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23 July 2014

The Cost of Human Error in the Operating Room

Every year, an estimated 15 million Americans suffer medical harm in hospitals. These errors can be dangerous to patients and also expensive; they cost the health care system $17.1 billion annually.

The most common cause is miscommunication between healthcare workers. Communication errors can be especially dangerous in the operating room; because of this, hospitals have a vested interest in improving communications among OR staff. However, they often turn to admonitions and behavioral sanctions, which are seldom effective.

Recently, some hospitals have looked to other high-risk industries for answers and best practices. Fields as different as aviation, nuclear power, and the military use Crew Resource Management (CRM) to improve communication and ultimately reduce errors and decrease costs.

CRM empowers each OR team member to identify and communicate potential patient harm and contribute equally to the solution. For example, an OR staff member at any level can voice his or her concern by calling a “time out” to immediately pause the surgery in order to discuss the concern or safety issue.

The elements of CRM include: 

  • Pre-procedure briefings 
  • Recognition and verbalization of safety-related red flags
  • Mandatory “time outs”
  • Collaborative creation of standards, procedures, and protocols
  • Empowerment of all team members
  • Immediate post-operative debriefs
  • Culture of continuous improvement

Our next post will examine the roadblocks to CRM and the benefits hospitals have experienced when implementing it. To learn more about reducing human error in the operating room, fill out this form to download our leadership brief.

16 July 2014

When Evaluating Your Hospital’s Partner, Ask These 4 Questions

For hospital leadership looking to partner with an outsourced anesthesia services group, our best advice is to make sure your goals are aligned with those of your potential partner. In the video below, the CEO and CMO of Jersey City Medical Center discuss four questions a hospital leader can ask to evaluate a potential partner:

  • What is my hospital’s mission? How will a partner help me achieve that mission?
  • Are the lines of communication open in both directions between my hospital’s leadership and the partner’s leadership?
  • Is my partner engaged with what I am trying to accomplish at my hospital?
  • Does my partner have a culture that is focused on safety, hospital efficiency, and quality care?

See their responses in this video:

Watch and read more testimonials from our hospital partners.

8 July 2014

Challenges of Leveraging Kaizen at a Hospital

Lean process methodologies were originally developed for manufacturing and industrial settings, so they may seem out of place in a hospital. But the principles behind lean processes are even more important in a clinical setting, where increased hospital efficiency can help manage risks and ultimately lead to better quality of patient care. Kaizen, which means “rapid improvement for the best” in Japanese, is one of these lean process methodologies. In an article for Beckers, Neonatology Chief Dr. Luiz Grajwer share his advice on how hospitals can use a Kaizen event and facilitator to address physicians’ hesitations.

“[Physicians] have our own language and our own way of communicating with each other, but we can be resistant to new terminology, which is why Kaizen presents a very real challenge to leverage in a hospital setting. Kaizen is rooted in the business world, which has its own lexicon and can seem like learning a different language.

However, once Kaizen is explained to physicians in terms they understand, these leaders can begin to see multiple solutions to the challenge at hand. Physicians who are familiar with the Kaizen event's goals can function as a bridge for all individuals involved in the process. In this way, he or she can create the environment that allows for visualization and analysis of the issues and support a culture that permits open communication, respect for all team members with the common goal of improvement, and value for all. This is why a Kaizen facilitator is another necessary member of any event. Interdepartmental communication is often a sticking point at many hospitals, but Kaizen integrates different sectors of the hospital, breaking down communication silos and setting aside traditional barriers that can prevent teams from finding ways to more effectively assist patients.”

For more information, read the full Becker’s article or contact us.

3 July 2014

Legendary Leaders Meet at HFMA

Strong leaders make a huge difference to a hospital or ASC because they provide clinical team members a set of goals and the tools to achieve them. Who better to make that point than two of America’s greatest leaders – George Washington and Abraham Lincoln?

From June 22 – 24, we attended the Healthcare Financial Management Association (HFMA) National Institute conference in Las Vegas to discuss the importance of effective clinical leadership with hospital financial executives. At our exhibit, we shared leadership trivia and Sheridan insights with attendees. Washington and Lincoln hosted our visitors, posed for photos and discussed leadership.

At the conference, attendees were interested to learn about Sheridan’s outsourced health services, including anesthesia department management, and how we ultimately improve our clients’ bottom lines by helping to reduce costs, improve hospital efficiency, and increase quality of patient care.

Did you get your photo taken with Abe and George? Flip through our event photos and find yourself!

23 June 2014

Kaizen in the Emergency Department: St. Mary’s Medical Center

What happens when ED patients experience long wait times to see a doctor and have to spend hours in the hospital? St. Mary’s Medical Center faced this issue in 2013. The hospital brought us in to help improve its emergency department’s workflow as well as communication between different ED staff members.

Over a 2-day Kaizen event, we worked with a 20-person team to increase patient satisfaction and reducescores at St. Mary’s. Our Kaizen team was led by a physician and included two RNs, members of the IT department and individuals from LAB and C/T. We identified and removed the critical constraints that were increasing length of stay for patients, and installed effective process tracking as an ongoing “plan-do-check-adjust” cycle, a 4-step management tool to monitor process improvement.

Today, this hospital is one of our highest-performing clients.

18 June 2014

Customized Pre-Admission Testing Helps Hospitals Allocate Resources

Each patient who comes through a surgery center is unique, with his or her own medical history and set of needs. But for a long time, hospitals used the same standardized pre-admission testing process, subjecting patients to unnecessary tests and resulting in higher costs. To combat this issue and increase hospital cost savings and efficiency for our clients, we researched best practices and developed ClearPATh, a proprietary pre-admission testing program that considers multiple factors and streamlines the testing process to reduce cancellations.

A Patient-Centric Approach
ClearPATh considers each patient’s medical history and takes a patient-centric approach to preadmission testing. The program includes guidelines and algorithms based on high-, medium- and low-risk procedures, as well as patients’ comorbidities. The same surgeon performing the same surgery on two different patients may order different tests based on the patients themselves.

For example, two patients may be having knee surgery. One, an otherwise healthy male in his mid-50s who exercises routinely, with no medical problems, no medications and no comorbidities who is having the surgery due to an athletic injury would most likely undergo basic blood work as a low-risk patient. The other patient, also in his mid-50s, with diabetes, high blood pressure, obesity, sleep apnea, multiple medications or a cardiac stent, would be considered high risk and need a cardiac evaluation, EKG, more blood work and blood glucose testing.

Testing in Advance
ClearPATh also stresses pre-admission testing before the day of the procedure. This allows the surgeon and anesthesiologist to review and coordinate prior to the procedure so that resources can be allocated properly. The patient and family will know whether or not to take time off work for that day. This reduces the incidence of same-day cancellations and increases satisfaction and ensures that the OR is booked accordingly.

We are in the process of bringing ClearPATh to all our anesthesiology programs.

13 June 2014

From CNN Health: 5 Questions to Ask Before Surgery

When preparing for surgery, patients may be anxious about many factors: the anesthesia process, the recovery time, or the success of the procedure itself. While many people reference the Internet as a guide, doctors and nurses are the best resources for detailed information about a specific case.


In an article on CNN Health, our Anesthesia Division’s Director of National Education, Dr. Adam Blomberg, shares his top 5 questions that patients should ask prior to surgery.

5 Questions to Ask Before Surgery

  1. Do I have to have this surgery? Find out if your surgery is medically necessary, what the alternatives are, and what the risks and benefits associated with each option are.
  2. Where is the surgery being done, and what is the facility's experience with this type of procedure? Look at the experience and expertise of the surgeon, staff and hospital – do they have established experience with your particular type of surgery?
  3. How do I prepare for my procedure – both physically and mentally? Ask if you need any testing beforehand, or if you need to make any changes to your medication, eating, or drinking before the procedure. Also, you need to prepare your family or friends because chances are you'll need their assistance when you come home. Be sure to have caregivers ready to help you.
  4. What are my anesthesia options? Some surgeries require a specific type of anesthesia, but you may have options. Talk to your doctor about the different types of anesthesia. If you do have the option to choose what kind to have, make sure you understand ahead of time what the risks and benefits are.
  5. What will my recovery be like? For some surgeries, reactions such as pain or nausea may be common. Learn what your expected recovery time frame will be like and what you can do to alleviate these symptoms.

Read the full article on CNN.com.

27 May 2014

ClearPATh: Our Quest to Maximize Operating Room Efficiency

Surgeries can account for 60 percent of a hospital’s revenue, and same day case cancellations and delays significantly eat into the bottom line as unused operating rooms cost hospitals upwards of $80 per minute. We realize that coordinated pre-admission testing procedures are key to reducing these problems and increasing hospital efficiency, so a team of Sheridan anesthesiology leaders collaborated in a year-long process to develop ClearPATh as a solution.

ClearPATh helps to verify surgical readiness, schedule only necessary pre-operative visits, communicate proper patient instructions for same day surgery and ensure that all proper, relevant tests are completed. In the past, surgeons would order as many tests as possible prior to surgery, with the idea that if the anesthesiologist had all that information, the case would not be cancelled. However, evidence shows that unnecessary testing increases costs, particularly for insurance companies, and increases patient dissatisfaction. Patients not only have to travel to several locations for tests but can be denied surgery due to false positives, which happen in otherwise healthy patients.

“When the ClearPATh system is implemented within a hospital’s perioperative process, surgeon satisfaction significantly improves,” explained Dr. Adam Blomberg, vice chief of anesthesiology for Memorial Regional Hospital in Hollywood, Fla. “More of a surgeon’s procedures actually take place when they are scheduled and they start on time, all due to careful planning and preparation before the patient even enters the operating room.”

We began introducing ClearPATh as part of our outsourced anesthesia services in late 2013, and it has already decreased same day cancellations, increased on-time starts and maximized operating room efficiency. In particular, one hospital has already decreased cancellation rates from 8.7 percent to 3.3 percent since ClearPATh’s introduction.

We are rolling out the ClearPATh methodology to each of our anesthesiology programs. To learn more about Sheridan anesthesia, visit this page.

22 May 2014

Strategies to Increase Efficiency and Patient Satisfaction in the ED

Hospital leaders in the emergency department juggle many elements to improve patient care, including capacity, length of stay, patient wait times, and left before being seen scores. It can be easy to identify a problem when one of these areas doesn’t run smoothly, but it can be more difficult to find the solution and pinpoint the specific adjustments needed to increase hospital efficiency and patient satisfaction scores.

We have several proven strategies in place to improve customer service in our clients’ emergency departments. These strategies include:

Chart Audits and Case Reviews – To monitor and evaluate the quality of care provided by physicians and mid-level providers in the ED, Sheridan provides chart audits on all mortalities, 72-hour returns requiring admission and high-risk presentations. Additionally, chart reviews are performed for cases in which a complaint has been filed or cases requested by the facility.

Ancillary Services Utilization – In order to maintain efficient and effective use of resources, Sheridan monitors hospital data on utilization of ancillary services to discover best practices and opportunities for improvement.

EMS Programs – As part of our community outreach programs, our Medical Directors participate in EMS outreach programs to foster communications and relationships with EMS units servicing our client hospital. The EMS outreach program may include:

  • Contact with EMS through site visits to EMS stations
  • Physician ride-alongs
  • Educational in-services for paramedics
  • Feedback to paramedics regarding patient outcomes

Want to learn more? Visit our "Emergency Medical Solutions" page.