"We were growing from more of a community hospital to a medical center operation. We were expanding service lines, growing new segments of business in different specialties, and that was creating new demand," Ouimet says. "I could see a difference between what we needed and what we had, and we had a mismatch. The old model wasn't necessarily a fit."
Ouimet looked to high performers demonstrating all best practices in the industry and ultimately decided to go with the group now known as Team Health of Knoxville, Tenn., which uses a CRNA-supervision model.
"Outside the main OR, locations where we needed anesthesia were growing and we needed a way to better meet the needs of all," Ouimet says.
The ability to match the care team model to her needs was important in a new partner, she says, as well as its ability to work with some of the providers the hospital had used under the previous model. But also important was cost savings per encounter, she says.
"Under the old anesthesiologist model, for the same price you have less coverage. But it's not just a dollar thing; it's about skill sets. We were doing procedures in remote locations at odd hours because of anesthesia availability."
Ouimet found she could leverage a much broader team that included an advanced practice nurse provider with a physician supervisor. "We could cover more physical ground, with more eyes on the patient and more flexibility," she says. "Plus, there's more coordination, and handoffs aren't as abrupt."
And, unlike the Providence Regional transition, Wheaton Franciscan Healthcare–All Saints had the added benefit of cooperation from the prior anesthesiology group.
There was need to convince surgeons as well as patients who might expect an anesthesiologist to be present throughout the surgery. But a 30%–40% holdover in anesthesiologists on the team from the previous regime helped, as did a public information campaign.
"We took that as an opportunity to really educate on this," she says. "The anesthesia group, Team Health, was good at understanding the problem, because they wanted to work in partnership with our surgeons and wanted to be credible."
Eventually, Ouimet says, as the new group accommodated requests from some surgeons that anesthesiologists be present throughout surgery, surgeons largely became comfortable with the new group and demands for that type of accommodation fell sharply.
"Now we don't have people not doing cases here because we can't meet the need," she says.
Cindy Lilley, RN, BSN, MSHA, is director of surgical and perioperative services at Legacy Good Samaritan Medical Center in Portland, Ore., part of Legacy Health, which has 1,100 beds and net operating revenue of $1.3 billion in fiscal 2012. She speaks to the improvement in flexibility the hospital's new model of anesthesia—also using Team Health—has provided since it switched to the medically supervised anesthesia model using CRNA in September 2010.