Non Operating Room Procedural Efficiency
Outside the OR Prcedural Efficiecy
As sedation polices change and with the growth of procedures outside the traditional operating room grow, the anesthesia department is being asked to provide more coverage for the procedures. These requests are both by providers and by patients as well as hospital administration. In addition, hospital quality and safety officers continue to advocate for anesthesia services for these procedures. Our practice is an integrated employed physician practice where the expectation is to cover these procedures when requested while still balancing financial stability. Our challenge is these procedural areas lack the structure and guidelines of the operating room to maintain efficiency. In addition, each area has a different set of managers and physicians and each have their own way of doing “their” procedures.
Our issue is how is the best way to coordinate these areas to have a single set of guidelines and structure for quality, efficiency and patient safety. The goal would be to reduce variation in care and streamline booking to maximize use of the provided time to cover the needed procedures.
I agree that ensuring consistency of procedural guidelines is essential. To that end, we identified a clinical nurse leader to provide oversight of the manner in which sedation was being performed in our procedural areas with the most significant activities occurring in our interventional radiology department. Workflows were reviewed, documentation tools revised, universal protocol reviewed to ensure consistency with the peri-operative processes. We were just recently reviewed by the Joint Commission who viewed every area in which conscious sedation was provided, and they were please with our processes. It took an individual with the requisite authority, working with Department Chairman to impact the changes that were necessary.
We have a team of anesthesist assistants who work in the OR and at regular times outside the OR. One of the anesthtist is Always available for supervision. The planning of the schedule for in/and ou of OR procedures is the same schedule.
Patients are also seen at th epre/assessment outpatient clinic, the same way they are seen before in/OR treatments.
Quality of care is assessed the same way as in the or.
I think, we are dealing with lives here and as part of best medical practices, we need to set SOPs and guidelines based on workload and financial viability. Its better to engage more anaesthetists to cover the Non-OP procedures. Data would be helpful taking such decisions. I would love to have some data and financial implication around these activities and then take a call.