Anesthesiology

Sheridan Healthcare has been supplying anesthesia services to hospitals and ambulatory surgery centers for nearly 60 years. We are more experienced than any other anesthesia provider in the country, and we’ve retained our first clients since 1953.

We work toward increasing the use of operating rooms and reducing overall hospital expenses. Access to an operating room is facilitated through better capacity management, efficient turnover, availability of coverage and improved on-time starts. Often, increased OR volumes, coupled with the collaborative working relationships our teams foster, result in the highest approval ratings from surgeons and hospital administrators.

Our locally based teams are comprised of full-time, board-certified or board-eligible anesthesiologists, CRNAs and AAs (anesthesiologist assistants). Learn more about our anesthsia management services.

Read our anesthesiology-related posts:

17 January2017

Study Identifies Risk Factors for Congenital Heart Disease in Infants

A study in the Canadian Medical Association Journal identified the chronic conditions that may predispose women to give birth to infants with congenital heart disease, also known as congenital heart defects or CHD.

The study reviewed the Taiwan Maternal and Child Health Database’s records of 1,387,650 live births from 2004 to 2010. The researchers investigated three data sets including:

  • Birth Registrations data on the sociodemographic characteristics of live births
  • Birth Notifications data on prenatal care and the lifestyles of pregnant women
  • Medical claims data from Taiwan’s National Health Insurance program

The researchers found that several maternal chronic diseases were associated with higher rates of CHD in babies. These conditions include type 1 and type 2 diabetes, hypertension, CHD, anemia, connective tissue disorders, epilepsy and mood disorders. Pregnant women who are identified as at risk can receive preconception counselling and developing fetuses can be more closely screened for CHD via fetal echocardiography. Early recognition of CHD can additionally help clinicians optimize the care of both women and infants.

That said, there are some limitations to the study. The detection period for the study was restricted to the first year of life. Potential cases of CHD may have developed in later years; however, under-identification should be minimal, given the high frequency of prenatal care and health checkups for infants under National Health Insurance coverage. Additionally, researchers noted that maternal lifestyle factors, including smoking and alcohol consumption, were likely to be underreported in the Birth Notifications data set.

About CHD

CHD affects nearly 1 percent of births per year in the United States and is a leading cause of birth defect-associated infant illness and death, according to the CDC. About 25 percent of babies with CHD have a critical CHD and generally require surgery or other procedures in their first year of life.

Although a few states track CHD among newborns and young children, no tracking system exists for older children and adults with heart defects. A study published last July estimates that approximately 2.4 million people – including 1.4 million adults and one million children – were living with CHD in the U.S. in 2010. Nearly 300,000 of those individuals had severe CHD.

Research projects like the review published in the CMAJ continue to improve care for people affected by CHD. Improved counseling and screening procedures for CHD have the potential to both reduce the prevalence of CHD and its resulting fatalities.

5 January2017

Our 10 Most Popular Blog Posts of 2016

The most-read posts on the Sheridan blog in 2016 focused on key topics – ranging from the challenges involved in the transition to value-based care and this country’s physician burnout epidemic to exciting technology innovations and trends in clinical practice.

The 10 most popular posts from the past year are:

  1. How to Manage the Burdens of Change on Physicians and Health Care Practitioners, a summary of Chief Quality Officer Dr. Gerald Maccioli’s presentation at the 2016 Health:Further Summit about the overwhelming burdens on providers created by current and planned changes to the U.S. health care landscape and strategies for managing them.

  2. Sheridan’s 2016 Leadership Conference Recognizes Eight Outstanding Clinical Leaders: Dr. Mike Adkins, Anesthesia Services Chief of the Year; Dr. Joseph Toscano, Emergency Medicine Chief of the Year; Dr. Frank Seidelmann, Radiology Chief of the Year; Dr. Mitchell Stern, Women’s and Children’s Chief of the Year; Dr. Adam Blomberg, Diamond Award Winner; Cindy Houck, CRNA, Platinum Award Winner; Dr. Gary Gomez, Innovation Award Winner; and Dr. Jonathan Katz, Innovation Award Winner.

  3. Six Physician Communication Strategies to Increase Patient Engagement and Improve Outcomes, including encouraging patients to talk about psychosocial factors that might be related to their conditions, tailoring communications to each patient based on his/her culture, values and beliefs to avoid inadvertent offense or mistrust, educating patients on care best practices and about responsible antibiotic stewardship, providing compassionate, personalized care and reassurance, and providing online information resources to educate patients and set appropriate expectations.

  4. Technology Innovations That Will Transform the Future of Radiology, including the groundbreaking work of the IBM Watson Health medical imaging collaborative, in which Sheridan and its chief of teleradiology, Dr. Glenn Kaplan, are playing a key role.

  5. Five Medical Practices That Soon May Be Outdated, including hospitals advising doctors not to apologize, prescription labels that don’t include what condition the drug is treating, monitoring handwashing by hospital staff, doctors spending more time on paperwork than on patient care, and making it difficult for patients to get their medical records quickly.

  6. The AMA’s New Tools to Ease MACRA Transition for Physicians, including the MACRA Assessment (aka Payment Model Evaluator), new MACRA-focused modules in the AMA STEPS Forward interactive, online practice transformation series, and the Inside Medicare’s New Payment System ReachMD podcast series.

  7. The Physician Burnout Epidemic, Part 1: Root Causes of This Alarming Trend, which looked at the factors fueling the increase in U.S. physician burnout. Part 2 offered strategies physician leaders can use to help combat burnout.

  8. Career Advice from Sheridan’s Chief Medical Officer for Radiology Services, Dr. Frank Seidelmann, including being proactive in managing your career, embracing technology and investing in your professional development and of the physicians you lead. 

  9. How Video Laryngoscopy Is Shaping the Future of Anesthesiology, which highlighted a discussion by Regional Medical Director Dr. Joseph Loskove, Chief Quality Officer Dr. Gerald Maccioli and National Education Director, Anesthesiology Division, Dr. Adam Blomberg in their Anesthesia News article, The Shift Toward Video Laryngoscopy: The Good, the Bad, and the Future.

  10. Pain Management Boosts Patient Satisfaction, which addressed the significant impact of addressing patients’ and caregivers’ concerns and setting their expectations appropriately – as well as treating patients’ physical pain – on their satisfaction with their pain management and overall care. 

22 December2016

Putting Patients at the Center of the Perioperative Period

Dr. Adam Blomberg, Sheridan’s National Education Director, Anesthesiology Division, is a strong proponent of putting patients at the center of the entire perioperative period rather than just during preoperative testing. That’s the focus of a new program, TEMPO, that Sheridan has just begun to roll out formally at two partner facilities. 

TEMPO evolved from Sheridan’s proprietary ClearPATh preadmission testing (PAT) framework, which significantly streamlined the PAT process by increasing efficiency and freeing up other operating room (OR) resources. This framework has helped Sheridan anesthesiologists reduce or eliminate unnecessary testing, consultations and preoperative visits and given them the tools to coordinate all the aspects of patient care they touch. ClearPATh has made PAT patient-centric rather than a cookie cutter testing approach. It has also shortened wait times and reduced same-day cancellations – a win-win-win for hospitals, physicians and patients. 

The new TEMPO framework, which builds on the success of ClearPATh, gives anesthesiologists the tools to take ownership of the entire perioperative period, rather than just preoperative testing. Dr. Blomberg explained that TEMPO is named for the “coordinated rhythmic movement” that the new framework is designed to orchestrate to further increase efficiency, reduce delays and improve patient satisfaction throughout the perioperative period. Speaking with Megan Wood of Becker’s Spine Review, Dr. Blomberg said, "It's a coordinated effort when a patient goes to surgery and there should be a rhythm to it; it should not be sporadic."

For example, postoperative nausea is a common patient complaint. The TEMPO framework gives Sheridan anesthesiologists streamlined, readily accessible guidelines for postop nausea management as well as other aspects of postoperative pain management, including ERAS (enhanced recovery after surgery) programs. Sheridan is also preparing to pilot preoperative pharmacogenetic testing next year that will help anesthesiologists tailor medications based on patients’ genetic data. This will not only minimize negative drug reactions but also help identify patients with a predisposition to narcotic addiction. For these patients, Sheridan anesthesiologists can find pathways for treatment using no or limited opioids during the perioperative period.

"If you have standardized care with evidence-based medicine practices, you're going to improve outcomes," Dr. Blomberg explained.
 
To learn more about how Sheridan is using TEMPO to put patients at the center of perioperative care, read excerpts of Dr. Blomberg’s interview in Becker’s Spine Review article, “Centering the perioperative period around the patient.”
 

21 December2016

Sublingual Sufentanil Safe and Effective for Controlling Postoperative Pain

A recent postoperative pain study sponsored by AcelRx Pharmaceuticals has demonstrated the safety and efficacy of sublingual sufentanil for controlling moderate to severe acute postoperative pain. AcelRx has an Investigational New Drug (IND) application with the U.S. Food and Drug Administration (FDA) to prove that sublingual sufentanil mini tablets are safe and efficacious in the treatment of moderate to severe acute postoperative pain. The sponsor approached Sheridan Clinical Research in April, 2016 about participating in this multicenter, randomized study of its 30-mcg sublingual sufentanil tablet, which must be administered by a healthcare professional. Sheridan anesthesiologist Juan Restrepo, MD, who had participated previously in a study of patient-controlled, 15-mcg sublingual sufentanil, was the Principal Investigator for the location research conducted at Boca Raton Regional Hospital. For this study, Dr. Restrepo followed a randomized group of patients who had a procedure with general or spinal anesthesia and who needed to remain at the hospital for at least 12 hours afterward.

Sublingual sufentanil adheres to the sublingual mucosa within seconds of administration. Due to its very small size, it causes minimal taste and saliva response, minimizing the amount of swallowed drug. The 30-mcg sublingual sufentanil tablet is in Phase III development. Per an Anesthesiology News article, the tablet is being developed in collaboration with the Department of Defense, which hopes to use it to treat moderate to severe acute pain in settings such as battlefield trauma, emergency medicine and ambulatory surgery.

Pamela Palmer, MD, PhD, chief medical officer and co-founder of AcelRx Pharmaceuticals, said in the article that results from the multicenter study suggest that 30-mg tablets are “efficacious and well tolerated across a variety of ambulatory surgery procedures for the management of moderate to severe acute postoperative pain.” She continued, “Patient comfort and satisfaction postoperatively and time to discharge are critical end points, and sublingual sufentanil appears to address both of these. Sufentanil’s prompt absorption into the central nervous system and lack of active metabolites scientifically support such desirable outcomes.”

 

 

Juan Restrepo, MD

15 December2016

U.S. Surgeon General Calls for Action on the Opioid Crisis

Opioid abuse remains a devastating public health concern, and the health care community has grappled with its role in the crisis and medical professionals’ responsibility to patients struggling with substance use. U.S. Surgeon General Vivek Murthy has responded with a report released last month analyzing the current opioid crisis and providing several recommendations for treating and preventing substance use disorders. These recommendations include:

1. Eliminate stigma

Misconceptions and negative judgments about people with substance use disorder abound, and the report stresses that even medical professionals are not immune to seeing addiction as a “moral failing or character flaw.” Murthy’s report states that substance use disorder is a medical problem, and that as such doctors should lead a cultural shift in thought through advocating for medicine and counseling treatment for affected patients.  

2. Provide effective screening

Along with its goal of changing societal perceptions of addiction, the report calls for changing the health care system’s process for identifying substance use disorder. Effective screening must occur in general health settings, including primary, psychiatric, and emergency care centers. With this change, physicians can identify affected patients earlier and create individual treatment plans for them.

3. Make use of medication

One of the many misconceptions about the opioid crisis is the assumed futility of medical treatment – it is essentially seen as “substituting one substance for another,” so abstinence is believed to be the best treatment plan. Murthy’s report extensively disputes this belief, asserting that using approved medicines within a broader behavioral therapy plan can help treat substance use disorder.

4. Involve an integrated medical team

Ultimately, Murphy’s report declares that effective substance use treatment plans must involve an integrated team of social workers, recovery specialists, nutritionists, and other caregivers. As with programs designed for diabetes or cancer treatment, all aspects of the affected patient’s life must be considered to address and treat the disorder.

Programs to Aid in the Fight Against the Opioid Crisis

Many patients first encounter opioids during the surgical period. As the nation’s largest anesthesia provider, Sheridan is piloting several initiatives aimed at combating the opioid crisis by reducing the opportunity for exposure. 

  • Sheridan anesthesiologists and their surgical colleagues are piloting ERAS (enhanced recovery after surgery) programs, using a combination of non-steroidal anti-inflammatory agents and specialized regional nerve blocks with local anesthetics to optimize recovery and minimize narcotics use. 
  • We are also preparing to pilot pre-operative pharmacogenetic testing next year. Not only will this testing help anesthesiologists tailor medication based on a patient’s genetic data, thereby minimizing negative drug reactions, but it will also help identify patients predisposed to narcotic addiction. For these patients, Sheridan physicians can find pathways for treatment using limited to no opioids during the perioperative period. 

Our goal is to gather and share data on the effectiveness of these programs to help enrich the health care community’s efforts to stop the opioid crisis. 

14 December2016

Using Icon-based Transport Labels to Cut Blood Product Waste and Save Money

Even simple, inexpensive changes can have a big impact on solving challenging problems. A great example is the University of Florida (UF) College of Medicine successful initiative that dramatically reduced blood product waste and saved the hospital nearly $20,000 in five months, just by replacing text-heavy instruction labels for blood transport coolers with intuitive, icon-based labels.

A multidisciplinary committee comprising blood bank staff, anesthesiology staff and operating room managers determined that a significant cause of operating room blood product waste was units that were stored and/or returned outside the required temperature range established by the American Association of Blood Banks (AABB), according to the abstract of a presentation at the 2016 annual meeting of the International Anesthesia Research Society (IARS). The committee was inspired by a Mayo Clinic study of a blood transport and storage initiative that significantly reduced median monthly red blood cell and fresh-frozen plasma waste and saved approximately $9,000 per month after replacing existing storage coolers and improving the educational cooler label. The UF College of Medicine committee decided to start small by testing the impact simply changing the label. 

According to a recent Anesthesiology News article. Ashley Screws, M.D., an anesthesiologist at the UF College of Medicine and UF Health Shands Hospital in Gainesville, Florida, worked with her team on the visual, icon-driven label design to replace the previous text-heavy label that was often ignored. The new labels were implemented hospital-wide in September 2015.

A $20K Savings In Just Five Months

Dr. Screws and co-investigators, Jeffrey White, M.D., and J. Peter R. Pelletier, M.D., compared data for blood product waste collected during October/November 2014 with data for blood product waste collected during October/November 2015. During October/November 2014, 235 product units were marked for waste, 25.5 percent of which were returned to the blood bank outside of regulation temperature range, and the total calculated cost of this waste was $9,167, per the abstract ($8,717, according to the Anesthesiology News article). During October/November 2015, after the new transport cooler labels were implemented, only 149 blood product units were wasted and only 10.7 percent of those were returned outside of temperature range, a $3,178 total calculated waste cost – a $6000 ($5,500) year-over-year (YOY) savings for those two months. The number of lost platelet units, the most expensive of the blood products, decreased from six units during October/November 2014 to only two platelet units during October/November 2015.

During the presentation, Dr. Screws reported the researchers also compared blood product waste collected December 2014–February 2015 with waste collected December 2015–February 2016, according to the article. During December 2014–February 2015, 99 product units were marked for waste, of which 34 percent were returned to the blood bank outside of regulation temperature range – a total calculated waste cost of $21,987 for the quarter. During December 2015–February 2016, only 32 blood product units were wasted, of which only 11 (34 percent) were returned outside of regulation temperature range at a total calculated waste cost of $8,155 versus the same period the prior year – a savings of nearly $14,000. Including the $6,000 savings during October-November 2015, that’s a $20,000 YOY savings over five months, even though large transport coolers in which massive transfusion protocol blood products are dispensed did not have the new labels until December 2015. 

The hospital plans to build on this success by creating new labeled bags for platelet transport to prevent them from being placed inside coolers improperly and an electronic medical record reminder to encourage proper and timely blood product return.

13 December2016

Five Key Strategies for Driving Change in the OR

Now more than ever, hospitals and ambulatory surgery centers are seeking anesthesia partners capable of driving positive change in their operating rooms. However, for many anesthesia providers, there are hurdles that must be overcome before such change can be realized.

Anesthesia groups of any size, regardless of their financial strength, can employ proven strategies to ensure the success of facility-wide patient care improvement initiatives. Here are five such strategies that Dr. Adam Blomberg, Sheridan’s national education director, has found to be effective.

Collaborate with nursing and surgeons on incremental steps toward larger improvements

Securing the buy-in of nursing and surgical staff is crucial for ensuring that improvements are universally adopted. Regular status meetings and Kaizen lean process improvement events are examples of methods used for promoting collaboration among all stakeholders in the OR.

Break down the silos

Collaboration is only possible when individuals involved in improvement activities are able to communicate freely across departmental boundaries. Traditionally, the hierarchical structure of the operating room inhibits the flow of information upward. By establishing relationships early on, it is possible to avoid the political turmoil that hampers most improvement efforts.

Work with the C-suite to form a collaborative governance structure

Once key stakeholders have been brought into the fold, the structure and operations of the core improvement team need to be formalized. Often, this will require a significant investment in resources and time; however, the return on such investments usually outweigh upfront costs. Clearly communicating the proposed benefits of the program will help to ease any uncertainty on the part of administrators.

Practice evidence-based medicine

No amount of investment in time and resources can make up for variability in the provision of anesthesia. This is why it is imperative to standardize processes early on and in accordance with evidence-based best practices. Collaboration with other local anesthesia groups can facilitate this process through the sharing of best practices; however, it is ultimately up to anesthesiologists, CRNAs and AAs to determine which practices fit the unique cultural and financial requirements of their facility.

Develop sound preadmission testing guidelines

One of the most significant challenges anesthesiologists, CRNAs and AAs face today is addressing the inconsistencies associated with a variable preadmission testing process. Overcoming this obstacle is no easy feat, given that surgeons’ ordering patterns often reflect years of deeply engrained practices. However, by slowly introducing standards in collaboration with local surgeons, anesthesia staff can realize significant returns almost immediately through fewer canceled cases and greater OR efficiency.

As clinical outcomes begin to take center stage under MACRA, anesthesia providers will be increasingly called upon to address the myriad of challenges facing surgical service lines at facilities across the United States. Confronting the root cause of these problems will require close collaboration among surgical, nursing and anesthesia staff, as well as the buy-in of administration. Learn how our anesthesia leaders have used collaboration and expertise to support higher quality patient care and improved stakeholder satisfaction.

6 December2016

ANESTHESIOLOGY 2016 Presenters Included 16 Sheridan Thought Leaders

The American Society of Anesthesiologists (ASA) annual meeting has been the world’s most comprehensive anesthesia-related educational event for the past 66 years. ANESTHESIOLOGY 2016, held October 22-26 in Chicago, Illinois, attracted more than 15,000 anesthesia professionals from more than 90 countries, including physician anesthesiologists, nurse anesthetists, anesthesiologist assistants, respiratory therapists and pharmacists. Attendees participated in their choice of more than 600 educational sessions spanning 12 clinical tracks. The more than 100 world-class presenters, anesthesiology thought leaders, included 16 Sheridan physicians.

Eight Sheridan physicians and physician leaders presented nine of the topical educational sessions:

Gerald Maccioli, M.D., M.B.A., F.C.C.M
Chief Quality Officer, Sheridan Healthcare
The Role of Critical Care Anesthesiology in the Perioperative Surgical Home

Jay Epstein, M.D.
State Issues Forum

Adam Blomberg, M.D.,
National Education Director, Anesthesiology Division, Sheridan Healthcare
Town vs. Gown is a Dated Concept: The Academic/Private Hybrid Model of Perioperative Care II

Asha Padmanabhan, M.B.
Chief, Department of Anesthesiology, Plantation General Hospital, Plantation, FL
Leadership in Private Practice

Patrick Ziemann-Gimmel, M.D.
Program Chair. Flagler Hospital, St. Augustine, FL
Welcome and Introduction at ISPCOP Symposium

Stephen Grice, M.D.
Anesthesiologist, Department of Anesthesiology, Northside Hospital, Atlanta, GA 
High Risk for the Non-Obstetric Anesthesiologist

Leopoldo V. Rodriguez, M.D., F.A.A.P. 
Co-Chair, Ambulatory Anesthesiology Quality Committee, Sheridan Healthcare
Hanging Tough on Ambulatory Patient Selection

Kishor Gandhi, M.D., M.P.H., C.P.E. 
Anesthesiologist, University Medical Center of Princeton, Plainsboro, NJ
Disaster in the Office 
Anesthesia for Shoulder Surgery; Continuous Catheter Versus Single-shot Block: Do We Have the Silver Bullet?

 A range of medically challenging cases were presented by eight other Sheridan anesthesiology thought leaders:

  • Michael Adeleye, M.D., Pediatric Anesthesiologist, Plantation General Hospital, Plantation, FL
  • Raul Cruz, M.D., Vice-Chief, Department of Anesthesiology, Kendall Regional Medical Center, Miami, FL
  • Mike DiMeola, M.D.
  • Jeff Huang, M.D., Director of Research Council of Department of Anesthesiology, Associate Director of Research of Department of OB/GYN, Arnold Palmer Medical Center, Orlando, FL
  • Javier Lopez, M.D., Chairman, Department of Anesthesiology, Kendall Regional Medical Center, Miami, FL
  • Isabelle Jean-Pierre, M.D., Director of Neuroanesthesia Rotation, Kendall Regional Medical Center, Miami, FL
  • Nick Nedeff, M.D., Medical Director, Graduate Medical Education and Director, Immersive and Simulation-Based Learning, Sheridan Healthcare
  • David Riesco, M.D., C.H.S.E., Director, Trauma Anesthesia, Kendall Regional Medical Center, Miami, FL

The cases they presented included intraoperative use of Heliox in acute upper airway obstruction; venous air embolism during emergency craniotomy; airway management in a patient with osteogenesis imperfecta; airway management of a patient with Ludwig's angina; adult epiglottitis; 3-year-old boy with neurofibromatosis and sublingual abscess; pediatric facial burns; seizures following spinal for Cesarean section; and complicated removal of adductor canal catheter following knee arthroplasty.

3 November2016

Sheridan CRNA Jobina Ruiz Featured on AANA Journal’s October Cover

Sheridan is proud that the cover of the AANA Journal’s October issue features a photo of Sheridan Certified Registered Nurse Anesthetist (CRNA) Jobina Ruiz setting up for an obstetric fistula repair surgery in Rwanda. Ruiz participated in a global anesthesia immersion experience in Rwanda with the International Organization for Women and Development (IOWD) at the beginning of this year, when she was a student registered nurse anesthetist at Northeastern University. The IOWD is a non-profit organization that, among other things, provides free treatment and care to Rwandan patients suffering from obstetric fistulae, gynecologic and pelvic floor disorders. Ruiz, who was invited to participate in the mission at the invitation of her instructor, made the trip at her own expense.

Her 16 days in Rwanda with the IOWD was a valuable and eye-opening experience. For the first few days, she worked with the gynecological surgical team on general anesthesia cases and had the opportunity to watch those patients over an extended period of time. For the rest of her stay, she worked primarily on less invasive fistula repair cases and cystoscopies under epidural and spinal anesthesia. 

Working with the IOWD volunteers and local clinicians in Rwanda was both challenging and exciting. It provided Ruiz with many new learning opportunities, for example, administering anesthesia drugs such as halothane and sodium thiopental that are no longer used in the United States. Language barriers sometimes made communication challenging, and learning about the cultural differences between Africa and the U.S. was fascinating but also could be frustrating, such as the local cultural bias against using extreme measures to save the lives of critically ill neonates. But Ruiz fell in love with Africa and the people she met there – especially the women whose pain she helped manage during obstetric fistula repair surgeries. 

 

Jobina Ruiz draws blood from a Rwandan woman’s anti cubical vein as an anesthesiologist places an epidural to administer a blood patch

Fistula, a hole in the wall between a woman’s bladder and vagina, is a terrible condition found in women who have experienced a prolonged and obstructed labor without medical assistance, or sometimes as a result of injury to the bladder during a difficult surgery. This hole causes constant urine leakage. If the rectal wall is also affected, the woman also has no control over her feces. Ruiz learned that Rwandan women with untreated obstetric fistula are ostracized by their husbands and shamed by society, becoming social outcasts.

These women were incredibly grateful for the help of the surgical team volunteers, looking at them with eyes filled with hope and saying in their native language, “You’re going to fix me!” Ruiz said she’s equally thankful for having had the opportunity to meet and help them. “I helped these women,” she explained, “but in return they taught and helped me so much more! I am a better person because of them and this experience, and I am extremely grateful I was able to go.” She also appreciates the experience of having to make do with very limited supplies, equipment and drugs: “It taught me what I’m capable of.” Ruiz, who is well traveled, said she is anxious to return to Rwanda, next time with her husband.

She joined Sheridan in early September, immediately after passing her CRNA exam, and works at Memorial Regional Hospital in Hollywood, Florida. Prior to returning to school to earn her graduate degree and CRNA certification, she worked as a critical care registered nurse at the Mayo Clinic in Scottsdale, Arizona and NYU Langone Medical Center, Beth Israel Medical Center, New York-Presbyterian Hospital and Midtown Surgery Center in Manhattan, New York.

She hit the ground running at Memorial Regional, becoming a preceptor for nursing students after just two weeks. Her favorite thing about being a Sheridan CRNA is the strong sense of community. “It’s like being welcomed into a family.”

24 October2016

Using CRM and Time-Outs to Focus Hurried OR Teams on Patient Safety

The shift to value-based care and the imminent implementation of MACRA have made efficiency healthcare’s new mantra, and U.S. hospitals and healthcare systems have made operating rooms a high-priority target for optimization. ORs in U.S. hospitals generate about 70% of a hospital’s revenues and operate at a staffed-capacity utilization of 60-70% and OR time costs roughly $80 an hour, so it’s not surprising that metrics like on-time starts, turnover times, same-day cancellations and OR under- and overutilization are under scrutiny. But speed is not the same thing as efficiency, and the faster OR teams work, the greater the risk of something going wrong. 

Dr. Adam Blomberg, National Education Director for Sheridan’s Anesthesiology Division, has long been an advocate of improving efficiency in the OR, calling it a win for “the anesthesiologists, surgeons, nurses, administrators, and most of all, the patients.” But he also worries that the enormous pressure on healthcare providers nationwide to speed up care delivery could eventually result in rushing at the expense of patient safety. An April 2016 analysis commissioned by The Leapfrog Group conservatively estimated that more than 206,000 avoidable deaths in U.S. hospitals each year are caused by medical errors, and those numbers could increase if hospitals’ drive for greater efficiency isn’t paired with an equally strong push to improve patient safety.

In a recent interview with Becker’s ASC Review, Dr. Blomberg urged surgical teams to slow down while speeding up – to work quickly and efficiently but also to remember to “slow down, take a deep breath and still think of the patient first.” He is a strong proponent of crew resource management (CRM) for OR teams. CRM training brings all team members together to learn how to communicate, make decisions and work together as a team both efficiently and effectively. It also standardizes the routine use of checklists and protocols, such as empowering any team member who identifies potential harm to the patient to call a “time-out,” immediately causing the entire team to pause and discuss that member’s safety concern. 

Dr. Blomberg is also Chief of Anesthesiology at Memorial Regional Hospital (MRH) in Hollywood, FL, which is part of the Memorial Healthcare System (MHS) that has experienced significant quality and safety improvements, fewer untoward outcomes and sentinel events, and improved patient experience and satisfaction after implementing CRM.

Dr. Blomberg stresses to his teams the importance of time-outs and has standardized the use of an anesthesia time-out at MRH to make sure the patient and the OR team are on the same page prior to induction of anesthesia. Sheridan’s standard anesthesia time-out is a brief conversation between the anesthesia care team and the circulating nurse to verify that the team has the correct patient, correct side and correct equipment in the OR, and that any necessary vendor or representative for surgical equipment is available prior to induction. The anesthesia time-out can take place after the patient has had pre-op sedation but before he or she is under general anesthesia. Sheridan anesthesiologists also do a surgical time-out with the surgeon as a final double-check prior to incision.

Twelve years after The Joint Commission’s Universal Protocol was introduced, creating widespread adoption of pre-procedure verification, site marking and time-outs, embedding patient safety into surgical teams’ SOP is more important than ever. It’s time we made National Time Out Day redundant.

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