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OR General Anesthesia

 

 

Thomas M. Dodds, M.D.

Vice Chairman

 

 

True to demographic trends we continue to experience steady growth in OR surgical cases at our Lebanon Campus.  In parallel, we have had explosive growth in demand for the provision of anesthesia services for the provision of anesthesia services outside of the OR.  Non-operating room anesthesia (NORA) growth rates have exceeded 10% per year (see accompanying chart).

 

In support of this growing demand we opened four new ORs in fiscal year 2005 and expanded our offsite (NORA) coverage.  Anesthesia staff now provide coverage for 29 locations on a typical day (23 ORs, Regional Block Clinic, PACU, Obstetric Suite, Pediatric PainFree program, and 2 NORA sites).

 

Orthopedic surgical cases continue to contribute disproportionately to our OR growth.  With the establishment of a Regional Block Clinic there has been a "sea of change" in the perioperative care of this patient population.  There has been a substantive improvement in the provision of post operative analgesia in these patients.  The block clinic has also improved the efficiency of care rendered to these patients (including the day of surgery discharge of patients that have historically been hospitalized).

 

We continue to partner with surgical sections that are regional and national leaders in the delivery of innovative care.  The pioneering work of our vascular surgeons in endovascular techniques is a notable example.  Recent construction of several OR suites designed specifically for laparascopic surgery has supported the growing demand for endoscopic procedures.  We continue to be regional leaders in more complex laparascopic surgeries - notably bariatric and urologic procedures.

 

Though our NORA case volumes have grown dramatically the demand for these services continues unabated.  We have created a subspecialty team focused on the cost-effective and efficient delivery of NORA services.  As part of this effort we have developed an RN sedation team that cares for patients who benefit from IV sedation, but don't necessarily require the involvement of an anesthesia team.  our routine cataract patients are now under the care of this RN Moderate Sedation Team (read more about this team in the Moderate Sedation Overview).  This allows us to focus physician and CRNA resources on more complex cases.  

 

While heartened by the steady growth in demand for Anesthesia services we are not immune to the forces impacting academic Anesthesiology departments throughout the country.   Struggles we face include declining reimbursement and rising personnel costs (the latter due to the tight supply of Anesthesiologists and CRNAs nationally).  Less obvious is the impact of shifting case mix:  The shift toward less invasive surgical approaches is attended by longer and less remunerative cases.  Likewise, coverage of multiple offsite locations - most with consistent demand - is difficult to accomplish in a cost effective manner.

 

We continue to anticipate steady growth in demand for Anesthesia - particularly NORA - services.  We hope to continue our leadership role in developing innovative strategies to care for our diverse patient population.  Further on the horizon we are excited to be in the planning stages for a freestanding ambulatory services center.