Outpatient anesthesiologists are dedicated professionals committed to strong leadership and clinical expertise in the outpatient setting, and one of the most significant trends occurring within outpatient anesthesiology is the movement of procedures traditionally performed in hospital facilities into ambulatory surgery centers (ASC) and physician offices.Patients with a higher risk of complications who, historically, might have been deemed too risky for the outpatient setting now have access to safe, outpatient procedures. For instance, regional anesthesia under ultrasound guidance provides greater post-operative pain control and permits complex cases to be performed in an outpatient environment. Now, sleep apnea patients who run the risk of post-operative respiratory complications can have their procedures done in an outpatient environment and avoid general anesthesia while orthopedic procedures that were traditionally only done in hospitals, such as bone fractures, can now be performed safely. The use of regional anesthesia is especially important as more complex orthopedic cases move into the ASC setting. Peripheral nerve blocks especially are popular for orthopedic cases because they allow the provider to isolate and anesthetize a specific area in the arm or leg without putting the patient to sleep.
In addition to the use of complex regional anesthesia, outpatient anesthesiologists are also using multi-modal preemptive anesthesia, or the use of intravenous and oral medications, to reduce the need for post-operative narcotic pain relief and alleviate post-operative nausea and vomiting. Nausea and vomiting can be a major determination of patient satisfaction in a surgery center, as the patient will likely remember the post-operative recovery period better than the actual surgery. By using multi-modal preemptive anesthesia, anesthesiologists can help reduce recovery room time, decrease the risk of readmissions and reduce the patient’s risk of developing chronic pain conditions. There are also economic benefits to utilizing these modalities, including greater operating room throughput and faster discharge of patients. Therefore, ASCs on a budget should consider multi-modal preemptive anesthesia to prevent delays and clogged PACUs.
Because of the inherent differences between the hospital and outpatient setting, the specialization of the ASC environment gives anesthesiologists the chance to perform procedures more efficiently. The ASC environment doesn’t require the complex processes and equipment that are necessary in a hospital environment because of higher-acuity cases. Additionally, the advantages of the ambulatory environment appear to have an impact on both patients and surgeons. For one, outpatient anesthesiologists work in a smaller space with a smaller, more consistent group of staff, generally dealing with high volumes of the same procedures and developing criteria to make sure only appropriate patients are treated in the ASC. Also, smoother scheduling allows for faster turnover of cases, which is linked to improving patient and surgeon satisfaction.
Still, patients should be critical of accreditation achievements when choosing centers. Anesthesiologists should aim to work at accredited centers that follow the same standards as hospitals, in both credentialing and governance. Currently, anesthesiology practices are under greater pressure from accrediting bodies; new requirements from The Joint Commission in demonstrating ongoing professional provider evaluation are forcing anesthesiology practices to identify solutions to meeting these obligations and challenges. These solutions require leveraging informatics as well as human resources with specific content knowledge. This forces anesthesiologists to either invest themselves in building this infrastructure support or seek to affiliate with national physician-driven organizations that have the business scale to deliver these critical services. In fact, SAMBA (Society for Ambulatory Anesthesia) is working assiduously to define best practices, enhance patient safety, and establish independent thinking apart from a traditional, hospital-based focus.
With all the changes in the field, it is not surprising that outpatient anesthesia has gradually become a subspecialty within the profession, meaning more attention is paid to research, clinical best practices, and networking for anesthesiologists who work in ASCs. In the end, ASCs provide improved efficiency and fewer delays, without the presence of emergency procedures that can disrupt that daily flow in the surgical theatre.
