In this episode Kristin and David Andrews, MHS, CRNA, President of the Oregon Association of Nurse Anesthetists and Clinical Director of Outpatient Anesthesia Services, sit down to discuss the challenges facing outpatient anesthesia providers.

Information about Outpatient Anesthesia Services can be found at their website www.oasor.com.

Shownotes:

–  Challenges faced in operating outpatient surgical facilities include scheduling and flexibility in order to be a profitable company.

–  Patient selection is a challenge.  The last thing you want to do is cancel a procedure on the day of surgery.  Make sure that a solid pre-anesthesia assessment is taken care of ahead of time.

–  How do you assess risk?  There is a push to limit pre-operative testing because it does not necessaritly result in better outcomes.  Also, it costs more and can be a hassle for patients.

–  There is financial pressure not to cancel cases.  How do we attenuate this – by trying to get as much patient information as possible before the actual surgery.  Train your office to get particular information depending on how patients present.

–  Ultimately it boils down to the provider on that day to make the decision whether or not to proceed.

–  There is a constant balance between rapid turnover and patient safetly.  Develop a quick, systematic efficient method of putting people to sleep and waking them up.  If you feel rushed, take a deep breath and slow down.  Every patient deserves the best care.  Ultimatley you are accountable for the care you give.

–  Critical incidents are rare in the outpatient setting but the most common are airway related.  In order to deal with this properly you need preparation.

–  Goals for the outpatient setting: Nausea free, quick wake up, prompt discharge within an hour, pain free and comfortable.  Regional anesthesia works great for this setting.

–  Outpatient is a service industry.  CRNAs should be able to be flexible to accommadate surgeon preferences and needs within safe boundries.

–  Anesthesia is the same regardless who is providing it; the way that CRNAs can really excell is by providing excellent service.