The Anesthesiologist and Health Care Redesign
Sunday 9 a.m.-12 p.m.
Upper Level 4
James Rathmell, M.D.
Delivering anesthesia care isn’t always as efficient as it can be. It is not always the fault of anesthesiologists, surgeons or the team in the operating room (O.R.). Key drivers of inefficient care often come directly from having to deliver care in an inefficient environment. In recent years, process and architectural design specialists have been transforming the way health care is delivered.
“We are seeing attempts to think carefully about how we care for our patients and come up with new ways of doing things better,” said James Rathmell, M.D., Chair of the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital, Boston. “Redesigning health care is not about administering anesthetics in a different way, it is about how anesthesiologists are doing novel things to improve the delivery of care.”
Dr. Rathmell will moderate a groundbreaking session, “The Anesthesiologist and Health Care Redesign,” from 9 a.m. to noon Sunday in Upper Level 4. No one knows the barriers to working more efficiently in the O.R. environment better than the people working there day in and day out. So it should be no surprise that anesthesiologists are leading the pack in redesigning perioperative care.
Hospitals have tried to improve O.R. utilization by juggling surgical time blocks. But surgeries seldom back up because of problems in the O.R. The delay is usually downstream, all too often because of a lack of ICU space or a hospital bed.
“People get stuck in the recovery room because they can’t get a hospital bed,” Dr. Rathmell explained. “And because recovery is full, patients sit in the O.R., even when the surgery is completed. You can’t get the next case started because the hospital census is too high.”
One new solution: Schedule O.R. time based on ICU availability and hospital census. A 2 percent change in midweek scheduling at Massachusetts General Hospital produced a marked increase in O.R. throughput by minimizing delays that originated outside the O.R.s.
Vanderbilt University has taken the lead in redesigning surgical care from admission to discharge. Some anesthesiologists talk about the Perioperative Surgical Home model of care, but the real focus is creating and optimizing strategies to manage postoperative pain and symptoms, such as nausea and vomiting.
“It is early in the experience, but they have positive outcomes to share,” Dr. Rathmell said. “The data show that if you get an anesthesiologist involved early in pain and symptom control, starting in the pre-op clinic, you can maximize the likelihood that the patient will make a fuller, more functional recovery.”
Memorial Sloan Kettering Hospital, New York, has gone one step further. It built a new short-stay surgical center designed from the ground up to improve the efficiency of care. A patient checks into a room, goes to surgery, comes back to the same room for recovery and goes home just hours later.
“They are going to be doing cancer surgeries with 23-hour stays that have classically been two- and three-day admissions,” Dr. Rathmell said. “They had to think very carefully about what needs to happen in those 23 hours and where it can happen most efficiently and effectively.”
In addition to the Sunday seminar, there are several dozen posters exploring different aspects of health care redesign in different settings.
“This is the one place you can get a glimpse at the experiments that are going on in redesigning health care,” Dr. Rathmell said. “These are the first steps that are likely to change the way all of us practice in very short order.”
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