Anesthesia and Operating Room Efficiency
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This article appears in the December 2012 issue of HealthLeaders magazine.
Anesthesiology may be a sleeper in healthcare, in a manner of speaking. While not traditionally regarded among the top service lines, anesthesiology programs are a direct link to a hospital's biggest moneymaker: surgery in the operating rooms.
As much as 60% to 70% of hospital revenues are tied to the operating room, and anesthesia administered in the OR or other parts of the hospital are critical because of their widespread impact, according to Sabrina Bent, MD, MS, clinical associate professor of anesthesiology and director of research at Tulane University in New Orleans.
Yet throughout the United States, when surgeries are canceled at the last minute—often because patients decide to delay or forego the procedure, and sometimes because of scheduling problems in hospitals—it can cost healthcare facilities millions of dollars in lost revenue.
Hospitals are homing in on anesthesia programs to buttress their ORs and improve coordination with patients to reduce delays. They are also initiating changes to improve scheduling and staffing, and overcome bottlenecks in patient flow, which are the result of inefficient and unpredictable OR scheduling.
"Anesthesiologists are the traffic cops" in the OR, says Martin De Ruyter, MD, associate professor in the department of anesthesiology at the 606-bed Kansas University Medical Center in Kansas City, Kan. De Ruyter says effective partnerships with the anesthesia department help improve physician communication and accountability, which directly impacts perioperative care.
That coordination is essential to reducing inefficiencies in care caused by the cancellations of procedures, which cost $1 million in 2009 at the 235-bed Tulane Medical Center, according to Bent. This financial fallout prompted Tulane to take steps to revise its scheduling programs, with anesthesia service a key element for improved preoperative procedures, she says.
For several years, the 866-bed St. John's Regional Health Center in Springfield, Mo., organized programs to improve flow in surgical cases for its 39 surgical suites. Anesthesiology was a major focus of a physician-led committee exploring patient flow, says Jeff Hawkins, RN, MHA, OR administrative director for Mercy Health, which runs St. John's. "There is an oversight coordinator who works hand-in-hand with anesthesia, looking at the rooms, what's open, what's not, where we can put people in," Hawkins says. "There's a lot of communication going back and forth. There is a long list: What did we capture, what did we miss?"
By focusing on OR efficiency and service, the scheduling changes are often coordinated by anesthesiology leaders, says John Herring, MD, the anesthesia medical director at the 280-staffed-bed St. Luke's Hospital, in Cedar Rapids, Iowa, who also practices with Linn County Anesthesiologists. One of the areas that the hospital focuses on is block scheduling, a procedure in which anesthesiologists have flexibility in scheduling to ensure that different ORs are utilized and reducing the number of empty suites on some days and overcrowded ones on others.
"It's beneficial for everyone to improve scheduling processes and define block scheduling," says Herring, noting that there should be efforts to "reduce the unintended but frustrating competition for resources."
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