7 Tips for Improving Efficiency in Your Anesthesia Department

When hospitals reduce turnover time and increase operating room efficiency, everyone wins: the anesthesiologists, surgeons, nurses, administrators, and most of all, the patients. However, patients all too often wait for too long in the pre-operative area, or sometimes, the recovery room isn't ready for the patient postoperatively. Inefficiency breeds dissatisfaction in patients as well as throughout the operating room staff. Since the goal of any hospital is to ensure patient satisfaction while providing the highest possible standard of care, increasing efficiency is critical.

Statistics also show that the OR generates as much as 60 percent of hospital revenues. Canceled or delayed procedures cut into that. But the anesthesiology department is uniquely positioned to help improve communication, the cornerstone of efficiency in the OR. By working with surgical services and hospital administrators, the anesthesiology department can improve both pre- and post-operative care and reduce turnover time. Here are seven tips, which can be divided into three categories: pre-operative testing, communication and planning, to improve OR efficiency.

Increase efficiency with smart pre-operative testing procedures
While some pre-operative testing may be necessary, some can do more harm than good by causing procedures to be delayed.

1. Eliminate unnecessary pre-operative testing. Many surgeons subscribe to the old school of thought that requires extensive pre-operative testing on patients. While a diabetic patient or patient with a history of cardiac problems needs more extensive testing, healthier patients, such as athletes undergoing joint surgery, may not require a full blood workup or EKG. This can sometimes lead to false positives that delay surgeries.

Instead, physicians and anesthesiologists need to communicate and formulate a pre-operative testing plan that takes into account the patient's medical history to reduce unnecessary and costly testing while at the same time, increasing patient satisfaction by decreasing burdensome testing. By communicating with the patient's surgeon and primary care physician, anesthesiology departments can ensure that the patient receives surgical services on schedule, reducing cancellations.

2. Review pre-operative test results and patient data in advance. For elective surgeries, every operating department should have pre-operative testing completed at least one day before the patient's scheduled surgery. By reviewing these patients' results, the surgical team will know that the patients have the medical and cardiac clearances to undergo surgery.

Improve operating efficiency by communicating
Communication is the cornerstone of efficiency. Not only does the anesthesia department need to communicate within the OR, but outside it as well, from patients to pre-operative and recovery room staff. Operating in silos throughout the hospital not only decreases efficiency but can also be dangerous for patients.

3. Communicate with the surgical team, operating room team and patients. Communicating is the best way for the anesthesia department to know when the surgery is scheduled, how long the surgery is scheduled for and when the surgeon expects to finish the operation. This prevents the anesthesia team from re-dosing a patient too close to the end of surgery, requiring more time on a ventilator. The key is to time the anesthetics to the surgeon's timing.

At the same time, facilitating communication with the rest of the team, including the recovery room staff, ensures that they are ready to receive the patient once the surgery is finished. Meanwhile, the pre-op team is preparing the next patient for surgery so that the patient has his IV in place and is ready to go, preventing delays.

Most patients are not OR veterans and may have misconceptions about their upcoming procedure. For example, they may think that they can't eat or drink anything after midnight, even if their surgeries are scheduled for early afternoon. Patients may also be nervous or not know where to go in the hospital. They need to know what to expect: what kind of fasting is required, where to check in for the procedure and what they can expect after the procedure.

Plan for the expected — and unexpected
Careful planning, from scheduling to being prepared for the worst, can prevent empty operating rooms, patient dissatisfaction and lost revenues for the hospital.

4. Schedule smarter. Some hospitals will schedule surgeries horizontally, using all ORs for 7:30 a.m. surgeries and leaving the rooms empty afterward. An empty OR is the height of inefficiency, and it does nothing to maximize the use of the staff's and surgeons' time.

Block scheduling consolidates OR schedules into vertical blocks, working with surgeons to ensure that the time booked for the procedure is enough time and maximizes the use of the OR. This prevents the likelihood of patients and surgeons waiting while the previous procedure finishes, which takes away from both surgical time and anesthesia time and can lead to worry in patients who are already anxious about their procedures.

5. Consider hospital reconfiguration. Sometimes, the layout of the hospital itself can lead to inefficiencies throughout the surgical process. The pre-operative area may be on the other side of the hospital and the recovery room may be downstairs. Not only does it take longer for patients to be transported through the hospital, this type of configuration also increases the time it takes for the anesthesiologist to travel, walking from the recovery room to the pre-operative area to take care of the next patient.

Hospital administrators may balk at the idea, but smoothing the patient flow by moving the pre-operative area and recovery rooms closer to the ORs decreases turnover time as well as improves patient satisfaction.

6. Standardize as much as possible. While each patient is different, some things can be standardized, such as the types of anesthetic used and the protocols for surgery. For example, in total joint replacement cases, the anesthesia department can standardize the regional or general anesthetic used and post-operative and intraoperative pain care so that the surgeons know what to expect every time.

Standardization can also encompass the quality of anesthetics. By keeping up to date on evidence-based medicine, the anesthesia department can choose the best quality anesthetics for the patients, preventing complications in the recovery room that can eat into patient satisfaction and be potentially dangerous.

7. Be prepared for the unexpected. While most anesthesiologists would agree that to practice anesthesiology is to practice with the unexpected, there are situations that are beyond the control of the operating room team that can decrease efficiency.

To prepare for unexpected situations, the staff needs to undergo regular training, including drills of possible scenarios such as fires, earthquakes or even violence. Twenty years ago, no one would have practiced what to do if a shooter came into the hospital, forcing a lockdown. However, as recent events have proved, that is one of the scenarios that is possible and that staff should be trained for so that if it does happen during a surgery, the procedure can be completed.

The underlying theme in all of these tips is to communicate with everyone involved in the surgery. Inefficiencies occur when people, whether it's the surgical staff or the patients, don't know what to expect. By mapping out procedures and sharing them with the key players, the anesthesia department can increase efficiency and decrease turnover time, leading to increased patient satisfaction and increased hospital revenues.

Dr. Adam L. Blomberg is the National Education Director for Sheridan Healthcare’s Anesthesia Division. Dr. Blomberg also serves on the Anesthesia Quality Committee at Sheridan as the chair of the Provider Education Subcommittee, and he is the Director of Clinical Education at Memorial Regional Hospital, Sheridan Healthcare’s flagship anesthesia practice in Hollywood, Fla. Dr. Blomberg completed his training at Brigham & Women's Hospital, a teaching affiliate of Harvard Medical School in Boston in the Department of Anesthesiology, Perioperative and Pain Medicine. During his final year of residency, he served as chief resident. 

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