RESEARCH
Increasing Access to Care and Optimizing Surgical Outcomes
One of the top priorities for the Department of Anesthesiology is multidisciplinary collaboration with surgical colleagues to improve patients’ access to care and optimize surgical outcomes. In 2022, we focused on optimizing patients for ambulatory surgery and reducing same-day case cancellations by utilizing a case cancellation bundle intervention. The initiative was developed using a prospective cohort of patients scheduled to undergo Otolaryngology ambulatory surgery. The bundle intervention included objective screening tools such as health screening and anxiety screening questions, educational materials to reduce patients’ anxiety prior to surgery, and enhanced communication techniques between patients and providers. In addition, we standardized our preoperative triage, implemented evidence-based clinical guidance for common diseases, and improved interprofessional communication between the surgical, anesthesiology, and scheduling teams.
As part of this multidisciplinary initiative, the Department of Anesthesiology Research Lab created a never-before used automated tool that helps to determine which patients are at a high risk of case cancellation. This tool was developed as part of a collaborative project with Dr. Jeffrey Freda, Montefiore Health System’s Vice Chair of Perioperative Medicine, and Dr. Richard Smith, Chair of the Department of Otorhinolaryngology, Head & Neck Surgery, and has effectively reduced same-day surgery case cancellations. One of the main negative effects of same-day case cancellations is that patients’ untreated health conditions that require surgery are prolonged. Further, same-day cancellations reduce utilization of operating rooms, affect surgeon productivity and staff morale, and result in additional costs for patients, physicians, and hospitals.
After identifying which patients are at a high risk of same-day surgery cancellation, our Pre-Anesthesia Testing team works together with Surgical Services to mitigate these cancellations by providing interventions that allow patients to get the treatment they need on time. These interventions include consultations with patients who have a history of anxiety disorder as well as arranging free transportation to and from the hospital for those that have a barrier to accessing transportation. Dr. Carina Himes – previously at Mayo Clinic – joined the Montefiore Einstein Department of Anesthesiology as the new Director of Pre-Anesthesia Testing in 2022 to lead this endeavor.
As part of our larger multidisciplinary mission to optimize surgical outcomes, the Anesthesiology Digital Health Team also developed two additional automated tools to improve the perioperative process for patients and increase efficiency on the day of their procedures. One of the tools is an automated classification system that determines the patient’s score according to American Society of Anesthesiologist guidelines. The other tool estimates how long a patient will be in the Post-Anesthesia Care Unit to optimize OR workflow. This research was published in multiple articles in the Journal of Clinical Anesthesia.
Read the publications:
Patient referrals
At Montefiore Einstein Anesthesiology, we know providing patients with the best possible care includes teamwork and trust. We work closely with our valued referring physicians to ensure open communication and reliable expertise.