The Montefiore Einstein Department of Anesthesiology is leading a perioperative quality improvement initiative with the goal of reducing anxiety among patients directly before undergoing surgery. In collaboration with Perioperative Medicine leadership, Ambulatory Surgery Nursing, and the Department of Psychiatry, the initiative is focused on ensuring preoperative anxiolytic medication can be safely administered in the Ambulatory Surgery Unit with the ultimate goal of improving patients’ perioperative experiences and surgical outcomes.

Approximately 80 percent of patients demonstrate symptoms of anxiety prior to surgery. To address this common concern, the Department of Anesthesiology has been working on a comprehensive solution throughout the last year. The initiative began in June 2023, when Department Chair Dr. Matthias Eikermann and Vice Chair of Perioperative Medicine Dr. Philipp Fassbender collaborated with Vice President of Perioperative Medicine Dr. Jeffrey Freda and Davy Bascara, Senior Director of Ambulatory Perioperative Services, to implement a new preoperative anxiolysis policy. The new policy instructs anesthesia providers to administer anxiolysis to patients in the Ambulatory Surgery Unit rather than waiting until they are brought into the operating room.

Most recently, Drs. Eikermann and Fassbender assembled a quality improvement team to collect data on patients’ preoperative anxiety, which has provided further evidence for administering anti-anxiety medications in the ASU. The Anesthesiology Digital Health Laboratory is collaborating with Dr. Fran Ganz-Lord, Montefiore Health System’s Assistant Vice President of Quality and Medical Director of the Montefiore Center for Performance Improvement, to improve the patient experience through this initiative.

“We were seeing a lot of patients who had high blood pressure and a high heart rate before going in for their surgeries, which are signs of anxiety,” Dr. Fassbender explained. “It is well known that anxiety is not only an inconvenience for our patients, but it also increases the requirements for narcotics and increases the complication rate.”

The quality improvement team includes Dr. Ling Zhang, Director of IT Innovation, and Dr. Tina Ramishvili, Anesthesiology Research Fellow. By analyzing data from the last year, the team found that only 15 percent of patients were receiving anxiolysis medication in the ASU, while 45 percent of patients received the medication once they were in the operating room. After speaking with Department of Psychiatry and Behavioral Sciences Chair Dr. Jonathan Alpert and Chief of the Department of Psychology Dr. Simon Rego, the team set out to study patients’ preoperative anxiety by administering a short questionnaire – guided by the Amsterdam Anxiety and Information Questionnaire – to patients before they go in for surgery.

From June through August 2024, the team collected 765 patient assessments, providing the Digital Health Lab with data to support the policy regarding preoperative anxiolysis administration. Dr. Ramishvili conducted many of the patient assessments and oversaw a group of Albert Einstein College of Medicine students, who participated in data collection. Dr. Ramishvili is now working on data analysis to better understand patterns in symptoms of anxiety among the patient population surveyed.

"We are trying to find out if there are certain factors that make patients more anxious, such as analyzing whether there is a correlation with the type of surgical procedures they are having or a correlation with sex or age," Dr. Ramishvili explained.

The researchers found that while patients had anxiety in the ASU, their anxiety typically increased once they entered the operating room. But for patients who received Midazolam in the ASU, their anxiety did not increase. As such, the team’s goal is to increase anxiolysis administration in the ASU to 30 percent from the current 15 percent so that more patients can benefit from this intervention.

Approximately 80 percent of patients demonstrate symptoms of anxiety prior to surgery. To address this common concern, the Department of Anesthesiology has been working on a comprehensive solution throughout the last year. The initiative began in June 2023, when Department Chair Dr. Matthias Eikermann and Vice Chair of Perioperative Medicine Dr. Philipp Fassbender collaborated with Vice President of Perioperative Medicine Dr. Jeffrey Freda and Davy Bascara, Senior Director of Ambulatory Perioperative Services, to implement a new preoperative anxiolysis policy. The new policy instructs anesthesia providers to administer anxiolysis to patients in the Ambulatory Surgery Unit rather than waiting until they are brought into the operating room.

Most recently, Drs. Eikermann and Fassbender assembled a quality improvement team to collect data on patients’ preoperative anxiety, which has provided further evidence for administering anti-anxiety medications in the ASU. The Anesthesiology Digital Health Laboratory is collaborating with Dr. Fran Ganz-Lord, Montefiore Health System’s Assistant Vice President of Quality and Medical Director of the Montefiore Center for Performance Improvement, to improve the patient experience through this initiative.

“We were seeing a lot of patients who had high blood pressure and a high heart rate before going in for their surgeries, which are signs of anxiety,” Dr. Fassbender explained. “It is well known that anxiety is not only an inconvenience for our patients, but it also increases the requirements for narcotics and increases the complication rate.”

The quality improvement team includes Dr. Ling Zhang, Director of IT Innovation, and Dr. Tina Ramishvili, Anesthesiology Research Fellow. By analyzing data from the last year, the team found that only 15 percent of patients were receiving anxiolysis medication in the ASU, while 45 percent of patients received the medication once they were in the operating room. After speaking with Department of Psychiatry and Behavioral Sciences Chair Dr. Jonathan Alpert and Chief of the Department of Psychology Dr. Simon Rego, the team set out to study patients’ preoperative anxiety by administering a short questionnaire – guided by the Amsterdam Anxiety and Information Questionnaire – to patients before they go in for surgery.

From June through August 2024, the team collected 765 patient assessments, providing the Digital Health Lab with data to support the policy regarding preoperative anxiolysis administration. Dr. Ramishvili conducted many of the patient assessments and oversaw a group of Albert Einstein College of Medicine students, who participated in data collection. Dr. Ramishvili is now working on data analysis to better understand patterns in symptoms of anxiety among the patient population surveyed.

"We are trying to find out if there are certain factors that make patients more anxious, such as analyzing whether there is a correlation with the type of surgical procedures they are having or a correlation with sex or age," Dr. Ramishvili explained.

The researchers found that while patients had anxiety in the ASU, their anxiety typically increased once they entered the operating room. But for patients who received Midazolam in the ASU, their anxiety did not increase. As such, the team’s goal is to increase anxiolysis administration in the ASU to 30 percent from the current 15 percent so that more patients can benefit from this intervention.