SAMBA Talks eNewsletter - February, 2006

Volume 5, Issue 9

S A M B A T A L K S - PAGE 2

February, 2006

JOIN THE DISCUSSION - TOP

Need advice about a problem case in ambulatory anesthesia? Want suggestions about a difficult situation in your ambulatory surgery center? Have a reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion" here.

To enter the Discussion with a question, reply, or other comment, please contact us. Your submission will be published in this section of the next available issue of SAMBA TALKS. Include your name (or initials), city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before the questions can be published.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - LAST MONTH'S QUESTION WITH REPLIES - ?? - TOP

INDUCTION ROOMS

In an outpatient surgery setting, do the benefits of induction rooms outweigh the costs? If you are building or renovating an outpatient surgery center, should induction rooms be included in the plans? How does one begin to assess whether this is worthwhile?

-- Anonymous, Toronto, Ontario.

REPLIES:

In the most cost-effective and productive places in the world, this concept does not exist; what is needed is more efficient architecture of the operating rooms to facilitate rapid turnover; the main reason to have separate induction rooms is to facilitate regional block placement and that can be done with a properly designed patient room; this again requires proper architectural design and flow pattern.

I think this paper [link to PubMed article in this month's newsletter] agrees with my assessment. The surgeon did the block in a
room before the OR was ready; this may be done in the waiting room if it is properly constructed (see my comment below). Anesthesia providers may also do such blocks (as we do in our ASC) in the properly conducted patient waiting area.

-- Kumar Belani MD, San Francisco, California

Great idea induction rooms..we use them at MGH to start lines, place blocks, premedicate the patient in close proximity to the actual OR - makes the scenerio very efficient, as far as both the patient and healthcare workers are concerned i.e. working as a team. In addition, the new meds that we are using for sedation via new technology - safe, of course - yet the drugs often require a 10-15 loading dose slowly to gain the max effect with minimum side effects slowly; an induction area in close proximity to the OR where the procedure is to be performed is somewhat of an 'ideal setting. It would enhance the efficiency in the OR...less turnover time, patients would be happy and the OR staff would feel like we all worked together as a a team to faciliatate.

-- Fred Shapiro MD, Boston, Massachusetts

I am familiar with induction rooms from my experience in Europe. The only way they can be cost-effective if the indcution of anesthesia (or blocks etc.) are performed while the surgeons are finishing the previous case. Thus, it would be necessary to have 2 anesthesia providers, one taking care of the patient in the OR and other inducing the patient in the induction room. The major benefit is turnover time - for which the OR has to be cleaned quickly (in Ireland the OR nurses did the job and did not wait for the cleaning personnel). Thus, there are many caveats in making the induction rooms cost-effective.

-- Girish Joshi MD, Dallas, Texas

The use of induction rooms can allow parallel tasks. However, they are probably not cost effective. Induction rooms , if used by anesthesia providers, require more personel. They are a luxury and if your Center is willing to pay the construction costs by all means ask for them. Many of the same tasks that are performed in an induction room can easily be done in a well designed holding room.

-- Grover Mims MD, Winston-Salem, N Carolina

At Groote Schuur Hospital in Cape Town, S Africa, induction rooms are used. Practitioners here, typically residents, take parallel processing to a remarkable level. During "quiet" times of the case-in-progress the registrar will pop in to the induction room to interview, or review, the next patient, establish intravenous access, and sometimes even perform a regional anesthetic procedure. (It should be noted that most patients are admitted to the hospital the night before the procedure and have already been evaluated by the residents). The door between the induction room and the operating room has windows through which monitors can be observed, and is often kept slightly ajar to facilitate monitoring. The registrar will often (but not invariaby) get the anesthetic nurse (not a CRNA but more on the lines of an American LPN) to keep an eye on things while these preoperative tasks are accomplished. This practice certainly improves operating suite efficiency, and turnover times are much lower than I have seen in any American or Canadian hospital. The impact on patient safety is unknown.

-- Gary Kantor MD, Cape Town, S Africa and Cleveland, Ohio.

?? -- THIS MONTH'S QUESTION -- ?? - TOP

QUALITY ASSURANCE - HOW TO BEGIN?

Our anesthesia group has obtained the exclusive contract at a new outpatient surgery center to open in Feb 2006. I have been assigned the duty of QA/QI. Does anyone have any pointers on where to begin this process. I have been doing research on the JCAHO and OSHA web sites. Any other pointers. Thanks.

-- Shonna Parks

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