We must meet the needs of our patients, the surgeons, and the facility if we hope to be successful in providing our necessary and critical service, all while simultaneously working in accordance with the standards and guidelines set before us to establish the principles of safe practice. Patient safety is, of course, our number one goal, and it is a bar that can never be lowered to accommodate any other consideration or direction. In many situations, anesthesia providers are poised to make decisions preoperatively, intraoperatively, and postoperatively to maintain the sanctity of patient safety while also greatly improving the efficiency and cost effectiveness of the OR. These decisions become valuable components of an efficient anesthesia practice, and making them thoughtfully and strategically assures that we are being responsible and considerate of the stakeholders who share vested interests in the overall success of the perioperative experience.
There are many considerations to account for in running an efficient anesthesia practice. The three components listed below are vital to success and can be greatly expanded upon for further improvement.
1. CONSISTENT COMMUNICATION AMONG THE ENTIRE CARE TEAM
A truly efficient perioperative department manifests from communication and planning by an interprofessional team providing key points of service across the perioperative continuum. Success or failure hinges on the honest, open communication between the surgeon, preoperative staff, anesthesia providers, and post operative staff who understand the key components of service that can never be compromised, and also those aspects of care that can be manipulated and streamlined to eliminate unnecessary processes, procedures, and old dogmas that aren’t found in the delivery of evidence-based care. Representatives from the entire care team should come together on a regular basis to convey rationale behind their needs. These discussions often reveal opportunities for increasing efficiencies and reducing costs, and their outcomes should be measured and reviewed on both patient safety and efficiency scales.
2. CRITICALLY EVALUATING THE PREOPERATIVE PROCESS
An area that deserves a thorough review in evaluating the efficient flow of patients through the surgical experience is preoperative testing. The basis for this discussion rests with early patient evaluation and preoperative testing, since this process establishes the anesthetic plan and the necessary considerations that will assure the safe delivery of the anesthetic. It should also specify required tests and minimize day-of-surgery delays or cancellations. The decisions made jointly by the surgeon, anesthesia providers, and preoperative assessment team to establish the guidelines for testing and clearance should be an ongoing process and under constant review and evaluation. As clinicians, we have all been told since the earliest stages of our educational experiences, “If the test is important enough to order, then it is important enough to see the results before proceeding to the OR.” A key point is to allow sufficient time to perform the preoperative assessment, determine the need for tests, evaluate the results, and determine the correct path before proceeding with the scheduled surgery. Frequent delays and cancellations should be a trigger for the need to reassess the preoperative process.
3. STANDARDIZATION OF PROCESSES AND PROTOCOLS
The next area of discussion is the standardization of documents and processes. Most facilities today perform procedures that require anesthesia care in areas outside of the conventional operating suite. Consider the standardization of forms, records, and anesthesia carts to the extent that it is possible across all areas. This will facilitate accurate and efficient documentation when the anesthesia provider knows where to look on the record for key data and where the appropriate check boxes and graphics are located. Having standardized anesthesia carts ensures that each anesthesia provider can walk into any case, in any area, and immediately find the critical tools and medications necessary to function at a high level. The goal should be to minimize confusion and promote accuracy and efficiency on the written record while delivering the same safe patient care in procedures, regardless of location. Most anesthesia providers will agree that sticking to a routine is advantageous. We tend to “make our nest” the same way for each case, no matter the duration or complexity, and the same can be said for many processes, such as the steps that must be completed before rolling the patient to the OR, the transfer process from the stretcher to the OR table, the time out procedure, and the intraoperative communication with the surgical team. New teammates should receive an orientation to the established procedures and the processes that are followed, recognizing that there is always variability across specialties and even individual surgeons and OR teams. Scheduled departmental meetings provide a great way to share techniques and suggestions for improvement that might become standard procedure for the entire team. While there are many ways to deliver that “perfect” anesthetic, perhaps a member of the team has a technique that all teammates could benefit from learning. Once again, communication seems to be a recurring theme for a department functioning in an environment of change and striving to deliver the best care possible.
It has been said that anesthesia is the profession that one will never outgrow. The first anesthetic induction I performed was with sodium thiopental, and my then state-of-the-art monitors included a manual blood pressure cuff, an earpiece attached to a precordial stethoscope, and a tiny EKG tracing that moved across the screen as a bouncing dot of light. Indeed, much has changed since then, and it will continue to change. Although the delivery of anesthesia care has never been safer than it is today, it will continue to be refined, and the pressures to provide cost effective, efficient care will continue. What we can never allow to happen is to fall into the trap of continuing a practice or a process simply because it is the way we have always done it. Bob Dylan said it best: “The times they are a changing,” and our profession has changed, too. Safe anesthesia care provided in an efficient and cost effective fashion will continue to be the desired goal for all future providers. I look forward to seeing the innovation and change in the approach to improve and refine our current models. Together, we have the ability within NorthStar to be leaders in the industry and I am delighted to be a part of the team.