Anesthesiologists, CRNAs and/or anesthesia assistants play a vital role in the day-to-day operations of an ASC. Many anesthesiologists serve as medical directors, and their presence each and every day has a significant impact on the overall function of the center. With this responsibility in mind, they should set good examples for the rest of the medical staff and the employees. They must be involved with defining the scope of services provided, especially for pediatric patients.
Anesthesiologists should also be involved in determining education and experience criteria for all providers, including non-anesthesia providers – whether credentialed or employed – who are administering moderate or deep sedation. Anesthesia privileges should be specific for age (neonate, infant, adult, etc.), sedation, general and regional anesthesia, including specific privileges for the use of ultrasound guidance in performing blocks. Anesthesia providers must be current in ACLS and PALS. We all acknowledge their expertise in airway management, but just completing a residency or other training program does not guarantee that they are up-to-date with current resuscitation principles.
Without question, anesthesia providers must be familiar with and follow all of the center’s infection control and safety policies. Hand washing/disinfection should be scrupulously practiced; and safe injection practices must be followed at all times, not just when being observed by the accreditation team. This is even more important during these times of frequent medication shortages. Accreditation standards and other national and international guidelines do not change because of these shortages. Since anesthesia providers administer most medications in ASCs they must make sure that everyone understands this fact and that shortcuts are not taken. By their own example, they must set the highest standard.
Anesthesia providers must play an active role in assessing the need for any pre-admission or pre-procedure laboratory or other testing (EKG, ECHO, X-ray, ultrasound, MRI, etc.). As part of their pre-anesthetic assessment they must also review and authenticate (by initials or signature, date and time) the results pertinent to the anesthetic management of the patient.
Anesthesia providers must obtain informed consent from the patient and document this process, making sure also that the patient has had an opportunity to ask questions. While a separate consent form is not needed, the accreditation surveyors will certainly look for appropriate documentation.
Anesthesia providers must actively participate in the prevention of wrong side, wrong site surgery. If blocks are done prior to induction of sedation or general anesthesia, the block site must be marked when laterality is involved. In addition, the anesthesia providers must all actively participate in the immediate pre-operative, pre-induction time-out in the operating or procedure room.
If non-anesthesiologist providers administer sedation or anesthesia, there must be clear policies and procedures that outline the responsibilities of each provider as well as who is ultimately responsible for all anesthesia care. This has to be in addition to credentialing and privileging or job descriptions. Anesthesiologists should participate actively in peer review activities, preferably with specific criteria for ‘routine’ reviews as well as for event-related reviews like multiple attempts at intubation, failed blocks, persistent nausea/vomiting, or unanticipated transfers to hospitals.
Anesthesia providers are strongly advised to follow the center’s policies for use of personal protective equipment, including when and how to discard gloves, gowns, shoe covers and masks. If a bloodborne pathogen exposure takes place, the anesthesiologist must know the protocol for immediate treatment and follow-up to ensure that appropriate measures are taken.
Education and leadership in CPR and Malignant Hyperthermia drills are expected functions of anesthesiologists. Participation in other drills, including fire and evacuation, should include all anesthesia providers who must assure the safe, continued care of patients during these circumstances.
Anesthesiologists must play an active role in overseeing all stages of care in the PACU. Pain management, therapy for nausea and/or vomiting and respiratory assistance are among the key areas requiring active involvement. Assessment of recovery from anesthesia – including the use of established criteria – must also be part of the anesthesiologist’s responsibilities.
This is by no means an all-inclusive list of how anesthesia providers can help you continually prepare for an accreditation survey. In general, you should make sure that they understand the importance of their activities, not only in assuring high quality of care, but also in making certain that the center is completely ready for accreditation or other inspections. Most anesthesia providers will willingly and actively participate.