Anesthesia providers seek optimal outcomes with maximum efficiency. In a recent survey, we asked them which of the products and technologies that have innovated the field over the past decade offer the greatest amount of assistance toward saving time and reducing risk. If you're looking to get more out of your anesthesia services, make sure you equip your providers with the following tools.
1. Airway visualization devices
The device that was most frequently mentioned, by a wide margin, as improving efficiency at the head of the surgical table was airway visualization technology such as video laryngoscopes and video-equipped stylets.
"The video laryngoscope systems now available have really revolutionized difficult airway management, expanded airway resources and improved patient safety," says Gary Friedman, MD, president of the New Hampshire Society of Anesthesiologists and vice chairman of the anesthesiology department at Southern New Hampshire Medical Center in Nashua, N.H.
Video-assisted laryngoscopy "does take some stress from ugly airways," says another provider. "I can only count on 3 fingers the times it has been a lifesaver, but those 3 fingers are grateful."
Once primarily seen as a tool for training intubation skills, video laryngoscopes are now often the first choice of providers when establishing an airway, their widespread popularity due to the ability to "see around the corner" of respiratory anatomy.
"The improvement in optics has made them that much more user-friendly," says Louis G. Stanfield, CRNA, PhD, DAAPM, who practices at Mercy Medical Center in Sioux City, Iowa. "The lighting, color and detail are outstanding. They provide an excellent view and they don't require a lot of manual force," even when used for challenging intubations and oversized patients.
If you're in the market for a video laryngoscope, Dr. Stanfield advises, look for the largest possible screen, perhaps even a model that features a separate monitor connected to the handle by fiber optic cables. For portability's sake, some laryngoscopes integrate the screen into the handle, which not only limits the size of the screen and its resolution, he says, but also can tilt the screen out of your sight while you're maneuvering the blade.
2. Ultrasound imaging
"Anything that avoids general anesthesia increases throughput," says Jay Horowitz, CRNA, president of Quality Anesthesia Care Corp. in Sarasota, Fla. "We're trying to do as much as possible under regional. Then patients end up pain-free, not nauseated, on their way out the door. It's a win-win-win, good for everybody."
That's a big reason why ultrasound imaging technology has also gained a loyal following among anesthesia providers. "Ultrasound for regional is now almost a standard of care," says A.S. Lineberger III, MD, of Spectrum Health in Grand Rapids, Mich.
TAP blocks, femoral nerve blocks, continuous peripheral nerve blocks and other regional anesthesia techniques can still be placed with electrical stimulation and the patient's motor response, of course, but ultrasound is by many accounts an addictive add-on. "This has vastly improved the safety and accuracy of regional nerve blocks," says Dr. Friedman, since it provides users with a real-time view of anatomy to locate and target nerves for precise delivery of the anesthetic agent, without assumptions of what's beneath the surface.
"To place blocks under visualization is vastly better," says Mr. Horowitz. It increases the quality of the results and decreases the incidence of failed or less-than-fully-effective blocks.
"This technology has been around for a while, so contact your colleagues online and ask them, 'Which do you like?'" he says. "Size matters, and in this case, smaller is better," since a compact machine can move easily from the block room (another efficiency essential for regional anesthesia) and pre-op bays. Additionally, the quality of the image is key. "Landmarks and nerves are small, so you'll want higher resolution."
3. Vein-finding technology
Ultrasound also serves as one of the methods along with infrared light, near-infrared light, and light-emitting diodes ?that vein-finding devices have put to use in bringing visualization technology to vascular access.
Dehydration, obesity, skin pigmentation and recent chemotherapy are just a few of the factors that can defeat the easy identification of usable veins from a surface examination of the potential intravenous injection site. But these devices, which employ a computerized analysis of the absorption and reflection of light or energy at the site, can make vessels visible to increase the likelihood of first-stick success, which benefits nurses and patients as well as anesthesia providers.
Reuben Wechsler, MD, MBA, chief of anesthesiology at Emory University Orthopaedic and Spine Hospital in Atlanta, Ga., sees a staffing solution in it. "It helps pre-op nurses with difficult insertions, freeing anesthesia personnel," he says.
"It's rare to use ultrasound for IV access, but it's a great tool when needed," says Dr. Lineberger. Adds Dr. Friedman, "These have really helped to improve vascular access, reduce OR delays and improve patient satisfaction."
4. Anesthesia information management systems
The efficiency of the anesthesia care your providers deliver depends largely on how resources from drugs and OR time to workforce management and patient monitoring are applied to the task, says Mark E. Hudson, MD, MBA, an associate professor of anesthesia at the University of Pittsburgh (Pa.) School of Medicine.
"Resource efficiency is a function of being more cognizant of where efficiency occurs," he says. "If the OR schedule isn't efficient, anesthesia care can't be. If we are assigned to cover something inefficient, we will be inefficient."
Ashish Sinha, MD, PhD, DABA, agrees, adding insights from his own experience. "What hurts us the most is not knowing, a lack of information in the process. Video laryngoscopes can help with efficiency, smoother IV starts, too, but the real hold-up is usually a lack of information," says the vice chair of anesthesiology and perioperative medicine at the Drexel University College of Medicine in Philadelphia, Pa. "It's a matter of sharing where resources are being used. So the biggest efficiency builder is some sort of system that makes every player aware of everybody else, that can track the whole process."
Anesthesia information management systems (AIMS) can manage the case scheduling and tracking needs that Dr. Hudson and Dr. Sinha describe. "Can you do that without a system?" asks Dr. Sinha. "Absolutely. But it's a bit easier with one."
In addition, AIMS have the ability to wrangle the reams of data that providers need to document during the course of a case, including patients' vital signs, the amount of inhalational gases used and the injectable drugs administered, letting the providers focus on the patient, not on recording data.
AIMS "has eased charge capture and coding for billing," says Dr. Wechsler. Notes Dr. Friedman, "I can't imagine doing a case without an AIMS anymore."
"All our ASCs have converted to electronic charting and AIMS," says Dr. Lineberger. "Very efficient and helpful. The only liability is quick, short cases, like an ENT peds room." As Dr. Stanfield points out, a system that automatically gathers data will provide much more in the way of time- and effort-savings than one in which much data entry is dependent on the user, and which might not improve on paper charts.
"Information is what you do with it," admits Dr. Sinha. So when you talk to peers about AIMS to educate your purchasing decision, be sure to ask "not just what do you love about the system, but also what are the limitations of it? Find out what are its potential applications? How can this change your efficiency?"
5. Medication labeling systems
In order to prevent medication errors and ensure patient safety, every drawn syringe must be properly labeled with the name of the drug, its strength, the date and time it was drawn, and the initials of the preparer. This information must be legibly written, without smudges or any other marks that would obscure the details.
"I average 9 to 12 meds per case," says Dr. Stanfield. "If I have to write them all out each time, that's time I'm not attending to the patient or working toward case turnover."
With that in mind, a medication labeling system can be an extremely useful accessory. Whether it's a stand-alone unit on an anesthesia storage cart that scans the bar codes of drug vials ("I want one of these!" says Dr. Friedman) or a feature integrated into an automated drug dispenser, a system that prints out highly readable adhesive labels for each syringe saves time while making safety a certainty.
If your budget's tight, however, there are other options for maintaining medication labeling standards. Sheets or rolls of labels pre-printed with drug names and strengths, with space for writing the preparation variables, and pre-filled, pre-packaged, pre-labeled sterile syringes in standard doses and concentrations are but 2 options.
Either way, says Dr. Stanfield, it is "penny-wise and pound-foolish" to painstakingly count costs on your medication budget if you're going to neglect labeling's potential impact on your turnover time.