that provides an in-person evaluation has been associated with lower same-day delays/cancellations, cost reduction in length-of-stay and readmission rates, and decreased anesthesia-related mortality events.

To this end, anesthesia departments would benefit from a well-designed pre-anesthesia testing process. Some questions that may help in your thoughts towards pre-anesthesia testing:

1. Do you currently have a well-designed pre-anesthesia testing clinic staffed with a RN or Advanced Practice Nurse?
2. Are evidence-based pre-anesthesia testing guidelines/algorithms in place for staff reference in their patient care practice?
3. Is there surgeon collaboration with the pre-anesthesia testing clinic?
4. Is the clinic capturing all surgical patients? If not, why? How can this improve?

 Patients that participate in a pre-anesthesia experience have the opportunity to ask questions, receive education, and participate in their surgical care.

Intraoperative/Post-anesthesia Care

The adoption of evidence-based anesthesia practices may be the most challenging for anesthesia leadership. Clinicians tend to stay loyal to the anesthesia practices that were developed during their education, and typically need strong reasons for change. Department leaders can be instrumental for clinical excellence advancement through education, process implementation, and celebrations.

Educate providers on the department’s commitment towards clinical excellence. Choose areas that require small changes, such as PONV prevention. Include the team in evidence-based outcome review and implementation strategies. Collect the data throughout implementation. And finally, celebrate the outcome!

Once the department recognizes that changes in practice can lead to clinical excellence, they will begin to embrace larger changes: Hip fracture management, joint replacement multimodal anesthesia, etc.

 Team

Clinical excellence cannot happen in a vacuum. It only happens when teams decide to work together towards a collective goal. To develop this team spirit, department leaders can organize journal clubs or monthly case study reviews. Encouraging providers to participate in hospital committees can be a valuable contribution to the team.

Anesthesiologists and nurse anesthetists, working together, can provide a transformative impact on patient care, operational efficiency, and cost containment.

Clinical Excellence. It’s hard to define, but it’s a goal worth pursuing.