August 11, 2014

We recently had the opportunity to talk with one of our favorite surgeons about what she wants from her anesthesiologist or care team.  Some of the items on the list below will be very familiar—so much so that it’s surprising that the issue still comes up.  Others are specific to our surgeon’s specialty, otolaryngology, they may sensitize readers to analogous concerns affecting other specialties.

Classic Bêtes Noires

• I would like fast turn-over times; my time is valuable.

Anesthesiologists’ time is valuable too, and they like fast turn-overs as much as do the surgeons.  This is an area where performance metrics can be particularly helpful.  If turn-overs take longer than national or local benchmarks, there is a wealth of information on how a facility might improve (e.g., numerous publications by Franklin Dexter, MD, PhD including Economics of Reducing Turnover Times, 2014; Laura Dyrda, 8 Steps to Quicker Turnover Time in ASCs, Beckers ASC Review, December 26, 2012).  Because of differences in the equipment and clean-up time required by different types of surgeries—total hip replacements are associated with much greater times than cataracts—and in the facility and staffing variables that affect turn-over times, the benchmarking data used should be as granular as possible.  If your performance is superior or is at least improving, showing the surgeon the data may improve his or her impression.

• Sometimes the anesthesiologist is on the phone with his stockbroker, instead of paying attention to the patient.  This is quite alarming.

Divided attention on the part of the anesthesiologist or CRNA is dangerous.  Telephone conversations should be limited to those that benefit the patient, as we concluded after reviewing recent litigation and some of the literature in our Alert of May 5, 2014, The Distracted Anesthesiologist.  The same goes for checking e-mail messages or the Internet.

Food for Thought

• I realize that some patients require more procedures from the anesthesiologist than others, but in my humble opinion, sometimes certain individuals are too aggressive; not every patient requires an arterial line, for example.
• I would like to be informed if there is a problem with the patient; some anesthesiologists just try to fix things without telling me—for example, maybe I am impinging on the endotracheal tube and that is why they have high ventilation pressures or maybe I am touching the carotid artery and that is why the pulse dropped; communication is key.

Communication is key to all successful relationships and joint enterprises, in or out of the OR and the hospital.

ENT Concerns

• STAY OUT OF MY WAY!  We share the airway often and this can be a problem.

(Emphasis in original.)

• I would like a non-traumatic intubation please—no bleeding to obscure whatever I need to do.

Everyone would prefer a non-traumatic intubation, whether or not bleeding interferes with the visual field.  It is obvious why it is particularly important to the otolaryngologist working around the larynx and trachea that the airway be clear of blood.

What We Have Also Learned

ABC staff have heard of quite a few other preferences, needs and requirements in our work with surgeons and surgeons’ offices as well as with anesthesiologists.  On-time case starts are the fundamental complement to our ENT friend’s fast turn-over times.  Other scheduling issues are the anesthesia group’s willingness to accommodate add-on cases and its flexibility in booking cases after hours and on weekends.  Noteworthy, too, are the following:

• Consistency among the providers in a group

More and more surgeons are seeking consistency in their anesthesia providers.  They believe that consistency improves quality of care and efficiency.

They want a pit crew environment in the OR, where all the providers know each other and all are familiar with the protocols in use and with each other’s responsibilities.  Personalities should be compatible.  “They also want these providers to be interested in their specialty.  As an example, someone who loves doing ortho cases may not be that interested in a cardiac case.”

• The anesthesia group is in-network with all payers

The surgeon does not want to hear patients’ complaints about their anesthesia bills.  He or she especially does not want to face patients who are angry that the anesthesiologist—whom they did not choose—turned out not to be participating in the same network as the surgeon, radiologist and hospital.

• The patient has been worked up to avoid delays

The surgeon wants to be sure that any needed tests and lab work have been completed timely—and that the documentation is on hand so that the case can proceed on time.

• Overly conservative and ready to cancel

Sometimes the anesthesiologist can be rigid about clinical indicators that a patient is medically stable (such as potassium levels).  Understandably enough, the anesthesiologist may hesitate to do the case because he or she will be responsible if the patient “crashes.”  This can delay surgery or even cause multi-day postponements if the surgeon has a full load.

Above all, surgeons and hospital and ASC administrators alike want safe, effective and consistent anesthesia services—and satisfied patients.  Fortunately, these are not rare.

With best wishes,

Tony Mira
President and CEO