The business side of surgical fast-tracking

If patients required less anesthesia and woke up and left the surgical suite sooner, wouldn’t it make sense to adopt fast-tracking procedures in your organization? Before you decide that fast-tracking is right for your inpatient or ambulatory surgical services, ask "What are we trying to accomplish?"

In other words, "What’s your business plan?" asks Franklin Dexter, MD, PhD, associate professor in the department of anesthesia at the University of Iowa in Iowa City. It might be to take care of all the patients who come to your facility at the lowest cost. If yours is a for-profit facility, however, it’s important to evaluate whether fast-tracking might actually decrease revenues instead of costs.

Typical objectives for fast-tracking include:

1. reduce costs;

2. enhance patient satisfaction;

3. raise the through-put of a surgical facility;

4. increase revenues.

The first two are the most common objectives of fast-tracking, according to Dexter. Most of the cost savings accrue from lowering the costs of phase I post-anesthesia care unit (PACU). However, most institutions will fail to decrease costs if they use fast-tracking for random patients. "The cost savings will materialize only if you fast-track around 50% or more of the patients," he emphasizes. (See "Brain wave monitor fine-tunes anesthesia doses," p. 28.)

As for patient satisfaction, fast-tracking is a winner — under the right conditions. Those conditions include careful post-surgical pain management and alignment of patient and family expectations regarding discharge times and home care. (See cover story, "Fast-track surgery pleases patients, saves resources.")

The goal of raising through-put in a surgical facility often surfaces as a facility looks for ways to avoid a bottleneck, caused by, for instance, limited availability of ventilators or a shortage of nurses trained for PACU care. Regardless of your objective, successful fast-tracking depends on two conditions:

• Anesthesiologists and nurses develop and approve protocols for patient selection, patient education, and PACU follow-up.

• Phase I PACU is located immediately adjacent to the phase II PACU. The same nurses should staff both units. "If a patient suddenly needs intubation, you can’t run down the hall to get a crash cart," Dexter warns.

Need More Information?

For techniques and best situations in which to practice monitored anesthesia care, contact:

- Alex Macario, MD, MBA, Assistant Professor of Anesthesia and Health Research & Policy, Department of Anesthesia, Stanford (CA) University School of Medicine. Telephone: (650) 723-6411. E-mail: amaca@leland.

- Franklin Dexter, MD, PhD, Associate Professor, Department of Anesthesia, University of Iowa, Iowa City. Telephone: (319) 356-2782. E-mail:

- Suzanne Richins, RN, MBA, FACHE, Director of Patient Care, McKay-Dee Hospital, Ogden, UT. E-mail:

For more about the BIS Monitor for anesthesia care, contact:

- Paul Manberg, PhD, Vice President, Clinical and Regulatory Affairs and QA, Aspect Medical Systems Inc., 2 Vision Drive, Natick, MA 01760-2059. Telephone: (508) 653-0603. E-mail: Web site: