September 12, 2016

This week’s eAlert offers a compendium of news items and practical advice for anesthesia providers and practice managers, gleaned from a variety of sources.  We hope you find these items interesting and useful in your anesthesia practices.

Join the Conversation on Cost

Do you have an idea for using improvements in quality to drive reductions in the cost of care?  Has your practice tried something that worked?  Share it.

Clinicians and financial managers have plenty of innovative ideas for reducing costs, but these ideas rarely percolate into the public sphere. To change that, Neel Shah, MD, MPP of Harvard Medical School has founded a non-profit organization called Costs of Care to facilitate idea-sharing and learning among healthcare professionals.  Costs of Care sponsors a learning network and a Creating Value Challenge for clinicians, and offers a COST (Culture, Oversight, System support, Training) framework to help clinicians understand and implement high value care interventions in their practices and institutions.  

According to Dr. Shah, who spoke at a recent Hospitals and Health Networks webinar, “The New Conversation on Cost,” healthcare organizations need a strategy for reducing costs that combines the insights of financial managers with the insights of the physicians and nurses who work on the front lines of care delivery and who understand the care and processes that provide value.

It’s a stereotype that clinicians don’t care about cost, Dr. Shah says.  They do care, but their perspective has rarely been a part of the conversation and they rarely receive cost information on a consistent basis.  That needs to change.

A Health Affairs study in which orthopedic surgeons at six major healthcare systems were asked to estimate the cost of 13 commonly used orthopedic devices found that only 20 percent of the surgeons could correctly estimate the cost of the devices.  (Estimates within 20 percent of actual costs were considered correct.)  However, when asked whether they consider cost a key criterion in device selection, 80 percent said yes.  Other research has shown that when cost data is embedded in electronic medical records, costs decline.   

Considering that the decisions clinicians make control about 80 percent of the costs that flow through healthcare and hospitals, this gap between awareness of costs and the desire to be a part of the solution offers a tremendous opportunity for healthcare organizations, Dr. Shah says.

Turn the Tide on Opioid Abuse

United States Surgeon General Vivik H. Murthy, MD, has launched a website, Turn the TideRx.org, to involve healthcare professionals in leading a nationwide movement to solve the U.S. opioid crisis and to educate patients and the public about the dangers of opioid abuse and addiction.

In an historic letter to 2.3 million clinicians sent in late August, Dr. Murthy asks healthcare professionals to pledge their commitment to fighting opioid abuse.  The letter includes a pocket card outlining the Centers for Disease Control and Prevention’s recently adopted opioid prescribing guidelines.

Dr. Murthy’s Turn the TideRx campaign builds on the Department of Health and Human Services Opioid Initiative and the National Pain Strategy, the federal government’s comprehensive plan to reduce the chronic pain burden in the U.S.

In addition to providing a place where clinicians can pledge to combat opioid abuse, the Turn the TideRx website offers space for clinicians to share insights, experiences and strategies that have enabled them to improve their practices, recognize opioid addiction and connect addicted patients with treatment.

The site includes a Pain Treatment Toolbox for clinicians along with current information on opioid dosing and assessing opioid use disorder and overdose risk, and educates patients about how opioids work, alternative pain management strategies, and protecting themselves from opioid overdosing, side effects and addiction.

Dr. Murthy has been touring some of the communities hardest hit by the opioid abuse epidemic, listening to individual stories and speaking with community leaders about the practices that have worked for them and the challenges that remain.

“As cynical as times may seem, the public still looks to our profession for hope during difficult moments.  This is one of those times,” writes Dr. Murthy in the letter to clinicians.  “I know solving this problem will not be easy.  We often struggle to balance reducing our patients’ pain with increasing their risk of addiction.  But, as clinicians, we have the unique power to help end this epidemic.”

‘Green’ the OR

With the unending struggle to stay on top of regulatory changes and cope with healthcare’s frenetic pace of change, it’s easy for thoughts about healthcare’s environmental impact to fall by the wayside.

It might be time to reconsider. According to Practice Greenhealth, a nonprofit organization that promotes environmental sustainability in healthcare, “hospitals have the second largest energy footprint of all sectors, are huge water users and generate 5.9 million tons of waste annually.”

In response, the organization has developed the Greenhealth Cost of Ownership (GCO) Calculator to help healthcare organizations make more environmentally responsible product and device choices.  The tool enables hospitals to determine the hidden costs of products and devices related to maintenance, energy and disposal, and water consumption.  Healthcare suppliers and manufacturers also can use the calculator to identify their products’ strengths and weaknesses from an environmental standpoint. 

The higher initial cost of green products can sometimes act as a barrier to more environmentally sustainable purchasing, notes Beth Eckl, Practice Greenhealth’s director of environmental purchasing.  With the GCO calculator, “Hospitals now have a way to analyze the additional costs of a product and make strategic purchasing decisions that are good for the environment, good for patients and staff, and good for the bottom line,” she says. 

The GCO calculator is available to download and stores all data generated by the user.  Practice Greenhealth will hold free webinars on the GCO Calculator on September 13, 27 and 29, 2016.  To download the tool and register for the webinars, click here. 

Noting that an estimated 20-30 percent of hospital waste is generated by the OR, Practice Greenhealth also sponsors a Greening the OR™ initiative, a long-term collaboration to help hospitals better manage resources in one of the highest supply-consuming and waste-producing areas in the healthcare sector.  The program offers a Greening the OR™ Checklist, webinars and webinar archives, guidance documents, articles and case studies.

To help anesthesiologists become better environmental stewards, the American Society of Anesthesiologists has developed a comprehensive manual, Greening the Operating Room and Perioperative Arena:  Environmental Sustainability for Anesthesia Practice.  Produced by the ASA Task Force on Environmental Sustainability Committee on Equipment and Facilities, the manual was updated in July.  Topics include environmentally responsible anesthetic equipment choices, fresh gas flow management to reduce environmental contamination, and waste stream management and recycling.

Tips for Time Outs

According to the Agency for Healthcare Research and Quality, quoted in our May 16, 2016 eAlert on the importance of surgical checklists, “Checklists are a remarkably useful tool in improving safety, but they are not a panacea.  As checklists have been more widely implemented, it has become clear that their success depends on appropriately targeting the intervention and utilizing a careful implementation strategy.”

In other words, while surgical checklists play a critical role in reducing medical errors, they only work if the entire surgical team conscientiously follows the checklist every time.  Achieving that level of compliance can be a challenge.

Outpatient Surgery offers the following tips to help surgical teams verify, site-mark and hold time outs without fail.

• Label regional block syringes.  Tape yellow “time out” stickers over the thumb inserts of syringes every time you prepare drugs for regional blocks.  This simple step will keep you from operating the syringe or delivering the block until you remove the label.  Removing the label will remind you to verify that you are administering the medication to the correct site.
• Hang reminders on IV bags.  Patients should not receive preoperative sedation or leave the preoperative holding area until their surgical site has been marked.  Hang hard-to-miss signs on the IV poles by patient beds to indicate patients whose surgical site is waiting to be marked.  When the surgeon has marked the site, place a brightly colored sticker identifying the surgical site directly on the IV bag so the entire team can see it.
• Sound off for time outs.  Blow a kazoo or a ring a hotel desk bell to cut through the noise and distractions and get the entire team’s attention before a time out. 
• Involve patients.  Give every patient a single-use marking pen following preoperative preparations.  Explain the importance of site marking and instruct them to ask their surgeon to sign their surgical site.  This step ensures that it is the surgeon who marks the surgical site and involves patients in their care and safety.

ABC Clients:  As always, if you have any questions, please contact your client service executive.

With best wishes,

Tony Mira
President and CEO