Five Ways Anesthesia Can Drive Quality Improvement
By Leo Penzi, MD, Executive Vice President & Chief Medical Officer, NAPA
What does it mean to drive quality improvement (QI) today? We used to measure quality by assessing complication rates based on available patient outcome data. Looking at overall outcomes yields some useful information, but because medicine is a team sport, it’s often difficult to discern the impact of one individual or metric. Accordingly, the definition of quality has changed over time. In the new school of thinking, our specialty’s QI initiatives are focused on measurements that optimize the opportunities that anesthesia clinicians have to directly influence patient outcomes. Here are five ways that our anesthesia clinicians are enhancing value for patients and healthcare partners:
- Reducing length of stay. As anesthesia teams take a more proactive approach to perioperative care and pain management, the improved level of care has contributed to shorter postoperative hospital stays, as well as the ability to refer more procedures to settings outside of the operating room. The movement towards standardized pre-procedure evaluations and optimization strategies also makes it possible for more patients, even those with complex comorbidities, to be candidates for minimally invasive procedures, with lower risk of complications like respiratory depression and pneumonia. Better ambulatory experiences and decreased need to stay in the hospital increase patient satisfaction (and higher satisfaction scores boost operating margin).
- Reducing opioids in recovery. Facing the nation’s opioid crisis, our clinicians are uniquely positioned to minimize the use of narcotics. Rather than the “old school” practice of determining how to control pain after patients appeared in the recovery room—usually with an opioid—anesthesia clinicians are now thinking more proactively about how to manage post-operative pain. Strategies which range from administering pre-operative and intraoperative non-narcotic analgesics to using many more regional anesthesia techniques, either as a primary anesthetic or in combination with other modalities, have significantly reduced the utilization of opiates.
- Reducing surgical site infections (SSI). NAPA is at the forefront of creating safety-focused cultures in healthcare environments. Among our notable innovations is NAPA Peak Performance2, a scalable, third-party Remote Video Auditing (RVA) technology blended with behavior modification strategies and real-time feedback, that helps hospitals enforce infection prevention measures to approach 100% daily compliance with the Surgical Safety Checklist, hand hygiene, and terminal room cleaning protocols (along with driving higher OR room turnover and case volume). Recognizing how the platform gives hospitals a framework to build and measure a “highly reliable” organizational culture, The Joint Commission awarded NAPA Peak Performance2 a place in its Resources Quality and Safety Network (JCRQSN). Leadership by our anesthesia Chiefs also drives a patient-first culture in which safety is the highest priority in the more than 300 healthcare settings where NAPA provides anesthesia services.
- Increasing surgeon satisfaction. As the quarterback in the OR, anesthesia clinicians can play a vital role in communicating with our surgical colleagues and creating collaborative environments that help surgeons achieve their objectives. Addressing surgeons’ needs means delivering the highest quality care to their patients, as well as providing tools and teams that effectively boost OR throughput to maximize surgical volume and OR scheduling.
- Improving the patient experience. It’s not enough for the anesthesia department to simply get patients safely to the recovery room. The value-driven payment era demands that we do better to empathize with our patients, demonstrate our professionalism, build stronger perioperative relationships with families, and survey our customers to understand how they experienced our care. Being a quality practitioner today requires our anesthesia colleagues to have more touchpoints with the patient—reaching out earlier, spending more time to discuss the anesthetic plan, listening to patient and family concerns, and being prepared with non-narcotic strategies to manage post-op pain, both in the OR and beyond.
Like medicine overall, it takes teamwork to improve quality in anesthesia. Inspired leadership creates a culture that engages all team members, recognizing that frontline practitioners and frontline OR staff who interact with patients daily often have the best information and answers. Anesthesia teams measure up to high achievement when they take every opportunity to learn from every patient and every QI survey response, so we can all deliver exceptional experiences, every day.