As part of the Anesthesia Care Redesign at the Hutch Ambulatory Surgery Center, more attending anesthesiologists are now working independently to provide anesthesia services to patients rather than utilizing the Anesthesia Care Team Model. By the end of December, the Department of Anesthesiology will have onboarded a total of 33 new full-time faculty members in 2024. As part of the Anesthesia Care Redesign, both new and veteran attendings are providing anesthesia care at the Hutch Ambulatory Surgery Center for one-week rotations.

Dr. Tracey Straker, Vice Chair of Clinical Operations, Dr. Curtis Choice, Senior Director of Network Integration and Expansion, and Department of Anesthesiology Chair Dr. Matthias Eikermann have been leading the initiative, with support from Dr. Preeti Anand, Hutch Site Director for Anesthesia Services. Dr. Straker explained that utilizing full-time anesthesia providers rather than locum tenens professionals not only allows for cost-savings for the institution, but it also has far-reaching positive impacts on patient care.

“As a department, we are aligning our clinical operations with patient-centered care,” Dr. Straker said. “Once you have someone who is invested in the institution as a full-time provider and they align themselves with the value and mission of the department and institution, the patient outcomes are better.”

Dr. Anand said having both full-time attendings and nurse anesthetists rather than locum tenens providers at the Hutch has resulted in a great level of quality improvement. In addition to providing excellent anesthesia care, full-time CRNAs provide another invaluable service to the Hutch, as they teach the Nurse Anesthetist Students who rotate at the center.

“The whole Hutch team including the Perioperative and Nursing staff have been supportive of this new care model and working to make it a smooth collaboration,” Dr. Anand said. “And we have received a great response from attendings who want to come to Hutch and improve the quality of care we provide.”

Dr. Eikermann emphasized the excellent work of the department’s attending anesthesiologists and their contributions to making this project a success.

“Our faculty members have been instrumental in the development of this new care model, and I am very proud of their performance,” Dr. Eikermann said. “In this period of transition, we have had many attendings step up to the plate to ensure we are continuously providing exemplary patient care at the Hutch Ambulatory Surgery Center.”

Dr. Choice explained that there are multiple benefits for faculty members to participate in the Hutch rotations. Chief among these benefits is the opportunity for attendings to sharpen their skills by providing anesthetic care personally rather than through the Anesthesia Care Model.

“For many of our faculty, it’s nice to get back into doing your own cases and keeping your clinical skills and your anesthetic management fresh and up to date,” Dr. Choice explained. “Working at the Hutch also lends itself to a nice work/life balance because there is a more predictable ambulatory schedule without emergent cases.”

Dr. Choice, who served as the Anesthesia Site Director at the Hutch ASC from the center’s opening in 2014 until 2020, said during the surgery center’s early days of operation, there were several attending anesthesiologists working on individual cases. With 16 operating rooms at the Hutch, the new care model allows the department to capitalize on its new anesthesiology physicians amid a nationwide shortage of anesthesia providers. The American Society of Anesthesiologists report that 78 percent of healthcare facilities have a shortage of anesthesia providers – up from 35 percent before the COVID-19 pandemic. According to the American Association of Medical Colleges, it is expected that there will be a dearth of 12,500 anesthesiologists by 2035 and a shortage of 7,800 CRNAs by 2028 nationally.

In addition, the Hutch Ambulatory Surgery Center has recently expanded its surgical offerings to include pediatric patients. This is in line with the expansion of ambulatory surgery centers nationwide with more than 80 percent of surgeries in the United States now performed in the outpatient setting, according to the Ambulatory Surgery Center Association.

Dr. Bilal Tufail, a new attending anesthesiologist at Montefiore Einstein who completed the Advanced Airway Fellowship in the Montefiore Einstein Department of Anesthesiology earlier this year, is one of the attendings who has already provided care working solo at the Hutch. He said he was attracted to the opportunity of working at the Hutch so that he could maintain his hands-on clinical skills in addition to learning more regional anesthesiology techniques, which are frequently performed at the Hutch.

"And of course, the first thing is that this initiative is a priority for the department, and I wanted to help fill the need for providing services at the Hutch,” Dr. Tufail said.

Dr. Yao Liu, who joined the Montefiore Einstein Department of Anesthesiology this year as a full-time faculty member, said she has enjoyed working at the Hutch Ambulatory Surgery Center on an individual basis, as it has allowed her to keep her skills fresh and continue to learn new methods to optimize ambulatory anesthesia care.

“While I enjoy the rewarding experience of working with trainees, doing solo cases gives me the opportunity to learn more about my own strengths as well as ways I can improve,” Dr. Liu explained. “Being independent and efficient at a busy ambulatory center not only helps me to hone my skills but also allows me to develop a new perspective on anesthesia practice.”

Dr. Choice emphasized the benefits of having expanded the department’s pool of full-time faculty members over the last year, which has been instrumental in making this initiative a success.

“There is a lot more engagement from full-time department members because we all work as a team to ensure success and the very best in patient safety and anesthesia care," he said.