Although the development of anesthesia took place in the 1840’s, surgery was still not regularly performed due to fear of infection and other complications. That was until the Civil War started in 1861, which caused the number of necessary operations to drastically increase. According to an article in the newsletter of the American Society of Anesthesiologists by Maurice S. Albin, M.D., “The sheer magnitude of battlefield injuries during the conflict played a major role in establishing the regular use of anesthesia.” The need for surgery was greater than ever before, which gave physicians no choice but to use anesthesia to operate. Methods Prior to Anesthesia Prior to the the war, patients may have been given something to bite on, alcohol, opioid drugs, or put in physical restraints to keep them under control during surgery. According to Albin, “It was thought to be unmanly for a male to undergo surgery with an anesthetic, which was usually reserved for women and children. There was even a belief that the use of ‘cold steel’ had a beneficial effect, and it would not cause the depression thought to occur with the use of anesthesia.” “Real Men” Don’t Need Anesthesia The idea of anesthesia being “unmanly”, quickly shifted as the war progressed and the number of injuries rapidly increased. It became a necessity in battlefield hospitals, and is believed that there were around 120,000 uses of anesthetic agents by surgeons on both sides during the battle. Anesthesia on the Fly At the time of the Civil War, many surgeons and physicians had little no experience with using an anesthetic during operations. They were forced to rely on manuals which gave them instructions on how to properly use anesthetics such as ether and chloroform. Although many doctors lacked experience with these agents, mortality rates associated with the use of an anesthetic were surprisingly low. Albin stated, “After the termination of this horrendous conflict, these doctors would return to their practices, hospitals and medical schools, all the richer for being exposed to this unique American contribution to the life-easing quality of mercy — the discovery of anesthesia.” Physicians benefited from learning firsthand the techniques and uses of anesthetics, and many lives of wounded soldiers were saved as a result. Today, millions of people undergo anesthesia each year in the United States alone, and it has become extremely common. Although anesthesia has developed and changed over the years, its regular use was established during the time of the Civil War.
“That’s like comparing apples to oranges.” How many times have you heard or even used this expression? In medicine, no two patients, no two hospitals, not two…well, anything is the same. So why do so many healthcare facilities still use the excuse that there isn’t any difference between anesthesia management solutions organizations?
Opportunities arise daily where facilities can improve the management of anesthesia care. The passage of the Affordable Care Act may appear to have resulted in “affordable care” for everyone, but for hospitals, surgery facilities or healthcare practices, it has created more challenges than many believed it would. The game has changed from clear standards to blurred lines consisting of regulatory issues that make the possibility of being compliant more and more difficult. When this happens, facilities look towards third party solutions to help make sense of it all.
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.
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.
Faced with rising healthcare costs and an increasing number of patient procedures, medical centers are concerned about scaling up their anesthesia department to address these needs. They ask themselves: How much will it cost us to hire additional anesthesia staff? Who will handle the anesthesia billing? What is our liability associated with doing it all in-house? Hiring an outside anesthesia services provider answers all of these questions If you are an office-based surgeon, ambulatory surgery center or hospital, you will be relieved to know that when outsourced, you don’t pay for anesthesia services! Since it is a service requested by the patient the cost is borne by him/her, the insurance company or the HMO. Anesthesia providers like Steel City Anesthesia are no cost to you. In fact, they can actually help you boost your revenue! The specific anesthesia care model you adopt (CRNA, physician anesthesiologist or an anesthesiologist supervising one or more CRNAs), will determine how much the patient pays. A recent study published in the May/June 2010 issue of the Journal of Nursing Economics revealed that using a solo CRNA for anesthesia delivery is the most cost-effective. Companies that provide anesthesia services have been using this model for years for exactly this reason. By hiring them, you will quickly gain all of the benefits without any of the administrative hassles. Who is liable? Don’t stress about liability either! Outsourced CRNAs and anesthetists are independent licensed medical professionals who are accountable for their practice. Did you know that anesthesia delivery is no longer the liability (and does not require supervision) of the medical center? It’s the anesthesia provider who is liable. If you’re concerned about reputation, working with an established anesthesia management company eliminates these concerns. Ensure that your outsourced anesthesia service only hires accredited and dedicated CRNAs/anesthetists. What about billing? Anesthesia billing can be confusing, but anesthesia accounting specialists navigate the complexities and make sure the paperwork is in order. You needn’t be concerned about paying the anesthesia providers either. That is the patient’s and their insurance company’s responsibility. Not only that, you have an additional medical person on your team for free! Do you have questions about anesthesia liability, payments and billing? Ask us on this blog.
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