Anesthesia Ready Time

There are a lot of different fields that you can track on your anesthesia record. From checkboxes to radio buttons to drop down values to timestamps --which is a big one. 

One of the timestamps that's a bit unusual is the Anesthesia Ready Time, which brings up some questions that we’re frequently asked: 

• “What is Anesthesia Ready Time, and why should we track it?”
• “It's taking time away from me to have to put that in. What difference does it at actually make?” 
• “Billing isn't concerned about it. What are we gonna do with that information?” 

I think to answer that question, we need to zoom out of it and recognize that in any industry-  healthcare's no exception- you deal with perceptions versus data-driven decision making. The reality is, in anesthesia, that perceptions rule the day. We don’t typically have measurable workflows and outcomes to base our decisions on, and so in the absence of the data, what prevails?  

Personalities. 

Politics drive the conversation, which may not necessarily be the worst thing. You may have fantastic personalities and constructive politics in such a way that you're making the right decisions. But you also might not be, you might be actually making things worse. Worse for the patient, worse for the bottom line. You just don't know.

One of my favorite examples is this: You're in a monthly meeting, some type of committee meeting, and a surgeon makes a complaint that anesthesia is too slow. How do you respond to that? A charge has been made, and it's certainly not a favorable label. Is it true? Should there be any push back? 

Typically, what you see happen is the anesthesia representation, assuming you're even invited to the meeting, will say, “Well, there are many reasons for an anesthesia case to be delayed, and who knows what's actually happening?” But in the absence of that data, it can become a very kind of confrontational conversation. An accusation is made, and a defensive stance is taken, when there could have been a collaborative discussion, such as, “Well, let's look at the facts, let's look at the reports and the data and see.” 

Or perhaps, you reach out to the surgeon at that time, and you say, “Well, can you offer some more details, what do you mean by ‘too slow?’” Maybe it has nothing to do with turnover time, but perhaps they had a more specific complaint, and they say, “Well, the nerve blocks are taking too long in my room.” Well, okay. Really the only way to address a concern or a complaint like that (you see it all the time) is to look at this thing called Anesthesia Ready Time. 

We define Anesthesia Ready Time as the time the anesthesia team is finished with their initial work. It's the time period from when the patient came into the OR until induction is complete, vascular access is complete, any regional or neuraxial blocks are complete. It's when we're done with the patient, so to speak, and we hand over to the circulator nurse and say, “You can do your part.” And that part typically is positioning, and padding, and prepping. Everything that they need to do in preparation for the cut. 

If you have that Anesthesia Ready time, then we can do a lot! Now we can offer reports comparing Anesthesia Ready times across all patients. 

• When they did get a block and when they didn't get a block 
• You can aggregate just that one surgeon's cases to say, for example, “For all 40 of your cases, here are the 20 cases with a block and here are the 20 cases without a block.” 
• Looked at the distribution of those Anesthesia Ready times for each of the 20 cases. What happens? Time and time again, we see the average block can take four or five minutes. And so maybe 18 cases are four or five minutes, but there are one or two cases that are outliers, significant outliers, and maybe they take 15 or 20 minutes.

And it's those one or two cases that are informing the opinion at that meeting to say, “Anesthesia is slow” or “Nerve blocks are taking too long.” But once you have that timestamp and you have the reporting capability to look at those distributions, it changes the dynamic in the conversation. 

You now have the ability to respond: 

“Well, here's the delay it's actually causing. If we look at the average across all of them- let's say it's five and a half minutes- the results of that five-and-a half minutes for those 20 cases is that we have increased patient satisfaction, we have a decreased length of stay at our hospital, they have decreased use of the PCA, they're quicker to ambulate. All of these are things are the reasons we want to be doing regional blocks.” 

And now the question comes to the hospital administrator: “Is that delay, that extra time worth the benefit?”

And rather than, “It's anesthesia; It's a personal issue; It's me; I'm too slow,” it becomes, “Here is what the data shows the actual delay is, and is that worth this benefit?” And that question is a “yes” or “no.” It's now less about me and more about what we want to do as a hospital. What type of service do we want to provide to our patients? It's more collaborative.

But without the data, without measures like Anesthesia Ready Time, you end up in a world of just competing opinions. And in today's world we can do better, and we should do better.