Tony Mira, Chairman and Chief Executive Officer of MiraMed
Practice Management Pearls: A Rundown of Recent Anesthesia Research, Part 2
As a follow up to last week's eAlert, we review additional e-posters presented at the ASA's PRACTICE MANAGEMENT™ 2019. As mentioned last week, please bear in mind that each of these studies represent the experience of a single institution, and the same study at your own institution might well produce a different result. These summaries are offered to serve as a catalyst for discussion and planning.
Anesthesia drug costs. How well do you and your anesthesia colleagues know the costs of the various anesthesia drugs used in the OR and other anesthetizing locations at your facilities, so that you can make the most cost-effective choices?
To evaluate provider awareness at their institution and assess the need and desire for a single, central source of drug information for all anesthesia clinicians, researchers led by Nasir Khatri, MD, at the University of North Carolina Hospitals surveyed anesthesia department members regarding their knowledge of the intravenous drug costs associated with three specific procedures: laparoscopic cholecystectomy, pulmonary wedge resection and craniotomy for stereotactic posterior fossa mass removal.
Participants then viewed a four-minute educational video about the actual drug costs associated with these and other procedures, followed by a post-survey to re-evaluate self-perceived knowledge of drug costs and to assess desire among department members for development of a central anesthesia drug cost resource.
Most study participants revealed little awareness of anesthesia IV drug costs. Eight percent, 6 percent and 0 percent of anesthesia providers correctly estimated the IV drug costs associated with lap chole, wedge resection and craniotomy, respectively. This widespread lack of knowledge at least partly explains the significant variation in utilization costs at UNC, the authors reported.
The survey also revealed substantial interest among participants for a central resource for IV drug cost information, preferably through a website (47 percent) or mobile app (38 percent). The vast majority of providers (97 percent) expressed support for such a resource, with 98 percent indicating a belief that the resource would facilitate cost-effective care. The study was limited by the fact that it looked only at IV drugs and did not evaluate inhaled anesthetics or local anesthetics used in peripheral nerve blocks.
Preoperative evaluation. As abundant research has shown, preoperative evaluations can improve anesthesia care safety, efficiency and quality and the patient's perioperative experience. But is an in-person preoperative evaluation for every patient the most efficient use of resources?
Jagan Devarajan, MD, and colleagues at Cleveland Clinic wanted to know whether a screening tool developed at their institution could be used to identify low risk patients who would not need to be seen in-person before the day of surgery. Such a tool could free up time and resources for patients with multiple comorbidities who need extensive preoperative work and care coordination.
A valid screening test should have high negative predictive value and also accurately identify high risk patients to create "a window of opportunity for medical optimization" that could help reduce morbidity and mortality, they said, citing research showing that 11 percent of intraoperative events are due to poor preoperative preparation and that half of them are avoidable.
Two independent anesthesia researchers applied the 13-item questionnaire (see below) to a retrospective review of 70 charts to see whether responses to the questions would have identified high risk patients, and whether any patients who responded no to all of the questions were referred for optimization or specialty care.
All of the e-posters from PRACTICE MANAGEMENT™ 2019 can be seen here.
We want to hear from you. Do you have a topic you would like to see covered in an ABC eAlert? Please send your suggestions to email@example.com.
With best wishes,
President and CEO