As part of the Montefiore Einstein Department of Anesthesiology’s strategic goals to increase patient safety and improve the patient experience, department leadership has implemented a new bundle intervention in the preoperative period.

While a member of the anesthesia team has always conducted a preoperative assessment prior to surgery, the department has now standardized requirements for an attending anesthesiologist to interact with patients in the preoperative holding area. In addition, anesthesia providers will accompany the patient during transport to the operating room.

This increased involvement by the attending anesthesiologist offers multiple benefits, including reducing patient anxiety, improving safety by ensuring patients are transported to the correct operating room, and enhancing the overall patient experience during what is often a stressful time. The bundle intervention also ensures compliance with Epic documentation requirements and supports accurate billing and regulatory review processes, said Dr. Philipp Fassbender, vice chair of Perioperative Medicine for the Department of Anesthesiology, who is leading the initiative alongside Department Chair Dr. Matthias Eikermann.

“It is important for the anesthesia team to be with the patient when they are going to the operating room for a couple of reasons,” Dr. Fassbender explained. “First, the patient already has a connection to the anesthesia team after the preoperative assessment, which helps them feel safe. Second, we can help ensure a positive and calm transition of care from the Ambulatory Surgery Unit to the operating room.”

Beyond building trust between the attending anesthesiologist and the patient, the standardized preoperative evaluation allows physicians to assess and address patient anxiety levels. This component of the bundle builds on a quality improvement initiative launched several years ago to reduce preoperative anxiety.

The initiative began in June 2023, when Drs. Eikermann and Fassbender collaborated with Montefiore Einstein’s Vice President of Perioperative Services Dr. Jeffrey Freda and Davy Bascara, senior director of Ambulatory Perioperative Services, to implement a new preoperative anxiolysis policy. This policy instructs anesthesia providers to administer anxiolytic treatment to patients demonstrating signs of anxiety in the Ambulatory Surgery Unit, rather than waiting until they arrive in the operating room.

The Department of Anesthesiology’s Digital Health Laboratory conducted research last year that further supported this initiative. The team found that while patients experienced some anxiety in the Ambulatory Surgery Unit, anxiety levels typically increased once patients entered the operating room.

However, for patients who received midazolam, an anxiolytic medication, prior to transport to the operating room, anxiety levels did not increase after transport. Approximately 80 percent of patients exhibit symptoms of anxiety, such as elevated blood pressure and heart rate, during the preoperative period.

To ensure alignment with the new preoperative evaluation process, the Department of Anesthesiology added additional annotations in Epic, allowing the attending anesthesiologist to document whether an anxiolytic was administered or declined by the patient.

Currently, more than 60 percent of patients are offered and receive medication to reduce preoperative anxiety, contributing to an improved patient experience.

The bundle intervention has received strong support from interdepartmental colleagues, including Perioperative Nursing. Nursing teams have noted the positive impact that preoperative assessments and anxiolytic administration have on patients’ demeanor prior to surgery.

Having the attending anesthesiologist accompany the patient from the Ambulatory Surgery Unit to the operating room also supports greater continuity of care and optimization of anesthesia service revenue. Improved accuracy in billing for the start of anesthesia services further supports Montefiore Einstein’s commitment to patient-centered care by enabling the department to recruit additional exceptional anesthesiologists dedicated to serving the Bronx community.

“Anesthesiologists are well positioned to serve as patient advocates during the preoperative and postoperative periods, when patients are vulnerable due to anxiety, pain, and discomfort,” Dr. Eikermann said. “We help our patients go home after surgery with better experiences of their procedural care. Notably, this added preoperative service is nationally recognized as a billable contribution to care.”