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Benchmark your facility’s anesthesia practices

Ambulatory Safety Monitor, October 6, 2005

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The results of the AAAHC Institute for Quality Improvement's (AAAHC Institute) fifth Knee Arthroscopy with Meniscectomy study measure clinical performance on key processes and outcomes of this procedure. It also helps past study participants to trend their performance data and use the information for quality improvement.

In particular, the anesthesia results of this study give insight into the financial implications and patient safety effect of this area of practice. Organizations that decreased their overall facility time (defined as the time between when the patient checks into the facility to when he or she is ready for discharge) attribute that success in part to tracking anesthesia time. Those involved in the study and other anesthesia experts say that simple techniques in this area can make a big difference in your outcomes.

Anesthesia results from the knee study
The AAAHC Institute chose to study knee arthroscopy with meniscectomy in part because it is a high-volume procedure. In 1996, almost 250,000 knee arthroscopies were performed; almost 96% of these were completed in the ambulatory setting, according to the National Center for Health Statistics.

Forty-one organizations, representing about 20,200 knee arthroscopies performed annually, provided data for 992 cases outlined in the study. The results included the following comparisons from 2003 data to 2004 data:

• Six of 11 repeat study participants decreased their preprocedure times.
• Five repeat participants decreased turnover time between cases.
• Seven repeat participants decreased discharge times.
• Five organizations decreased their overall facility time. One of those facilities attributes this success to
  1. tracking scheduled v. actual procedure time twice a year
  2. moving the cases along more quickly if the patient arrives early
  3. tracking anesthesia time
  4. adding another scope
  5. using standard packs
  6. tracking postoperative nausea and vomiting (PONV) and setting up a protocol with anesthesia providers so patients are more awake, have less nausea and vomiting, and are more ready for discharge postsurgery

What anesthesia components should my organization benchmark?
Looking at the AAAHC's benchmark measures provides instruction about what you should look at in your facility. For example, one organization that reported a relatively short preprocedure time partially credits anesthesia for that success. The center pointed to anesthesia efforts such as the following as explanation of why preprocedure time shortened:

• Faxing preadmission test results to the organization's preadmission testing coordinator so anesthesiologists can review them prior to surgery and order additional tests quickly if they find abnormal results
• Bringing the patient and his or her chart to the postanesthesia care unit (PACU), where nursing and anesthesia concurrently interview the patient, review the chart, and complete anesthesia consent

Naomi Kuznets, PhD, director of the AAAHC Institute, suggests asking these questions when you benchmark the anesthesia practices in your organization:

• Was additional treatment (drug reversal, resuscitation, etc.)/hospitalization necessary due to the anesthesia administered?
• How does the patient rate her or his level of pain control during the procedure?
• Is preprocedure time (defined as the time between when the patient arrives and when the patient is brought to the procedure room) lengthened because clinical staff aren't ready to administer anesthesia?
• What is the time between when the procedure ends and when the patient is ready for medical discharge?
• What anesthetics/sedatives are used and how much does the ambulatory surgery center (ASC) pay for them by the milligram or microgram?

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