PROGRAMS FOR SUCCESS

At NCAC we've created a series of "Programs for Success". All of these programs are ambitious in scope and are designed with mechanisms for measuring results.

We work with our clients to create a plan for success for their Cardiac Anesthesia Departments. We strive to create measurable objectives that assure appropriate utilization of resources, reduce risk, and optimize reimbursement. We recognize that each client has different needs and we offer flexibility in designing options to meet those needs.

Cardiac Program Startup and Support Quality Improvement Risk Management Ergonomics Consultation Departmental Reengineering Blood Conservation TEE Education

Cardiac Program Startup and Support

Starting a cardiac program is a challenging venture for a hospital. Eliminate possible weak links in your system by locating reliable cardiac anesthesia coverage for your program. By covering this area with highly qualified professionals, you can then concentrate on issues of economics, territories, and politics that are part of start up programs.

NCAC has started three cardiac programs in communities and is skilled in the administrative and clinical issues needed to support the venture. We provide the following:

• setting up anesthesia equipment
• developing anesthesia policies and procedures
• developing perioperative TEE services
• training anesthesia technicians
• setting up an acute pain service

NCAC is experienced in Committee Involvement in Cardiac Program development, Certificate of Need applications, and External Review procedures.

New cardiac programs require support, as they mature and the caseload gradually increases. NCAC can help in supporting your program during the early "teeth-cutting" stages. Need support for your solo cardiac anesthesiologist - we can help with customized vacation coverage packages.

Quality Improvement

An effective QI program not only improves the quality of care delivered, but is often a vital adjunct to reducing risk. Quality care in cardiac anesthesia results in increased confidence in the service and subsequent increased utilization. Many quality assurance (QA) programs seen in cardiac anesthesia services today amount to little more than tokenism; addressing the minimum requirements to meet JCAHO or other agency regulations. Generally these programs do not identify the problems nor find solutions. They do not truly strive to instill the philosophy and methodology of quality improvement.

NCAC, as part of its commitment to providing quality care, offers a state of the art quality assurance and performance improvement program. This program creates expectations, defines the standards of care, identifies problems, develops corrective actions, provides education, measures outcomes, performs trending, and reevaluates effectiveness.

Besides cooperating fully with hospital QI initiatives, such as development of "dashboards", we also work with other agencies and departments to develop studies that allow us to evaluate systems. The NCAC QI Program takes the essential elements of cardiac anesthesia delivery and implements a customized tracking system for resource utilization, processes, and outcome. Some 40 independent qualitative and quantitative monitors are tracked monthly.

If you need a revamp of your QI program, let NCAC guide you through this important upgrade.

Risk Management

Malpractice claims can have a distressing effect on everyone and the impact can be economically severe on self-insured institutions. If patient confidence begins to diminish because of the negative image associated with malpractice losses, the financial health of the institution could be threatened. As a result, there is a need for a comprehensive, vigorous risk management program in cardiac anesthesia. NCAC has been very effective with developing such a program. The approach is ambitious both in scope and methodology. Virtually all high-risk areas in cardiac anesthesia are routinely studied and are incorporated into the QI plan. Standards of care and documentation requirements are constantly reinforced. Our customized intraoperative anesthesia record and pre-anesthesia assessment forms address the need for detail.

The hallmarks of the program rest on meticulous documentation and good clinical judgment. Our program addresses not only the generalities of successful risk reduction, but also analyzes the clinical services that most commonly result in litigation.

In selected cases, we provide legal consultation and "expert" witness
services, according to guidelines established by the American Society of Anesthesiologists. We base our approach on community standards of care, ASA practice standards, and what the literature states. Our clinical research-based staff has expertise in dissecting specific topics though literature analysis, and report compilation.

Ergonomics

At NCAC, we believe that effective communication is a vital component to the efficient operation of the Cardiac Anesthesia Department.

Consider NCAC's ergonomics program:

• if your cardiac anesthesia department inefficient and fragmented
• if your cardiac surgeons are unhappy with their coverage
• when you need an assessment of how your department functions
• if your department can run more efficiently at lower costs
• when you experience too much turnover

We can analyze the ergonomics of your department, address where the problems lie, and recommend strategies in finding answers to your medical headaches within a legal framework that does not breach any confidences or contracts.

We specialize in such areas as:

• conflict mediation and resolution
• leadership and management training
• orientation programs
• professional development
• off-site retreats
• problem identification and analysis
• productivity analysis

NCAC is committed to developing a collaborative team that incorporates all facets of the cardiac anesthesia including:

• anesthesiologists
• nurse anesthetists
• perfusionists
• technicians
• cardiac surgeons
• program administrative staff

Departmental Reengineering

Do you need to integrate your cardiac anesthesia and non-cardiac anesthesia services into one unified Department of Anesthesia? This requires careful planning and consideration of call schedules, daily workloads, and cross-coverage plans.

We believe that this can be effectively accomplished using a methodical, well-thought out strategy. Some of these elements are as follows;

• Respect, support and appreciation are the cornerstones of a successful Departmental reorganization.
  
  
• Maintain Departmental morale. Minimize a “sense of the unknown.”
  
  
• Establish Departmental goals and then create timelines for the successful implementation of each goal.

Blood Conservation

At NCAC, we have adopted the techniques of blood conservation that are promulgated by the Society for the Advancement of Blood Management. Some of the techniques that we use include acute normovolemic hemodilution, advanced cell saver technology and our on site point-of-care blood conservation and coagulation monitoring center.

• Acute normovolemic hemodilution - The patient's blood is removed and stored using a sterile technique prior to cardiopulmonary bypass. The blood removed is then replaced with volume expanders to enhance the circulation of the patient's remaining blood. This technique prevents the blood that is removed from being exposed to the adverse effects of the cardiopulmonary bypass machine. Although the cardiopulmonary bypass machine is necessary to perform most cardiopulmonary bypass procedures, it can cause unintended damage to the patient's own blood. At the end of the procedure, when cardiopulmonary bypass has terminated, the patient's blood that was removed is given back.
  
  
• Cell Saver - A device that recycles the patient's own blood that is shed during surgery. During the procedure the shed blood is collected, washed with saline and then returned to the patient.
  
  
• On site point-of-care blood conservation and coagulation monitoring center - A state-of-the-art intraoperative laboratory is set up to provide us with on site information regarding the status of the patient's blood clotting system. These tests allow us to obtain important information throughout the procedure to help us minimize blood loss during cardiac surgery and optimize blood conservation.

Education

Education is the keystone for NCAC's "Programs for Success". We provide customized education programs to fit your needs:

• refresher courses for anesthesiologists - a concise series of lectures and workshops designed to update cardiac or generalist anesthesiologists about theory, new pharmacologic agents, blood conservation techniques, etc.
  
  
• onsite clinical "mini-fellowships" - for anesthesiologists wanting to get back into cardiac anesthesia. While cases are ongoing, informal tutoring is performed. Other services including supervision and proctoring where one experienced anesthesiologist shadow's another.
  
  
• onsite TEE training, mentoring and mini-workshops. Perioperative TEE is now a crucial component of modern cardiac surgery. Our customized programs can take your practitioners through the basics, and get them started in building an experiential database. This process is essential for TEE credentialing. In addition, we can assist in preparation for the National Board of Echocardiography examinations, with our extensive library of hard-to-find lectures, tutorials, and articles.

NCAC is committed to a continuous education program. We will assist you in setting up an education program for your department including:

• formal monthly lectures series
• ACLS certifications
• specialty workshops
• journal clubs
• guest speakers
• accessing medical online information