Presented by Lia Lowrie, MD
Dr. Lia Lowrie presented the second plenary session on Monday morning, entitled “Defending your sedation program’s value to the institution.” She began the presentation by reviewing the up-front relative value that different programs and service lines have to a pediatric medical center.
Two services in particular, the congenital heart disease program and the NICU, have remained consistent money makers for most institutions, leading to a greater perceived value to the hospital system. However, services that don’t “make money” up front are still vital to support the many functions of the hospital – pediatric ICU and anesthesiology are two such services. Procedural sedation is less immediately obvious, because there is the ongoing perception that this work can be done (or even done better) by other groups.
We’re constantly being “bombarded” by clinical productivity and capacity questions that are all about doing more and more with less and less. The challenge lies in looking to define, and defend, your sedation service in ways that indirectly benefit the overall cost structure by more directly impacting service delivery, access and efficiency, patient satisfaction, and etc. – all of which centers nicely around the six domains of sedation quality as defined by the SPS Center of Excellence.
So, how can we better defend the value of our programs? As Dr. Lowrie explained, impacting the quality of sedation care in these domains is the best strategy i.e. “the best defense is a good offense.” In order to demonstrate our impact on safety, on efficiency (including cost), and on patient centered care, we need data, and we must be able to present that data across multiple organizational silos and in multiple contexts to be most effective. She then suggested several outstanding target strategies to provide better and more visible value to the institution.
First, helping to unload the ER by working to accommodate their urgent sedation cases when possible/reasonable can provide a safer and more timely/efficient experience for those patients. Second, having a process to identify and address lag times in MRI throughput can be extremely valuable to the institution in terms of minimizing down times (“got to keep that table running”) and in terms of streamlined throughput for multiple medical and surgical services looking for those results. Finally, maximizing nursing productivity by looking for overlapping skill sets and care opportunities such as vascular access or short stay can help staff meet the institution’s productivity goals yet avoid losing these expert colleagues to other completely non-sedation related areas.
Dr. Lowrie also suggested investigating to ensure that the linkage between sedation physician clinical work and the hospital’s financial reimbursement is a robust and visible one, both from direct professional fees as well as indirect benefit to all the proceduralists’ divisions and departments.
In closing, Dr. Lowrie reminded us that improving the quality of care provided to our patients always adds value. That value may be to patient outcomes, to team job satisfaction, or to the institutional cost structure – or, to all of the above.