Evaluating the Anesthesia Staffing Model for Efficiency

Without a doubt, the operating room (OR) brings in the lion’s share of a hospital’s revenue, amounting to as much as 70% or more.

So, why aren’t hospitals developing and expanding the OR? A tight market, staffing shortages, and a rise in performance-based payment systems makes it hard for hospital executives to find additional funds for existing OR services, let alone expand them.

 Still, with the OR a prime revenue-generator for any hospital, its operation should be scrutinized to see where cost-savings might be implemented. While few administrators would consider reducing the number of surgeries (that would strangle the golden goose!) to improve the bottom line, changes to the existing anesthesia staffing model may help.

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The Three Anesthesia Staffing Models:

 The optimal hospital staffing model should:

1.   improve efficiencies

2.   add revenue streams

3.   support clinical excellence

 Let’s look at the three most common staffing models for anesthesia delivery in the United States:

1.  All MD

 In this model, (most prevalent in one-or two-room surgery centers and less common in large ambulatory surgery centers), all anesthesia care is provided by medical doctors only, specifically physician anesthesiologists. The benefits of this model are that there are fewer providers involved and less supervision needed. From a cost-per-provider standpoint, this is the most expensive staffing model. In addition, providers in this model may be reluctant to participate in non-revenue producing, value-added services.

2. Anesthesia Care Team (ACT)

This model incorporates a physician anesthesiologist who supervises CRNAs (certified registered nurse anesthetists), with resident physicians-in-training who ultimately administer the anesthetics. While the increased number of providers requires a higher level of supervision, the added availability of another physician to work with OR nursing enhances efficiency. This model offers an intermediate level of costs.

 2.   CRNA Only

Under this model, anesthesia care is delivered by CRNAs independently, without the involvement of an anesthesiologist. In states where supervision is required, CRNAs practicing in this model can be supervised by any licensed physician. Because there is no anesthesiologist available to assist CRNAs with difficult cases, some surgeons may feel uncomfortable working in this staffing model.  However, this model is typically the most affordable of the three staffing models.

 At Concordia Anesthesiology, the process of analyzing the anesthesia staffing model to discover the appropriate provider ratios and staffing is the first step to improved efficiencies. It is an analysis focused on patient-centered care and alignment with hospital goals. Our model includes the placement of a Concordia-trained Director of Anesthesiology as the head of the local anesthesia department. In addition to overseeing day-to-day operations, the Anesthesia Director is responsible for creating an OR action plan, setting best practice standards, liaising with hospital administration, and ensuring proper staffing.

Maximizing efficiency in the OR helps hospitals increase revenue. Most important, improved efficiency results in improved patient care.