Using a physician anesthesiologist-led Anesthesia Care Team model increases patient access to care, compared to nurse-administered sedation for gastrointestinal (GI) endoscopy procedures, according to research being presented at the American Society of Anesthesiologists' ADVANCE 2022, the Anesthesiology Business Event.
The Anesthesia Care Team model allows us to optimize patient flow and utilize faster-acting medications, resulting in shorter total case lengths and reduced post-anesthesia care unit (PACU) length of stay for upper and lower GI endoscopic procedures, compared to a model where nurses provided sedation. This allows for scheduling more patients in fewer rooms in the GI suite per day and increases patient access to care."
Adeel A. Faruki, M.D., senior author of the study and senior instructor of anesthesiology, University of Colorado Hospital Anschutz Medical Campus, Aurora
Most anesthesia care in the U.S. is provided either by a physician anesthesiologist or a non-physician anesthesia practitioner supervised by a physician anesthesiologist within the Anesthesia Care Team model. This model and physician-led anesthesia care are widely recognized as the gold standard to ensure patient safety and the best outcomes.
The University of Colorado Hospital previously used a model where GI procedural nurses provided sedation under supervision from gastroenterologists for cases that did not require general anesthesia (called the GI luminal unit). The hospital transitioned to the Anesthesia Care Team model for all GI cases July 1, 2021.
In the study, researchers compared GI cases performed under the former nurse-provided sedation model to those performed under the Anesthesia Care Team model. They found it took less time to begin the procedure (sedation start to scope-in time) when deep sedation with propofol (MAC) was provided by the Anesthesia Care Team than when nurses administered sedation with fentanyl, midazolam and diphenhydramine. That change, along with a redesigned patient flow that required procedural consents to be signed before patients arrived in the GI suite, provided the opportunity to increase daily GI procedural volume by 25%, while using the same number of procedural suites, Dr. Faruki said.
Propofol is a fast-acting and effective medication with a higher-risk-profile, which physician anesthesiologists have the skills and training to deliver and monitor. "Propofol can result in very deep levels of sedation in a short period of time and, therefore, at most institutions, is restricted for use by anesthesia providers," said Andrew Mariotti, B.S., M.H.A., lead author of the study and M.D. candidate at the University of Colorado. "Unlike GI procedural nurses, the Anesthesia Care Team has the training and expertise to perform advanced airway and cardiovascular interventions if an emergency arises."
The researchers analyzed the sedation-to-scope-in time of 5,640 endoscopy patients, comparing 4,606 who received nurse-administered sedation for GI procedures between Jan. 1 and June 30, 2021, to 1,034 who had MAC between July 1 and Oct. 31, 2021. The point from sedation start to scope-in time was reduced by 2 to 2-1/2 minutes per case with MAC. Extrapolating to the typical cases performed at their hospital over a year (more than 2,600 cases), the authors said the time savings equates to more than 5,300 minutes, or 90 hours.
Because recovery also is faster with propofol, there were time savings in the PACU of 7 minutes for upper GI endoscopies and 2 minutes in lower-GI cases. The researchers also found patients reported being less groggy.
About 51.5 million GI endoscopies are performed annually in the United States, or about two-thirds of all endoscopies. The time savings for Anesthesia Care Team-administered MAC sedation likely would apply to non-GI procedures as well, the authors note.
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