Implementing a Regional Anesthesia Block Nurse Team in the Perianesthesia Care Unit Increases Patient Safety and Perioperative Efficiency

Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home

“…Examples include not only having more (1) housekeeping teams to reduce turnover times, 92,93 but also more (2) postanesthesia care unit (PACU) nurses, 41,[94][95][96][97][98] (3) transporters to reduce delays in PACU exit when patients are ready for discharge, 99 and/or (4) nurses to setup, assist anesthesiologists, and monitor patients after peripheral nerve blocks. 100 More expensive anesthetic drugs can be used to reduce OR times 101,102 and staff waiting 103 by reducing 104,105 annoying 106 prolonged times to extubation (i.e., 15 minutes or longer from end of surgery). Finally, the OR Medical Director can provide leadership to ensure the availability of 1 extra staffed OR when a service with 3 or 4 surgeons each has scheduled at least 8 hours of cases.…”

“…However, the interventions also include incremental variable costs (e.g., more PACU nurses). [92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109][110] Potential to Achieve Net Cost Reduction Is Limited to ORs with More Than 8 Hours of Cases Another limitation to decreasing costs through a reduction in OR time is that it is rarely effective except when there are at least 8 hours of OR time consistently for the service on the day of the week. 42,45,66,101,111,112 Many hospitals do not satisfy this condition.…”

Regional Anesthesia: An Overview

“…Because patients are charged for OR time beginning upon entrance to the OR, the anesthesia professional should perform RA blocks and insert temporary catheters in the preoperative area to minimize the amount of time that the patient spends in the OR. If the anesthesia professional performs the block in the preoperative area with the assistance of the preoperative nurse while the OR team is preparing the OR for the procedure, this could help improve perioperative unit efficiency . Performing the block outside the OR also prevents patients from hearing and seeing preparatory activities, which could make them more anxious.…”

“…To ensure that a local anesthetic is not injected into the vasculature, it is common practice for providers to pull back on the syringe before injecting to make sure there is no blood return. Performing this step can prevent the negative sequela of injecting into a vessel …”

“…If the anesthesia professional performs the block in the preoperative area with the assistance of the preoperative nurse while the OR team is preparing the OR for the procedure, this could help improve perioperative unit efficiency. 12 Performing the block outside the OR also prevents patients from hearing and seeing preparatory activities, which could make them more anxious.…”