Anesthesia Consulting requests usually are from two types of need: those requesting an evaluation of the clinical quality for the anesthesia practice and those wanting assistance with the perioperative process improvement along with practice management of the department. Regardless of the reason for the anesthesia consultation the process starts out the same with an extended usually 3-4 days diagnostic visit. This fact gathering process involves a series of confidential, in-depth interviews with every discipline of professional and administrators who interacts with the anesthesia department. The list of individuals conversed with includes administrators, surgeons, nursing staff, members of the anesthesia department along with financial experts. Further information is obtained from reviews of correspondence, contracts, charts credentials files, department minutes, quality measures and other pertinent documents and observations of facilities, equipment and workflow. After these meetings there will be recommendations on a detailed “turnaround” plan in which the diagnostic team then incorporates local leadership into the ways to improve the department.
Anesthesia consults that are requested to evaluate the quality of their anesthesia departments in order to make sure it is up to standard. The reason for their asking is usually due to one or more sentinel event, questions about a specific provider’s capabilities, concerns that the current anesthesia staff fails to match up to the surgical demand and therefore having an adverse impact on quality. Preoperative preparation, promptness of first-case starting times, between case turnover times and afternoon add on cases are also common complaints to consultants. Another frequent reason for requesting anesthesia consultation is when the anesthesia department has lost the ability to communicate either within the department itself and/or with administration, the surgical and nursing staff.
Anesthesia consultants find a wide variety of reasons for poorly functioning perioperative services. Patient flow problems can begin at surgeon’s offices and continue through hospital admission processes and cause surgeons, anesthesia staff and nurses to accept abysmally poor morning starts resulting from chronic frustration with the ability to have patients properly prepared and available for surgery. Block scheduling, if not carefully established and monitored, can be a major source of inefficient OR operation. Poor operating room or anesthesiology department leadership can be a real impediment to efficient OR operations.
Anesthesia consultants do have the same information available to them as do their clients, but given their knowledge of clinical stands, unbiased position and experience in managing similar problems for other institutions, they can often be the key to reversing an anesthesia departments or operating room’s downward spiral.