Getting a colonoscopy? Are you worried about the procedure? Check out this informative and entertaining video on colonoscopies. We promise it will make you smile!
March is National Colorectal Cancer Awareness Month. Cancer of the colon or rectum is the second leading cause of cancer-related deaths in the US. It affects both men and women and is one of the most commonly diagnosed cancers in the US. Chances of developing colorectal cancer increase with age with more than 90% of cases occurring in people aged 50 or older. If you are age 50 or older, one of the best things you can do to protect yourself against colorectal cancer is get screened on a routine basis. It is estimated that 60% of colorectal cancer deaths could be prevented if individuals were screened routinely. These screenings detect colorectal cancer early, when treatment is most effective. Individuals that have a close relative that has had colorectal polyps or colorectal cancer, or those with inflammatory bowel disease should also consider getting tested earlier than age 50 and more often than others. There are several tests used to screen for colorectal cancer. One of the more popular and effective of these is the colonoscopy. It is a procedure used to see inside the colon and rectum for detection of inflamed tissue, ulcers and abnormal growths. A colonoscopy is recommended every 10 years. This is one of the most common procedures our experienced CRNAs at Steel City Anesthesia put patients under for. Your doctor will provide you a detailed set of instructions on how to prepare for a colonoscopy; this is called bowel prep. All solids must be emptied from the gastrointestinal tract followed by a clear liquid diet. This allows the physician conducting your colonoscopy to thoroughly examine your colon without any obstructions. Throughout the procedure, you will be under a sedative to keep you relaxed and as comfortable as possible. How Can You Support Colorectal Cancer Awareness? You can spread awareness by wearing a colon cancer ribbon. The colon cancer ribbon is a small piece of dark blue ribbon folded into a loop. By wearing a ribbon, you show your support for colon cancer patients that have fought the disease to return to a normal life. You also spread knowledge about colon cancer and how it can be prevented. If a ribbon isn’t your thing, there are also rubber bracelets, T-shirts, pins and other items you can wear. Learn more on the Colon Cancer Alliance website.
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.
Colorectal cancer is the second most common cancer killer and third most common cause of cancer-related death in the United States. Early detection dramatically improves the chance of survival. Everyone over the age of 50 (93% of cases develop at and above 50) should have a colonoscopy (screening) every 3 to 5 years. However in the past, cost (co-payment/deductible) prevented people from going for much needed colonoscopies. Today, under the new Affordable Care Act, you and your family members may be eligible for some important preventive services like colonoscopies, mammograms and other cancer screenings at no additional cost to you. If your plan is subject to these new requirements, you would not have to pay a co-payment/co-insurance or deductible for recommended screenings. What is colorectal cancer? Colorectal (large bowel or large intestine) cancer is a disease in which cancer cells form in the inner lining of the colon or rectum (whose main function is to reabsorb water from the contents of the intestine so that solid waste can be expelled into the toilet). Most colon and rectal cancers originate from benign wart-like growths on the inner lining of the colon or rectum called polyps. What is a colonoscopy? Colonoscopy (screening) is a procedure that enables an examiner (usually a gastroenterologist) to evaluate the inside of the colon. It involves using a four foot long, flexible tube (about the thickness of a finger) called a colonoscope with a camera and a source of light at its tip. The tip of the colonoscope is inserted into the anus and then advanced slowly, under visual control, into the rectum and through the colon. Before the screening, intravenous fluids are given and the patient’s heart rhythm, blood pressure and oxygen in the blood are continuously monitored. He/she is usually sedated to reduce pain and induce relaxation. A colonoscopy often produces a feeling of pressure, cramping, and bloating in the abdomen which is normally relieved by medication. Identifying and removing polyps (through colonoscopies) before they become cancerous prevents the development or further spread of colorectal cancer. Who needs a colonoscopy? • Everyone age 50 and older – the average age to develop colorectal cancer is 70 years with 93% of cases occurring in persons 50 years of age or older • Anyone with a family history of colorectal cancer • Anyone with a personal history of colorectal cancer or adenomas at any age, or cancer of the endometrium (uterus) or ovary diagnosed before age 50. These groups should be checked by colonoscopy at regular intervals, usually every 3 to 5 years. Why should you have a colonoscopy if you have no symptoms? Adenomas can grow for years and transform into cancer without producing any symptoms. When symptoms develop it is often too late to cure the cancer as it may have already spread. Regular colonoscopies mean early detection and more successful treatments. Sedation or Monitored Anesthesia Care, which to choose? Sedation is an integral part of your colonoscopy. While there are various sedatives to choose from, propofol usage (used in Monitored Anesthesia Care MAC) has the most satisfying results. It is fast acting and takes effect right away. In addition, it has no long term effects (like nausea) and promotes quicker recovery times. It also works well for people who are on pain medication. An established anesthesia management company like Steel City Anesthesia has extensive experience with colonoscopy procedures. Our licensed anesthesiologist and nurse anesthetists are committed to patient safety and delivering quality care. We assign local CRNAs on a routine basis which helps improve your productivity, patient flow and revenue. Share your thoughts on…
According to the Centers for Disease Control and Prevention (CDC) more than 22 million men and women in the United States have not had a potentially life-saving screening test for colorectal cancer, and about 7 million women ages 50 to 74 have not had a recent mammogram. In fact, CDC director Dr. Thomas Frieden says that, “More than a third of Americans who need to be screened haven’t been screened.” Cancer screening saves lives. You are probably already aware that colorectal cancer (CRC) remains the second leading cause of cancer deaths in the United States as well as the leading cause of cancer deaths among nonsmokers. Breast cancer remains the most commonly diagnosed cancer and the second leading cause of cancer deaths among women in the US. Cancer screening with treatment has lowered colorectal and breast cancer mortality. Moreover, statistical modeling indicates that if current trends in health behaviors, screening, and treatment continue, Americans can expect to see a significant decrease in the CRC mortality rate by 2020. The CDC also points out that cancer screenings could save 10,000 Americans each year. Why people don’t get cancer screenings? Insufficient information about preventive screenings and treatment Fear Lack of medical and screening facilities No proper follow-up procedures No health insurance Cancer deaths are lower today than in the past. Although we cannot pinpoint whether this is because of an increase in screenings, improved treatments or both, we can be certain that early detection makes for more effective treatments and consequently lowers mortality rates. In colorectal cancer for instance, symptoms may not manifest for years and by then it might be too late because the cancer has spread. Regular screening after 50 is the only way to find out sooner and increases a patient’s chances of getting better. Lack of health coverage or medical insurance or low income is one of the main reasons why people don’t get cancer screenings. The new Affordable Care Act makes many of these important preventive screenings more accessible. Recommended mammograms, colonoscopies and other cancer screenings will now be fully covered by medical insurance. Which means there is no deductible or co-payment involved (check your coverage with your insurance provider). This is a huge move by the government for Americans to take better care of their health and avoid illness or get timely intervention. Many patients are also afraid of the pain and discomfort associated with cancer screenings. This either prevents them from being screened or coming for follow ups. People will be less skeptical if they are informed about using anesthesia to reduce/eliminate pain. Patients are usually sedated to make colonoscopies more tolerable, and it is not uncommon to administer sedation for a breast MRI especially if the patient has claustrophobia. Having a breast biopsy (removal of breast tissue for cancer screening) also involves the use of anesthetics. Examiners have a variety of sedative options to ease patient discomfort during cancer screenings but propofol usage or Monitored Anesthesia Care (MAC) delivers the best results. It takes effect right away and has little or no side effects, promoting faster recovery. This is extremely important as more positive patient outcomes encourage people to come back for follow-ups. Besides, the presence of a certified anesthesiologist or CRNA monitoring patient’s well-being throughout the procedure is comforting for the person undergoing the procedure and ensures quality care from the medical service provider. Steel City Anesthesia offers licensed CRNAs for cancer screenings. We have extensive experience with colonoscopies. Since we assign local anesthesia providers on a regular basis, our staff becomes familiar with your working style, increasing patient flow significantly. Steel City…
Don’t let physicians or insurance companies make treatment decisions for you With the rising costs of medical services, insurance companies are reducing coverage and/or impinging on patients’ rights to make important healthcare choices. This is especially true with regard to anesthesia services. Whether you are a physician or anesthetist, patient safety is non-negotiable and cost should never be the deciding factor when it comes to sedation. Patients should be informed of their options (if there are any) and the consequences of each one. It’s up to them to decide what they want. Unfortunately, patients’ best interests are not the prime focus of some medical service providers or insurance companies. Therefore, patients must be made aware of discrepancies and deviations from procedure so that they can protect themselves and avoid unnecessary risks. One of the many issues surrounds propofol usage. Certified anesthesiologists or nurse anesthetists are trained in propofol usage. This enables them to eliminate unnecessary risks and deal with problems effectively ensuring the patient’s well-being and quick recovery. If your physician, surgeon or office-based doctor is not licensed to administer propofol, he or she should not do so. It’s not only dangerous but also unlawful. Remember what happened to Michael Jackson? Physicians and insurance companies should not make treatment decisions, deviate from approved procedures, and/or make sedation choices for a patient. Several instances have come to light where doctors (not licensed anesthetists) are administering propofol anesthesia to their patients. This is extremely dangerous as in cases where patients are told it’s okay to have a light meal before the procedure (which requires anesthesia). This is certainly not okay! Some doctors or dentists don’t even provide for oxygen when the patient is under sedation. This is could be fatal as sedation reduces a patient’s ability to breathe. Moreover the physician or surgeon should really be focusing on his/her area of expertise to offer the best care rather than venture into an area in which he/she is not qualified. That is putting the patient’s life at risk. Also some insurance companies are discouraging propofol usage (or full sedation) unless the patient is in ‘the high risk category’. Insurance companies are not medically qualified to determine the type of sedation, who needs it, or who should provide anesthesia services. It has been proven that Monitored Anesthesia Care (MAC) is the quickest and safest form of sedation that also encourages faster recovery. Remember, anesthesiologists and CRNAs have specialized in anesthesia and are the best ones to administer sedation, monitor the patient throughout the process, and deal with any complications that may arise. After all, you wouldn’t ask a gastroenterologist to deliver a baby or a gynecologist to perform an endoscopy. Then why compromise on an anesthesia provider?! Michael Jackson’s untimely death is a classic example of unethical medical practices. His physician was not licensed or trained in propofol usage. Clearly, all patients are more comfortable when anesthesia professionals manage their sedation. And patient well-being and safety should be every doctor’s top priority. What do you think? Share your thoughts with us.
Don’t be party to unethical practices! Anesthesia services should always be administered and monitored by a certified anesthesiologist or CRNA. It’s the law. Failure to comply compromises patient health and safety, and doctors are liable. More importantly, no medical center or office-based physician should ever put a patient’s well-being at risk by not following ethical/approved procedures. Remember the Hippocratic Oath! However, there are some in the medical profession who don’t always make patient safety their top priority. And they are using the new anesthesia care model (anesthesia outsourcing) to exploit anesthesia providers and further their own ends, rather than provide more positive patient outcomes. It is important for anesthetists/CRNAs as well as patients to be aware of these malpractices that could have serious consequences on patient safety and healthcare integrity. There have been instances in which anesthesia service providers have been propositioned by healthcare facilities to offer kickbacks in return for that facility’s business. In one particular instance, an anesthesia service was asked for ‘something in return’ on a per case basis for being accepted as the anesthesia provider. Apparently the medical center and its physicians were billing under the anesthesia billing codes for the nursing sedation – with no anesthesiologist or nurse anesthetist present and did not want to give up this charge. Also, they managed to find anesthetists who were willing to go along with their scheme. It is scary to know that they seem to be able to get away with this unethical practice! Under anesthesia services, the cost of propofol usage and anesthetist’s services are paid for by the patient or his/her insurance company. No surgical center or office-based physician has the right to ask anesthesiologists or nurse anesthetists to give back something in return or be paid only a percentage of what is due to them. Be aware of these veiled kickbacks. The authorities overseeing medical care as well as the government have put systems in place to ensure best practices and reduce any risk to patient health. Being party to such schemes is tantamount to abuse of the healthcare profession and is considered a criminal activity. All anesthesia providers are certified either by the AANA or ASA and are well aware of the rules. Together we can work with relevant government agencies to preserve the integrity of the medical profession. Steel City Anesthesia is committed to best practices and patient safety. Share your thoughts or experiences on anesthesia partnerships.
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