ANESTHESIA SERVICE MANAGEMENT
Anesthesia-related costs are estimated to represent 3% to 5% of
the total health care expenditures in the United States.[50]
Most of these costs involve personnel.[51]
It
is important for OR directors to include anesthesia service management in their scope
of responsibility. In general, if the total OR process is streamlined and maximum
efficiency is achieved, productivity within the anesthesia service will be increased.
Better OR scheduling, on-time starts, efficient turnovers, and proper management
of add-ons and cancellations will result in concomitant improvement in anesthesia
service utilization.
The two main areas of anesthesia service management relate to
personnel issues and pharmaceutical costs. Recently, many authors have reviewed
optimal staffing patterns for providing anesthesia coverage for the surgical schedule.
[52]
[53]
The benefits
of physician-only versus concurrent supervision of multiple providers are not clear-cut.
Which staffing coverage one uses may depend on provider availability, as well as
local conditions. In addition to these considerations, the requirement for specialty
teams to cover areas such as cardiac, organ transplant, obstetric, trauma, and pediatric
cases may limit
TABLE 86-19 -- Dealing with disruptive behavior
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Educate the OR staff on hospital policies and definitions of
disruptive behavior. |
|
Set a low threshold for identification and reporting. |
|
The OR director should immediately respond to an incident. |
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Make the behavior the issue, not the individual. |
|
Focus on the acute behavior and not past frustrations. |
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Do not accept excuses or explanations of justification. |
|
Set clear target goals for behavior modification and then follow
up directly with the individual. |
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Be sympathetic to the perspective of public humiliation of the
individual. Deal with the individual in a quiet private setting with one or two
witnesses. |
|
Seek out other issues in the physician's practice that may be
the source of stress. Often, factors outside the OR lead to the disruptive behavior
that is manifested in the OR. |
|
Be prepared to enforce your disruptive behavior policy completely.
If the physician does not reform or persists in the disruptive behavior, removal
from the hospital staff may be the best solution. |
|
Enforce your policy evenly. Do not allow exceptions for behavior
of high-profile individuals. Frequently, action against one physician will demonstrate
the seriousness of your commitment to physician behavior standards and serve to deter
others from acting out. |
one's ability to maximize staff utilization. Today, more anesthesia groups are negotiating
financial support from hospitals for added call coverage for these specialty teams.
As pressure has increased to quantify anesthesia output, measurement of anesthesia
productivity has also been refined.[54]
[55]
[56]
Methods to track anesthesia output have evolved
from simple availability to more sophisticated measurements of production and call
coverage. Clear differences also exist between academic and private settings. Abouleish
and colleagues showed that an anesthesiologist in an academic setting needed to work
30% longer than one in private practice to generate the same level of billable services
(7.8 hours versus 6.0 hours).[56]
Because anesthesia drugs are expensive, they also are a frequent
source of discussion for areas to reduce hospital expenses.[57]
Anesthesia-related drugs may account for the majority of the top 20 most costly
drugs used in the hospital.[58]
This focus on drug
costs is becoming more important with ever-increasing pharmaceutical costs. Overall,
pharmaceutical costs may represent 5.6% of a hospital's total operating costs.[58]
Anesthesia drugs represent 22% of the total pharmacy costs.[59]
Often, the development of newer anesthesia drugs comes at significantly higher costs
(muscle relaxants, narcotics, antiemetics). These drugs have been touted as cost-effective
because of their ability to improve patient throughput (decrease OR or PACU times)
or increase patient satisfaction (faster discharge, less postoperative nausea and
vomiting). Studies have been inconsistent in demonstrating benefits from these new
drugs.[60]
[61]
Because of the many variables in the balance between drug costs and time utilization,
as well as the designation of fixed versus variable costs, true assessment of changing
practice standards related to drug choices is difficult. If anesthesia-controlled
costs represent 6% of the total cost for a surgical patient, how much of this percentage
can be manipulated to result in cost savings? Probably half of these anesthesia
costs are fixed, so only 3% of the hospital anesthesia costs are available for modification
(drugs and supplies). Experience has shown that intensive restructuring of anesthesia
drug use results in only small reductions in overall pharmacy costs. These savings
may be difficult to sustain, and a return to previous drug choices often occurs.
[59]
 |
