Anesthesiologists as 'Air Traffic Controllers of the OR'

Early results of a new program focusing on anesthesiologists' interactions with patients show promise toward improving patient satisfaction. "As hospitals prioritize patient satisfaction, anesthesiologists play a more visible role," says a Florida physician key to the program.

It's not by drugs alone that anesthesiologists can reduce patient anxiety and make them feel good about their experience in the hospital. Patient education provided by these specialists is helping one Florida hospital improve on a key indicator of patient satisfaction.

Boosting patient satisfaction can be a hard concept for leadership to grasp for many reasons:

• Each patient brings a different set of expectations for what "good" means;
• Measuring a patient's satisfaction with his or her care isn't an exact science despite the HCAHPS tool;
• Sometimes difficult to pinpoint who exactly is responsible for patient satisfaction when teams of caregivers share the load

At Memorial Regional Hospital in Hollywood, FL, however, a new program focusing on the anesthesiologists' interaction with the patient holds some promise toward improving patient satisfaction.

Anesthesiologists are part of a specialty committed to improving patient satisfaction and experience. In April 2013, the American Society of Anesthesiologists and its Committee on Performance and Outcomes Measurement issued a white paper detailing the importance of the anesthesiologist's role in patient experience, and issued four recommendations for collecting data to measure satisfaction.

"As hospitals prioritize patient satisfaction, anesthesiologists play a more visible role," says Adam Blomberg, MD, vice chief of anesthesiology at Memorial Regional Hospital and education director for the anesthesiology division at Sheridan Healthcare. "We realize that patients are becoming consumers and we thought, 'Who better to educate patients but anesthesiologists?' "

Blomberg says patients who are scheduled for surgery receive a welcome letter and are directed to an online portal that provides education about anesthesia services, such as what to expect before and after surgery. It's led to patients coming in and asking more pointed questions.

As a result, he says patients are also less anxious, which in turn can affect their perception of the quality of care they received pre- and post-surgery. "We started it [the patient education process] in mid-2013 with all surgeries," says Blomberg. "The goal is for patients to have one place to go for their questions, rather than going to Google."

Coordinating Care in the OR
Another key component to trying to improve patient satisfaction through Memorial's anesthesiology program is coordinating care among the clinical team. Blomberg says that by using a patient-centered approach during the perioperative experience, Memorial has reduced unnecessary testing.

Decreasing the number of tests a patient needed before surgery did not happen as quickly as the patient education element. Instead, Blomberg explains that process started slowly, and only began at the end of 2013. He had to educate providers, hospitals, and surgeons on latest guidelines to explain why he wasn't recommending as many tests.

Essentially, Blomberg found that more tests led to more information, but not necessarily meaningful information that changed a patient's surgery path. That line of thinking, or rather questioning, has caught on with specialty organizations and is an initiative of the American Board of Internal Medicine ABIM.

Cancellations Rack Up Costs, Dissatisfaction
Through its "Choosing Wisely" campaign, the ABIM, in partnership with the ASA, released five pre-operative and intraoperative tests or procedures that patients and physicians should question.

Blomberg says that more tests can lead to same-day surgery cancellations, which was both a red flag and an opportunity to improve at Memorial. "One of the biggest patient dissatisfiers is same-day cancellation," says Blomberg.

Same-day surgery cancellations also rack up hospital costs. A 2012 study from Tulane University Medical Center found that 6.7% of scheduled surgeries were cancelled on the same day in 2009, at a cost of $1 million. The cancellations were not exclusively due an excessive number of tests, but subsequent studies came to a similar, broad conclusion that most cancellations were preventable.

"The new coordinator of care is the anesthesiologist," says Blomberg. "We are the air traffic controllers of the OR."

The new processes in place at Memorial Regional have not yet been put to the patient satisfaction test; however, Blomberg says the hospital has been able to reduce same-day cancellations from 8% to 4% in just one year.

Memorial Regional performs 10,500 surgeries annually, which means, in real numbers, 420 fewer patients were inconvenienced by having to return home after fasting, mentally preparing for surgery, and taking time off of work for a surgery that got cancelled. That's a lot of HCAHPS surveys.