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Originally Posted by ADMIN

Cost-Cutting Benefits of Low-Flow Anesthesia
Have your providers take the “25% challenge” on inhalational cases.

From the Nov Issue of outpatient Surgery

Clifford M. Gevirtz, MD, MPH

With the simple turn of a dial on the anesthesia machine, your anesthesia providers could be saving you thousands of dollars a year in costly inhalational anesthetics as well as shortening times to patient recovery and discharge. Get them involved in your facility’s cost-cutting efforts by having them take the “25% challenge” as a quality improvement study. Here’s how it works.

• Get back to basics. Pick up Miller’s Anesthesia or any other respected anesthesia textbook and look up the chapter on “Uptake and Distribution.” There, you’ll find that while anesthesia providers need higher gas flows — typically in the 4 liters to 5 liters per minute range — at the beginning of the case, they can dial the flows down significantly to less than 2 liters per minute (or even better, 1 liter per minute) during the maintenance portion of the case, raising oxygen levels again just at the end of the case to flush out the circuit. While we all learn this in residen cy, many anesthesia providers quickly forget it over time, slipping into complacency and leaving the flow set at the same rate from beginning to end. This is an unnecessary waste of expensive inhalational agents like sevoflurane and desflurane, as well as oxygen.

• Audit your gas flows. Before you ask your anesthesia providers to change their ways, get an accurate portrait of their current behavior. Audit gas flow rates by taking a single operation, say a gall bladder case, tallying up the number of liters of inhaled anesthetics the anesthesia provider administered and averaging that number over 10 cases (preferably performed by the same surgeon). If you use electronic medical records, this data is fairly easy to obtain and analyze.

• Challenge providers to reduce flows by 25%. With a good baseline of data to begin with, challenge your anesthesia providers to reduce their flow rates by 25%. Remind them that the textbooks say they don’t need to maintain rates at 4 to 5 liters per minute throughout the duration of the case. In fact, 2 liters per minute should be the maximum flow rate used during maintenance. Don’t set a one-size-fits-all solution, but rather let each provider decide where and when he can dial down the use of inhaled anesthetics and oxygen. Use the friendly competition among providers and the financial needs of your facility as incentives for those hesitant to take up the challenge.

• Share your results. Continue to audit flow rates and see how they change from one month to the next. Tally up the cost savings, too, and share these with your anesthesia providers. Soon they will see that the 25% challenge is a simple way to cut costs without impacting the quality of patient care. OSM

cliffgevirtzmd@yahoo.com