Anesthesia’s success in hospitals can create dangerous assumptions in the ASC, and Jeff Tieder, CRNA, clinical assistant professor of the nurse anesthesia concentration at the University of Tennessee at Chattanooga, joined Becker’s to discuss why boundaries matter.
As procedures increasingly shift from hospitals to ASCs, Mr. Tieder shares how communication breakdowns between ASC leaders and anesthesia teams can lead to inefficiencies.
Editor’s note: This interview was edited lightly for clarity and length.
Question: Can you talk about how you’ve seen communication breakdowns between ASC leaders and anesthesia teams impact patient outcomes or operational efficiency in real-world scenarios?
Jeff Tieder: The biggest breakdown when we’re looking at the ASC is the success of anesthesia. We are often a victim of our own success. We do such a good job in the hospital that our surgeons look at us and assume we can do the same procedures in the ASC. And as reimbursement pushes procedures towards the ASC, it becomes a mini-hospital.
But without clearly defined expectations and boundaries for anesthesia, surgeons may schedule patients at the ASC who really aren’t appropriate candidates. We’re the gatekeepers of who gets done where. We need to set and enforce criteria like BMI limits, NPO guidelines and policies around GLP-1 use. If we start making exceptions, it opens the door for others to push those same limits, and that’s when problems arise.
The result is inefficiency. Nobody wants cancellations. No one wants the patient to arrive and be turned away or told they have to go to the hospital to have their procedures done. We have to remember that while some use anesthesia teams at the hospital and ASC interchangeably, it’s not the same system. It’s better to say upfront that a case needs to be done in a hospital, especially if extended recovery or PACU care might be needed.
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