By: Robert Stiefel, M.D.
The impact anesthesiologists have on a hospital – whether positive or negative – is broad. Their work affects everything from outcomes and the level of patient satisfaction to scheduling and the facility’s bottom line. That’s why anesthesia services must be considered from the viewpoint of multiple stakeholders – hospital administration, surgeons, medical staff, OR nurses and patients.
Many hospital administrators are accustomed to wrestling with anesthesia groups that are unsympathetic to the needs of the hospitals and their staff. Anesthesia groups can be inflexible with their processes or scheduling, and unwilling to listen to constructive criticism. This leads to drama in the OR, challenges with scheduling and efficiency, and may impact patient care as well as profitability.
Administrators are looking for reliable measurements of their anesthesia cost, efficiency, quality and service satisfaction. They depend on anesthesia group leadership to help provide this data, and proactively act on the findings. With more hospital administrators exploring ways of controlling costs and integrating delivery of care to prepare for ACOs and bundled payments, their anesthesia department must adapt to help meet these hospital priorities.
Anesthesia quality also plays a large role in maximizing value-based purchasing, a top priority of hospital administrators. Post-operative pain management is a key factor in the calculation of HCAHPS scores. Administrators are looking for anesthesia groups to take the lead in the management of post-op pain, which will improve patient care, satisfaction and reimbursement.
Surgeons want an anesthesia group that provides high quality care, proactively addresses patient issues and will work to accommodate operating room efficiency and throughput. This means not only overall quality of care, but consistency in care between various anesthesia group members. For example, the anesthesia team must arrive in a timely manner in order to prepare the patient for on-time starts. It also means no surprise delays on the day of surgery because lab work or consultations have not been obtained or addressed prior to the morning of surgery and direct communication with surgeons about patient or scheduling issues. The anesthesia team must be a partner with the surgeon to move complete cases in an efficient manner.
Too often anesthesia departments fall short on some or many of these items, failing to meet the needs of their surgeons and, therefore, causing friction with a vital stakeholder.
OR Nurses and Other OR Staff
OR Nurses and OR staff already have difficult enough jobs ensuring the OR runs efficiently and patients are receiving quality care. They want an anesthesia department that they can count on to work with them to achieve these goals. Anesthesiologists that communicate with hospital staff, meet daily to coordinate scheduling, and are active participants in managing the daily OR schedule are perceived as partners in care, and meet the needs of these key stakeholders.
Patient satisfaction is an increasingly important element of payer reimbursement. Pre-op anesthesia evaluation clinics and post-op pain management both influence CMS-weighed patient surveys. Further complicating matters, studies have also shown that patient satisfaction often has little to do with clinical care. Patients no longer want their anesthesiologist to just put them to sleep and wake them up, they want to consult with an anesthesia provider directly before their surgery. This one-on-one time affects how patients perceive their quality of care and their responses to satisfaction surveys. Anesthesia providers must develop processes to adequately communicate with patients in preparation for their procedure, and where practical, manage their pain after the procedure. This is good customer service, but in the current environment it also links directly to facility reimbursement.
The needs of each of these stakeholders are diverse and when taken together, serve as a way to measure the affect of an anesthesia model on the health of the overall facility. Step back and evaluate the relationship of your anesthesia group with each of these parties, a problem in one area could have rippling, hospital-wide consequences.