In a webinar on Feb. 28, 2012, Robert Farrar, MD, JD, FCLM, vice president of medical affairs for Somnia Anesthesia; Brent Sommer, a CRNA at Desert Regional Medical Center in Palm Springs, Calif.; and Frank Schramm, MD, chief of anesthesiology at Providence Regional Medical Center in Everett, Wash., shared how hospitals can develop an anesthesia care team model that contributes to clinical quality and excellence in the operating room.
Dr. Farrar began the webinar by outlining the three general models for anesthesia care: the MD-only model, the "anesthesia care team" model, and the Certified Registered Nurse Anesthetist-only model. Dr. Farrar noted, though, that the CRNA-only model is relatively new, generally used at rural facilities and only permitted in certain states.
Somnia Anesthesia embraces the anesthesia care team model, in which anesthesiologists and CRNAs work together to oversee and administer anesthesia care. Under this model, an anesthesiologist directs and leads the team, while the CRNAs administer anesthesia under physician supervision.
This model is beneficial because it allows for high quality and safe anesthesia care while reducing the cost of sufficient anesthesia coverage, explained Dr. Farrar. While some may question the quality of a mixed-provider model, he said, "There is no conclusive study to show that MD-only anesthesia model is superior in quality and safety to the anesthesia care team model."
In terms of costs, the care team model is substantially more efficient. For example, anesthesiologists ($410k) are paid three times more than CRNAs ($158k), in terms of average salary, and are more costly to train. Additionally, the more cost-effective model may eliminate the need for an anesthesia subsidy and helps alleviate the current anesthesiologist shortage by utilizing CRNAs. According to Dr. Farrar, a recent survey found 47 percent of hospital administrators reported reducing or redirecting OR cases due to anesthesia staffing issues.
Dr. Farrar also noted the anesthesia care team model encourages shared and collaborative practices and reduces fatigue, which he believes can contribute to a safer environment.
Following Dr. Farrar's presentation, Mr. Sommer explained how the anesthesia care team model is used at DRMC and its El Mirador Surgery Center. Before the care team model was implemented, 13 anesthesiologists and a single CRNA provided coverage for the facilities. Now, 10 anesthesiologists and 10 CRNAs make up the care team. In the OR, the physician-to-CRNA ratio is 4-to-1, and CRNAs and anesthesiologists collaborate on cases. Mr. Sommer enjoys the opportunity to provide input on cases and believes the safety of patient care is enhanced when multiple clinicians from different view points come together on cases.
Dr. Schramm presented last, sharing his experiences with the anesthesia care team model at PRMC. PRMC implemented the model after contracting with Somnia Anesthesia, and he believes the new model has maintained the hospital's quality of care while significantly reducing anesthesia staffing costs. In fact, PRMC was able to reduce its anesthesia subsidy because of the new model in place, he said.
Today, the hospital employs what he called a "sliding scale supervision model," where patients are assigned to either an anesthesiologist, a CRNA or an anesthesiologist-CRNA team depending on their acuity and the procedure scheduled. "CRNAs typically provide care to patients in the OB ward and at the ASC; when they work at the main campus [with higher acuity patients], they work with an anesthesiologist," he said. "We view anesthesia as a 'team sport,'" he added.
Under the model, an anesthesiologist not assigned to the OR serves as a coordinator/facilitator who reviews case information and looks for any indication the case may be difficult. The chief of anesthesia then uses that information to assign the cases to each CRNA or anesthesiologist based on his or her unique strengths the day before the case is scheduled. During the cases, the coordinating physician is available for any questions. Following, 100 percent of cases are collaboratively reviewed to identify any areas that could have been improved. This model has developed "a culture of collaborative care with recognizes the individual providers' ability as well as the individual needs of the patient," said Dr. Schramm.
The model has proven successful at PRMC by expanding coverage, eliminating the anesthesia subsidy and decrease wait time for OB epidural requests. Additionally, the hospital's anesthesiologists now actively take part in quality improvement committees and participate in efforts to improve value-based purchasing and HCAHPS measures.
"I personally embrace and champion the anesthesiologist as the perioperative MD. This model allows us to use our medical training to facilitate the care of the most number of patients at the same time…and serve as ready resource for CRNA and other MDs," explained Dr. Schramm.
Dr. Farrar began the webinar by outlining the three general models for anesthesia care: the MD-only model, the "anesthesia care team" model, and the Certified Registered Nurse Anesthetist-only model. Dr. Farrar noted, though, that the CRNA-only model is relatively new, generally used at rural facilities and only permitted in certain states.
Somnia Anesthesia embraces the anesthesia care team model, in which anesthesiologists and CRNAs work together to oversee and administer anesthesia care. Under this model, an anesthesiologist directs and leads the team, while the CRNAs administer anesthesia under physician supervision.
This model is beneficial because it allows for high quality and safe anesthesia care while reducing the cost of sufficient anesthesia coverage, explained Dr. Farrar. While some may question the quality of a mixed-provider model, he said, "There is no conclusive study to show that MD-only anesthesia model is superior in quality and safety to the anesthesia care team model."
In terms of costs, the care team model is substantially more efficient. For example, anesthesiologists ($410k) are paid three times more than CRNAs ($158k), in terms of average salary, and are more costly to train. Additionally, the more cost-effective model may eliminate the need for an anesthesia subsidy and helps alleviate the current anesthesiologist shortage by utilizing CRNAs. According to Dr. Farrar, a recent survey found 47 percent of hospital administrators reported reducing or redirecting OR cases due to anesthesia staffing issues.
Dr. Farrar also noted the anesthesia care team model encourages shared and collaborative practices and reduces fatigue, which he believes can contribute to a safer environment.
Following Dr. Farrar's presentation, Mr. Sommer explained how the anesthesia care team model is used at DRMC and its El Mirador Surgery Center. Before the care team model was implemented, 13 anesthesiologists and a single CRNA provided coverage for the facilities. Now, 10 anesthesiologists and 10 CRNAs make up the care team. In the OR, the physician-to-CRNA ratio is 4-to-1, and CRNAs and anesthesiologists collaborate on cases. Mr. Sommer enjoys the opportunity to provide input on cases and believes the safety of patient care is enhanced when multiple clinicians from different view points come together on cases.
Dr. Schramm presented last, sharing his experiences with the anesthesia care team model at PRMC. PRMC implemented the model after contracting with Somnia Anesthesia, and he believes the new model has maintained the hospital's quality of care while significantly reducing anesthesia staffing costs. In fact, PRMC was able to reduce its anesthesia subsidy because of the new model in place, he said.
Today, the hospital employs what he called a "sliding scale supervision model," where patients are assigned to either an anesthesiologist, a CRNA or an anesthesiologist-CRNA team depending on their acuity and the procedure scheduled. "CRNAs typically provide care to patients in the OB ward and at the ASC; when they work at the main campus [with higher acuity patients], they work with an anesthesiologist," he said. "We view anesthesia as a 'team sport,'" he added.
Under the model, an anesthesiologist not assigned to the OR serves as a coordinator/facilitator who reviews case information and looks for any indication the case may be difficult. The chief of anesthesia then uses that information to assign the cases to each CRNA or anesthesiologist based on his or her unique strengths the day before the case is scheduled. During the cases, the coordinating physician is available for any questions. Following, 100 percent of cases are collaboratively reviewed to identify any areas that could have been improved. This model has developed "a culture of collaborative care with recognizes the individual providers' ability as well as the individual needs of the patient," said Dr. Schramm.
The model has proven successful at PRMC by expanding coverage, eliminating the anesthesia subsidy and decrease wait time for OB epidural requests. Additionally, the hospital's anesthesiologists now actively take part in quality improvement committees and participate in efforts to improve value-based purchasing and HCAHPS measures.
"I personally embrace and champion the anesthesiologist as the perioperative MD. This model allows us to use our medical training to facilitate the care of the most number of patients at the same time…and serve as ready resource for CRNA and other MDs," explained Dr. Schramm.
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More Articles Featuring Somnia Anesthesia:
Case Study: How One Pennsylvania Hospital Optimized Its Anesthesia Program
Somnia Names Dr. Donald Helfer II Chief of Anesthesiology at San Juan Regional Medical Center
Podcast Interview With Dr. Robert Farrar of Somnia Anesthesia: CRNAs in the Anesthesia Care Team Model