Anesthesiologists are part of the evolving healthcare world where the concept of their positions remain the same, but the everyday tasks surrounding it change.
Healthcare legislation and its corresponding marketplace are
driving two big focuses – practice evaluation and increasing
the quality of patient care.
About the same time as the Patient Protection and
Affordable Care Act was signed into law, the Anesthesiology
Clinical Institute launched the Qualified Clinical Data
Registry. This resource was designed for healthcare workers to compare notes about patient outcomes and facility
approaches. “This has been used as a benchmark, to see how
well you’re delivering care, what the variation of care may
be within your practice, how you compare to others, (and)
opportunities for improvement,” Dr. J.P. Abenstein, president
of the American Society of Anesthesiologists (ASA), said.
ASA later took the lead of this data repository.
He explained the accumulated data shows surgical teams
if there are variations in their care compared to other facilities. “People delivering healthcare don’t want to be an outlier,” he explained. These variations include: case length,
recovery time, type of care, anesthesia administered and
more, he said.
As an anesthesiologist, he was one example of how data
could change an approach. He works with open heart surgery patients and commonly used medazylyn on patients.
When he was comparing his results to other cases, Abenstein
noticed this drug significantly increased everyone’s mortality
rates when used on elderly patient with sycosis. “With the
data we’ve been gathering, we’ve pretty much stopped using
medazlyien on the elderly because of this complication we
were unaware of. Through this ongoing gathering of information, examining it in the context of how patients do and then
adjusting our practices, (we can) improve the care we deliver
to patients,” he said.
Another example is pain management. “What we’ve seen
with different approaches to pain, like multimodal and
decreasing the amount of narcotics we give, is patients have
less pain and can get out of bed sooner,” Abenstein said.
Since the data is based off of patient records, it’s normally
accurate with minimal human error, he said.
Perioperative Surgical Home
Abenstein said this data archive could increase efficiencies
in care, but ASA is pushing healthcare facilities to consider
another option to increase the quality of patient care too – the
Perioperative Surgical Home (PSH). Basically, it’s an extended, more comprehensive version of the Enhanced Recovery
After Surgery (ERAS) Program.
Abenstein suggests, as the healthcare industry turns more
into a market place, PSH will give facilities a competitive
edge. “We’re arguing that by delivering a higher quality of
care at a lower cost, by definition, you’re more competitive,”
Instead of thinking of the procedural period starting the
day of surgery, the PSH starts from the time the patient’s
surgery is scheduled to 30 days after they’re discharged from
the recovery room. Care is communicated with a big picture
focus involving all team members, meaning the silos of care
have been broken down, he said. The anesthesiologist will
take the lead, making sure the patient, surgical team and others are aware of the patient’s situation and what needs to be
done, he explained.
In the perioperative process, anesthesiologists would lead
consultations, selectively test patients for potential risks and
help patients reduce risk by encouraging behavioral changes
The day of surgery, the patient would be rotated through a
three-station unit including a perioperative preparing room,
the OR and an early recovery room. The anesthesiologist
would stay with the patient throughout their experience,
moving them through each step. Ideally, this means the three
main factors for delay – patients, the system and practitioners
– would be coordinated.
Following the procedure, anesthesiologists would work
with patients to implement the ERAS components. When
patients leave the facility, the anesthesiologist continues care
through follow up appointments.
While this means more work for the anesthesiologist,
Abenstein said the cost to the system hasn’t increased because
of the reduced complications. “It really depends on how you
account for these costs to tease out if there’s cost savings or
cost increase,” he said.
So far, about 50 United States facilities have incorporated certain
areas of the PSH and are reporting savings, Abenstein said.
Changes Could Create Better Outcomes
ASA offers methods for anesthesiologists to gain a competitive edge
by Rebecca Rudolph, editor