Presentation Transcript

1. How to set up Regional Anesthesia Service That improves Theatre Efficiency

   Prof. Krishna Boddu MBBS, MD (Anes), DNB, FANZCA, MMEd. Department of Anesthesiology & Pain Medicine University of Texas Health Sciences, Houston, Texas University of Western Australia, Perth, Australia Director, Regional Anaesthesia, Royal Perth Hospital, Perth, Australia Phone: +17138559971 (USA), +61416030020 (Australia) kboddu@yahoo.com www.nerveblocks.org
2. Our Mission Zero Suffering for 100% of our patients Is it possible?
3. Physicians Surgeons PT, OT, Wound Care RN Technicians, Theater Nurses, Ward Nurses, Registrars, Fellows Patients, Family Sharing The Same Goal & Vision By All Perioperative Physicians Hospital Management Midlevel Providers
4. What is Regional Anesthesia? It is one of the several modes of analgesia that might be superior but it is not the only mode of analgesia It is an extension of Acute Pain Service It provides better dynamic pain control, possibly decreases hospital stay, prevents development of chronic pain Generates more income than other modes of analgesia
5. 0 Setting up Regional Anesthesia Service is a “Project” & Every “Project Needs Planning” Any plan is better than no plan A reasonable plan is better than just any plan But a first rate plan with poor implementation Is not as good As a reasonable plan with first rate implementation! Implementation Is “Team Work” Project management Counseling
6. Improves Patients Satisfaction Provides Effective Dynamic Pain Control Least or No Adverse Effects Regional Anesthesia Provides Effective Pain Control As A Part of Multimodal Analgesia Adapt Techniques That…… Decrease DVT/ Pneumonia Early Return Of Bowel Function Facilitates Early Discharge More Direct & Indirect Incomes Prevents Chronic Pain Syndromes
7. Regional Anesthesia Service Models Expensive but Best Results Best for teaching (Not rushed) $ Generating Even for Follow Up Recognition For RA Service RA in separate dedicated area (RA Wing) RA in Induction Room (Ante room) Moderately Expensive Needs at least TWO providers Juggle two cases simultaneously Facility Fee split? RA in Theater as a part of Anesthesia Most Expensive with poor results Million Eyes Watching You & Surgeon breathing down your neck.
8. Which Regional Anesthesia model is best for your hospital? Based on workload & manpower In Operating Room : Only Specialist or Trainee In Induction Room : Specialist + Trainee/ CRNA Dedicated RA area : Dedicated RA team ------------------------------------------------------------------------ Based on number of cases per day Based on reimbursement structure Most of the Teaching Hospitals Should Have Dedicated Regional Anesthesia Team
9. OR/Theater Time Is Very Valuable If Surgeon & Anesthesiologist Are Not Working Simultaneously, OR Time Is Considered As “Non Productive” Time Anesthesia Time Productive When Surgical Team In Action Not Productive When Surgeon Is Sitting Doing Nothing while Paid. Examples: Pre Anesthesia Assessment IV Line Placement Nerve Blocks
10. Cost Savings By Conducting Blocks Outside OR
11. If Surgeon Is Breathing Down Your Neck,You Tend To Do Single Shot Nerve Block Single Shot Nerve Block Patient Very Comfortable Early Discharge from PACU Tired Surgical Resident Sleeping Block Wore Off & in Pain Frustrated Nurse Calls Primary Un-happy Resident Anesthesia- Surgery War !!!!
12. Poorly designed Regional Anesthesia leads to poor clinical care, resulting in poor clinical & financial outcomes
13. Dedicated RA Team Model Regional Anesthesia Team (Mobile Phones/ Pagers) APS Team Theater/ OR Team Board Runner Theater/ OR Scheduling Orderlies PACU Pharmacy PT/OT Over $650,000 investment by Hospital to save over $10,00,000
14. Man Power & Interest Survey Survey Your Department: For experience /comfort levels with various blocks, local anesthetics and catheter techniques How much your team is interested in introducing RA practice Their Educational Needs Identify core group of PARTNERS Gather Similar Information from Nursing & Technicians
15. Be Prepared To Answer The Question: Why Regional Anesthesia? From the Anesthesia standpoint From the Patient’s standpoint From the Surgeon’s standpoint From the Facilities standpoint From management standpoint From PACU standpoint From Physiotherapy/ Occupational Therapy standpoint
16. Challenge YourselfWhy Not Regional Anesthesia?&What are the limiting factors? Forethought / logistic coordination Proficiency/ thorough knowledge of anatomy/ drugs Need more manpower Would it be warranted by more revenues ?
17. Your “Trump Card” To ConvinceFor Regional Anesthesia Will Be… Regional Anesthesia Basically Removes Pain From Surgical Equation Any Method Of Pain Control That Reduces Adverse Effects/ Events Translates to Superior Method With Improved Outcomes
18. Hadzic et al. Results Pavlin et al.¹- 90 min. reduction in discharge time in RA vs GA pts. Pavlin et al.² showed max. pain score predicted recovery time, cumulative fentanyl predicted PONV Williams et al.³ – each nursing intervention assoc. w/ 27 to 45 min delay in discharge 1) Pavlin DJ, et al. AnesthAnalg 2002; 95:627-34 2) Pavlin DJ, et al. AnesthAnalg 1998; 87:816-26 3) Williams, BA et al. Best Pract Res ClinAnesthes 2002: 16: 175-94
19. Money Office Money Cow Any equipment you purchase is expected to be money generating
20. Be Prepared For Other common management questions: Why should we invest more money? Will it improve patient outcome? Will it decrease complications? Will it improve patient satisfaction? Will it improve the OR turn around time? Will it decrease hospital stay for the patient? Will insurance companies reimburse? The above are equivalents for generation of money
21. Create The Service Formally create a Regional Anesthesia Service Appoint leadership of the service START SLOWLY Gather all success stories & data for obtaining further support Realize success depends on a safe, efficient , and well coordinated service
22. Official inauguration of RA Service Invitees CEO or Health Minister Head of the Department Other Hospital Executives (CNO. CMO, COO, CFO etc) All department heads and all surgical consultants All charge nurses of every ward All OR/ theater staff (nurses, technicians, orderlies etc) Physical Therapy, Occupational Therapy, Pharmacy Also invite all key people from other hospitals in your town Make it a big deal. Make it as a Project for the Hospital not just yours
23. Ask Yourself Where ? Our Regional Anesthesia Real Estate
24. Educate the Masses Must establish educational programs for Anesthesiologists, R.N.’s, and Surgeons Patients need information too Communicate Identify block candidates ahead of time and prepare for them Know the Surgeon’s needs, likes & dislikes Close follow-up with patients an absolute must Regular meetings / discussions within your group
25. A SMALL TRUTH TO MAKE SUCCESS 100% A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Is Equal to 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Hard Work (H+A+R+D+W+O+R+K) 8+1+18+4+23+15+18+11 = 98% Knowledge (K+N+O+W+L+E+D+G+E) 11+14+15+23+12+5+4+7+5 = 96% Love (L+O+V+E) 12+15+22+5 = 54% Luck (L+U+C+K) 12+21+3+11 = 47%
26. Then what makes 100% ? Is it Money (M+O+N+E+Y) ? ... NO ! 3+15+14+5+25 = 72% Is it Leadership? NO ! (L+E+A+D+E+R+S+H+I+P)? 12+5+1+4+5+18+19+9+16 = 89% Every problem has a solution, only if we perhaps change our attitude. ATTITUDE A+T+T+I+T+U+D+E 1+20+20+9+20+21+4+5 = 100%
27. Thank You.