Guest Editor: Deliver Maximum Value

Amid shifting care models and dire staff shortages, the goal of those at the head of the table remains crystal clear.

Anesthesia is in the middle of a major transition period. Increasingly, we’re seeing a shift away from the low-value/high-cost or ratio-based TEFRA models and a movement toward more collaborative, interprofessional models.

In practice, this means anesthesiologists and CRNAs will continue to offer more direct services to patients. It also means that, where appropriate, we will continue to see an unassigned coordinating or “float” provider performing services traditionally handled by anesthesiologists and CRNAs. This system is desperate for increased value and productivity from a static pool of anesthesia providers. The staffing crisis in nursing tends to get the lion’s share of media attention, but there’s a dire shortage in anesthesia — especially in the ASC space. But that’s a topic unto itself.

Regardless of the staffing situation or the model we’re operating under, the basic philosophy of anesthesia and pain control remains unchanged: Deliver maximum value to the patient, the surgeon and the facility. Of course, where the care is being provided plays a key role. For instance, there are certain clinical judgments that are specific to an ASC setting and its inherent fast-paced nature. Still, it’s our job as anesthesia providers to never lose sight of our fundamental responsibility to guide our patients through surgery, a critical moment in their lives.

Another key aspect of outpatient anesthesia centers on patient selection. By nature, this requires difficult judgment calls. I often think of a new member of our anesthesia group who, in her very first week of practice, entered the preoperative area and encountered one such scenario. The patient looked fine upon examination but her background included a questionable cardiac history that could impact the case. Although the surgeon was politely asking what measures could be taken to proceed despite the problematic history, the new anesthesia provider urged a delay and consensus was reached with everyone involved. It was the right decision. By the end of that very same day, the patient ended up receiving a cardiac intervention. Who knows what would have happened if the group acquiesced to surgeon’s request to cautiously proceed with the surgery? These patient-selection judgment calls happen all the time, and anesthesia providers need to consider the risk of each case from at least four areas:

• setting
• surgery
• anesthetic, and
• patient comorbidity.

The better we, as anesthesia providers, understand and account for these factors, the better prepared we will be to make decisions that add true value. The best care, of course, is collaborative in nature. Each department — surgery, anesthesia, nursing and staff — should not only bring an expert-level understanding of their own area of specialty, but also a contextual knowledge of what others do. When anesthesia departments do this, it is especially beneficial because they are inherently connected to every piece of the perioperative puzzle — perhaps more so than other members of the team.

Anesthesia is about collaboration. Contrary to the “command-and-control” approach of the past — an approach that largely ignored outside concerns — anesthesia providers who employ a collaborative approach rely on communication, time and trust to focus on a joint goal of making sure a reasonable consensus is reached by all members of the team. In this Outpatient Surgery Magazine Anesthesia & Pain Control Special Edition, you’ll read case studies about regional anesthesia, learn best practices for preventing PONV, glean tips on making more realistic MH training and much more. Most of all, you’ll get real-life examples of collaborative anesthesia providers delivering the maximum value our patients, our surgeons and our facilities have to come to depend on from us. OSM