ON TARGET Reduced prices and better images have made using ultrasound for regional blocks increasingly attractive.

Perhaps no one in your facility has more of a hand in meeting the demands of an ambitious surgical schedule than your anesthesia providers. The more organized they are and the lighter their touch, the faster patients will be prepped for surgery and recovered for discharge. You can't cut corners in anesthesia, but you should be on the lookout for shortcuts — products and devices that save time and improve patient safety. Those aren't just fair game, they're opportunities no facility can afford to squander. Take a few minutes to reassess the performance of your anesthesia team. Are they taking full advantage of these potential efficiency boosters?

1. Ultrasound-guided blocks
One sure way to improve throughput in an ambulatory setting is to couple regional anesthesia with a reduced reliance on opioids for pain management. And one of the best ways to improve regional block placement is to use ultrasound-guided catheters.

A visual technology that was once expensive and grainy has become both much more affordable and much more efficacious. While prices have been dropping, imaging has improved to the point where trained providers can clearly see the tip of the needle and the thread of the catheter within the targeted space near the nerve, instead of having to rely solely on the unpredictable feel of anatomical landmarks.

William Landess, CRNA, MS, JD, corporate director of anesthesia at Palmetto Health in Columbia, S.C., sums it up best: "For more safe and rapid placement of regional anesthesia, ultrasound has become essential."

"And there's now plenty of evidence that ultrasound improves the efficiency of regional blocks," adds Brandon Winchester, MD, regional anesthesia fellowship director at Andrews Institute for Orthopedics & Sports Medicine in Gulf Breeze, Fla. "This is not a new concept."

The concept isn't new, but newer machines are easier to use. Add in features like touchscreen interfaces, smaller footprints and greater mobility, and the prospect of being able to repeatedly save valuable minutes while performing blocks is likely to make the technology a sound investment.

2. Video laryngoscopes
The debate continues. Should video laryngoscopes be considered an emerging standard of care for all intubations or should they be reserved for anticipated difficult or emergency intubations only, so providers don't lose the ability to perform direct laryngoscopy with more rudimentary tools?

There's no debate, however, that video capability has the potential to improve efficiency. Along with providing clearer views in an immediate situation, when seconds count and the airway needs to be secured as quickly as possible, the scopes can create digital records for the airway's anatomy that can be stored and made available for viewing before later intubations. Such records might be invaluable as providers plan for a case, since studies suggest that patients with difficult airways often fail to adequately inform subsequent providers.

HELPFUL TOOL Supraglottic airways allow for lower levels of anesthesia and faster emergence, which are keys to maintaining efficiencies in the outpatient setting.

3. Custom supply kits
Customizable anesthesia tray configurations ensure that providers have only the supplies they need on hand, and that can add up to big savings in both time and money. "It's tricky when you have a large group to get custom trays for everyone," says Michael Reines, MD, anesthesia director of the Reconstructive Surgery Center of Newport Beach (Calif.), "but if you can get everyone to agree, it's helpful."

No one has to spend extra time gathering items, and there's no waste of unused or unneeded items, says Dr. Reines. "When the procedure is completed, everything has been used and is then discarded appropriately."

If you can reach a consensus on the supplies that will be used, adds Mr. Landess, vendors are often willing to provide customized trays at no extra charge. "It's a customer perk," he says.

One vendor even offers a special tray for providers who specialize in continuous nerve blocks. Customized trays lessen clutter and improve efficiency, because now the block nurse or anesthesiologist doesn't have to manually drop in items like liquid adhesives or extension tubing for each block, according to Dr. Winchester.

He says small supply organization solutions like custom packs add up to minutes saved, by avoiding the constant scramble to find these items and keep them adequately stocked — all while trying to avoid delaying the OR. "That's the beauty of customization," says Dr. Winchester. "You get everything you want, and nothing that you don't."

ONE AND DONE Pre-filled syringes streamline medication administration, improve drug safety and reduce cross-contamination risks.

4. Pharmacologic aids
It was a long time coming for sugammadex, which was sold in Europe for a full 6 years before the FDA finally gave the agent its stamp of approval in 2015, but it's quickly become a welcome addition to the anesthesia arsenal, says Mike McKinnon, CRNA, a partner in a CRNA-only practice in Show Low, Ariz. The drug reverses the effects of the muscle relaxants rocuronium and vecuronium, so if a case finishes more quickly than expected, or an anesthesia provider administers more paralytic than was needed, you'll spend less time waiting for the drugs to wear off.

"The big benefit is a faster return to spontaneous ventilation," says Mr. MacKinnon. "That translates into faster room turnovers, because you're not sitting around in the OR for an extra 5 to 10 minutes, waiting for the patient to be reversed."

Antiemetics like ondansetron and NSAIDs like ketorolac are also "allowing for more effective treatment and faster discharge," says Dr. Reines.

5. Supraglottic airways
If you aren't using supraglottic airways in a majority of outpatient cases, you may be missing an opportunity to improve efficiency, says Dr. Reines. They aren't appropriate for every patient or every procedure, but patients typically tolerate the airways much better than they do endotracheal tubes. That allows for lower levels of anesthesia and faster emergence with fewer complications.

Which patients are appropriate and which aren't?

"It's a judgment call, but many variables can be accounted for," says Dr. Reines. "I've taken to using supraglottic airways on some obese NPO patients, and some anesthesiologists are comfortable using them on patients positioned on their side."

They're quick, they're easy to use and they're useful as emergency airway devices when needed, he adds. "There's no battery, no bulb, no handle mismatch, and there are no sterilization issues. Supraglottic airways may be the item that has improved anesthesia efficiency the most in my practice."

6. Pre-filled syringes
Ordering medications in pre-filled, dose-specific syringes lets providers skip drawing up medications from vials to syringes. From an efficiency standpoint, there's a lot to like about the pre-filled products. They also prevent potentially dangerous labeling and dilution errors, reduce the likelihood of direct drug contamination or cross-contamination, extend shelf lives and reduce waste, and improve staff safety by providing needle-free systems for administration. Some manufacturers of single-use drug vials include extra labels that can be removed from the vials and used to label syringes once the drug is drawn up. The labels are highly readable, which promotes drug safety, and shave a few seconds off of the medication preparation process.

7. Web-based technology
Web-based pre-admission software lets patients enter their medical histories ahead of time and at their convenience, which "cuts down on the time needed to conduct pre-op evaluations," says Dr. Winchester. Technology, in fact, can be used to optimize the complete surgical workflow — including scheduling, managing block times and data analysis of anesthesia. Any kind of computer-assisted device that assists in time management is a winner, says Mr. Landess. OSM