Personalized sedation system: boon or liability? A move by the Federal Drug Administration (FDA) to reconsider approval of a computer-assisted personalized sedation system is causing tumult among anesthesia providers. The system provides automated, minimal-to-moderate propofol sedation for patients undergoing colonoscopy and upper GI procedures. It will also allow gastroenterologists and nurses to administer propofol without the supervision of an anesthetist. While some anesthesia experts are skeptical about the safety of the device, others aren’t sold on its cost cutting benefits. Most agree that putting price and convenience before patient safety can have catastrophic results. At a time when more and more anesthesia providers are implementing CQI programs to enhance anesthesia service quality and reduce medication errors, using a personalized sedation system seems more of a liability than a way to deliver positive patient outcomes. Let us examine the benefits of Monitored Anesthesia Care (MAC) versus the personalized sedation system both for the patient as well as the medical center. MAC vs. personalized sedation system Liability: The greatest benefit of MAC done by an anesthesia services company lies in the transference of liability from the medical center to the anesthesia provider. This makes the anesthetist/CRNA responsible for patient’s safety and encourages more positive patient outcomes. Opting for the personalized sedation system would shift responsibility back to the medical center as anesthesia would be kept in-house. Cost to medical center: Outsourced anesthesia services like MAC are paid for by patients and/or their insurance companies. They are not a cost to hospitals, ambulatory centers and office-based practitioners. Healthcare facilities will need medical professionals to administer anesthesia through the personalized sedation system. The nurse or medical practitioner who performs this service will have to come from the medical center and be paid by them. Patient care: A CRNA or anesthesiologist working for an anesthesia services provider is trained to deliver quality patient care and performs the role of an anesthetist and nurse. This has been a boon to medical centers as they can allot their own staff to other areas that need attention. The new system will create a need to increase staffing or reduce the number of procedures performed as they will no longer bring in a company to do their anesthesia for them, which means that staff will be unavailable to them. Patient safety: Anesthesiologists and CRNAs are trained to deal with complications that may arise with propofol usage. In the absence of a qualified professional, unexpected outcomes could have deadly consequences. Remember what happened to Michael Jackson? Patient flow: Fewer complications and faster recoveries under the capable care of qualified anesthetists has led to a significant improvement in patient flow, increased number of procedures and revenue. One of the serious criticisms of the personalized sedation system is that the propofol it administers produces the effects of general anesthesia which means that patients will take longer to recover. This lowers patient satisfaction and reduces the number of patients returning for follow-up procedures. Slower recovery times, additional staffing requirements and lower patient satisfaction are bound to impact the income as well as reputation of the medical centers using these personal sedation systems. Even if the system does reduce the cost of colonoscopies and upper GI tract procedures, the fact that it compromises patient safety and well-being is hardly going to be welcomed by the patient themselves. If the computer-assisted personalized sedation system doesn’t benefit the patient or the medical center, then what is its real value? Tell us what you think about the personalized sedation system.
Focusing on CQI Meeting the anesthesia requirements of an increasing number of surgical as well as office-based procedures can sometimes compromise the quality of healthcare provided. Maintaining high standards means implementing a Continuous Quality Improvement (CQI) program to evaluate performance and identify areas in need of attention. CQI for medical services, often referred to as managed care, is based on evaluation of a product or the outcome(s) of a process. It involves a clear understanding of the needs and expectations of the consumers of these products or processes. Photo Source The greatest value of CQI is in identifying areas of change while planning improvements. A successful program depends on documentation, accountability and assessment. For anesthesia services this involves tracking complications and unexpected outcomes as well as anesthetist competency. 10 things an Anesthesia Services CQI program must include A detailed clinical assessment of the facilities you are working with to ensure they are in compliance with approved standards of health care Examining credentials of your anesthetists and CRNAs to minimize liabilities and implement best practices Having a well-documented plan for benchmarking your anesthesia services and evaluating anesthetists (like peer reviews) Implementing a proper anesthesia delivery process that conforms to required standards and minimizes error Online technology to facilitate communication between anesthetists, the anesthesia consulting firm and medical centers they service. Should also have an online mechanism for dissemination of information and education for staff. Regular reporting by anesthetists/CRNAs, patient satisfaction surveys, staff and/or client meetings to record and discuss cases (especially those with complications and unexpected outcomes) Routine checks on equipment and anesthesia providers to ensure compliance and maintain quality Assigning local staff familiar with the medical center/office-based physician’s modus operandi to improve patient outcomes Strategies for risk management as well as securing anesthetist and CRNA buy-in to change Process to measure results and effectiveness Share with us your CQI strategies for improving anesthesia services.
Using latest technology to stay-in-touch with anesthetists and medical centers Advanced information technology available today has great potential for improving the quality of anesthesia services. From online scheduling systems to reporting, education and a free exchange of experiences and ideas, anesthetists can greatly benefit from having easy access to an online community of their colleagues. Especially if you are part of/or managing a fast growing anesthesia consulting firm. Research has shown that communication is key to successful management and implementing best practices. Anesthesia outsourcing companies must take advantage of the latest online systems to… Maintain high standards of anesthesia service Stay connected with their anesthetists and CRNAs Provide easy access to hospitals, ambulatory centers and office-based practitioner clients Online systems reduces management time and effort Automation and online systems have proven to reduce management time and effort tremendously. They are also instrumental in increasing accessibility, accountability and efficiency. It may be easier to understand their effectiveness in light of how Steel City Anesthesia (SCA) has made it an integral part of their anesthesia delivery process. Our successful online scheduling system has advanced communication technology that: Enables our CRNAS across Ohio, West Virginia, and Pennsylvania to login and request work at a local facility, check schedules, and receive regular updates from SCA. Allows SCA to message all anesthetists via email and text, sending out work reminders daily and weekly. Provides updates to CRNAS about certifications, new laws, etc. Makes it easy for medical facilities to login to the system and see who is working there and when. This allows facilities to keep in touch with SCA administrators. Utilize progressive communication systems like the above to enhance your relationship with your anesthesiologist/CRNAS and facilities you serve. Share your ideas for improving anesthesia services on our blog below!
Photo Source The 2 new Rs of anesthesia patient safety: Right Indication and Right Documentation Medical practitioners are familiar with the 5 Rs of patient safety viz. Right patient Right drug Right dose Right concentration Right time However the rise of medication errors during procedures has necessitated the addition of 2 more… Right indication, and Right documentation You can never be too careful in the operating room or even during an office-based procedure. A small mistake can lead to disastrous consequences. As errors in the preparation and administration of medication seem to be on the rise, the need for the “double check” has become supremely important. And anesthesia service providers are not exempt. Here are some guidelines that will help reduce medication errors: Proper process: Implement a proper process including efficient double check techniques and equipment that facilitates right indication and documentation. Easy-to-read labeling: New and improved, easier-to-read standardized labeling, color and bar coding reduces chances of error significantly. Bar coding is also extremely helpful in improving documentation and billing. Diligent reporting: Regular communication among anesthesia providers about medication used, techniques and procedures increases awareness of issues as well as vigilance. Constant monitoring: There is no substitute for constant monitoring of a patient’s vitals and well-being for the slightest changes, to prevent small issues from assuming monumental proportions. Medical Director – Quality and Staff Anesthesiologist at Virginia Mason Medical Center in Seattle, Robert Caplan’s analysis of The American Society of Anesthesiologist (ASA) Closed Claims Projects revealed that of the 80 medication-error claims studied, 44% were the result of anesthesia administered at the wrong dose. Furthermore, a study published by the Canadian Journal of Anesthesia also found that anesthetists experienced more than one drug error in their practice with syringe swap being the most prevalent category. The standard and goals for reducing medication errors set by regulatory agencies like the Institute for Healthcare Improvement, Centers for Medicaid and Medicare Services, Institute for Safe Medication Practices (ISMP) and Joint Commission should form the basis of the process all anesthetists follow. Any deviation could increase your liability giving rise to serious malpractice issues. We welcome your ideas on processes that improve anesthesia services. Leave a comment on our blog below.
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