TEAM WORKS Anesthesia providers should do much more than sedate patients.

Your facility's anesthesia service affects everyone in the perioperative process. Don't believe me? Hire a provider who only works inpatient cases while your usual guy is away and see who complains. In anesthesia staffing, the right fit is everything. When you look at your providers, how many of these statements can you agree with?

They're ambulatory aces
Are your providers skilled in regional blocks and opioid-sparing multimodal analgesic approaches? Do they seek out the latest techniques to stay on the cutting edge of care, or are they rigid in their routines? Ask your circulators and PACU nurses (or those of the hospitals or ASCs where a service has worked) which providers' patients wake the fastest after surgery and whose patients' pain seemed most under control. Those are sure signs that a provider understands ambulatory efficiency.

They're team players
With the concept of the perioperative surgical home (see "A New Way to Manage Post-op Pain" on p. 7), the anesthesia community has grasped the idea that teamwork matters. Do your providers understand that their performance affects every other person on the team, that their role is no more and no less critical than that of every other player? Do they leave their egos at home? Here's an enlightening question to ask an anesthesia provider: In what way does the circulator or tech help you do your job better? (Also, how do you help them do their jobs better?) If he doesn't have an answer, he may not be looking beyond their own patient care silo.

They help you stay on track
Anesthesia providers have many ways to help ensure on-time starts and swift room turnovers. For example, regional blocks are best administered outside the OR, before the team is ready to begin a case. Providers who vigilantly monitor anesthesia levels toward the end of a procedure can help patients mobilize faster. And the true team players don't think it's beneath them to lend nurses and techs a hand by wiping down tables, drawing up local anesthetics for the next case or transporting patents to the PACU.

They educate your patients
One aspect of outpatient surgery that's occasionally glossed over is that we're essentially handing off a share of the post-op care to patients and their family members, who don't know all the details of follow-up care and will need thorough education in order to assume the role of caregiver. That's why anything an anesthesia provider can do to confirm the accuracy of patients' self-reported medical histories and communicate before the day of surgery what patients can expect from the anesthesia care they'll receive helps to improve surgical outcomes.

They speak up
Unless anesthesia providers are willing to listen and respond to the contributions of other surgical team members, and offer contributions themselves, they're not fully engaged in your facility's overall success. That's why providers who attend and actively participate in committee meetings are so valuable. The same can be said for providers interested in creating and reviewing policies and procedures, evaluating equipment, providing input on supply and drug purchasing decisions, and planning and evaluating patient safety, infection prevention and other quality improvement efforts.

They bring something extra
Anesthetists who bring some type of value-added services improve the facility, while boosting their own stock as well. For example, a provider whose pre-surgical assessment thoroughly vets patients for risk factors — the body mass index over a certain number, the obstructive sleep apnea that complicates airway management, the diabetic patient who needs to be first on the day's schedule, the clotting disorder that's a red flag for deep-vein thrombosis — is a safeguard that puts surgeons at ease. An anesthesia provider's knowledge and experience may be a rich source for educational in-services for staff and surgeons. A provider who is a pain management expert might even supplement an orthopedic surgery center's business.

They're diplomatic
A note on input from contract staffers: A bit of diplomacy will be required. You could see pushback when "You shouldn't do it that way" meets "This is how we've always done it." Make sure your anesthesia providers are able to be collaborative, not dogmatic, since you can't unilaterally change practices that affect everybody. Involve the entire team in a discussion of the changes they suggest, as well as alternative solutions, before you consider implementing them. As members of a team, we all have a common goal: to achieve outstanding patient care, efficiency and cost effectiveness. The beauty of a teamwork approach is that everyone brings a different perspective.

They bring a competitive edge
Anesthesia providers don't always recognize all the benefits they can bring to your facility and your patient care. In a competitive healthcare economy, though, a reminder that you're aiming for efficiency, value, and patients who are pain-free and back to their daily lives in days can encourage your providers to be invaluable team members and help get you the results you're looking for.