Q: What are some anesthesia trends you’re seeing in the ASC setting?
Dr. Irvin Thomas: From the clinical standpoint, two of the main trends we’re seeing are the increased role of peripheral regional anesthesia and an increasing number of patients with more significant medical problems undergoing procedures in ASCs. For certain orthopedic procedures, peripheral regional anesthesia alone, or in combination with general anesthesia, may offer certain advantages. These include higher patient satisfaction scores due to excellent post-operative pain control and a lower incidence of post-operative nausea and vomiting, greater surgeon satisfaction, earlier discharge times and potentially lower costs.
We’re also seeing an increase in the number of patients who would have been traditionally treated in a hospital come to the ASC. Furthermore, there has been an increasing shift of “hospital” surgeries to the ASC. For example, laparoscopic cholecystectomy, cervical spine fusion and total knee replacement are now performed routinely at some ASCs. This is driven by economics to a large extent. However, newer medications with shorter half lives and a shorter duration of action give us the opportunity to treat these “hospital patients” in the outpatient setting.
Q: Is the use of regional blocks unique to ASCs?
IT: No. Hospitals use regional blocks as well. The decision to provide this service depends largely upon clinical skills of the anesthesiologist, surgeon requests and OR scheduling as these nerve blocks requires extra time to perform. ASCs that are willing to take the extra time to do them could benefit as a result of patients coming to the ASC for this type of anesthesia service.
Q: What other challenges do ASCs face regarding anesthesia services?
IT: One of the biggest challenges is to ensure we are identifying only the patients who can be appropriately cared for at an ASC to undergo a procedure there. If a patient has significant co-morbidity, we need to ensure that the appropriate studies have been done to ensure they can safely have their procedure performed in an outpatient setting. This may involve a lot of work the day before surgery, or even the day of surgery, to make sure the patient is ready to undergo a procedure at an ASC.
Staffing also presents a bit of a challenge. As more patients come to the ASC and volume grows, there are staffing issues for both the ASC and the anesthesia providers that have to be dealt with. You want to do a lot of cases, but if cases run over their scheduled times, you have to be prepared for overtime costs. We’re also seeing a growing trend toward Saturday hours, which is not traditional in the ASC. As an ambulatory anesthesia group, we’re starting to see some demand for weekend coverage. I expect that this will continue to grow as Saturday hours are great from a patient satisfaction standpoint. A patient could have a procedure on Saturday, recover on Sunday and be back at work by Monday.
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