Anesthesia in the News
  • Hail an Uber for a Ride From Surgery

    Policies regarding post-surgical transportation of patients have been a critical tenet of healthcare organizations’ discharge process and care coordination—and their commitment to patient safety.

    However, in 2017, the American Hospital Association (AHA) deemed transportation to be a key social determinant of health due to its impact on patients’ access to health services and subsequent health outcomes.  In fact, the AHA document listed transportation issues among older adults as the third most common barrier to accessing health services.  With a 2021 Gallup poll finding that nearly 1 in 3 Americans “readily access rideshare services,” is it time for outpatient surgical facilities to reevaluate discharge regulations and policies regarding post-anesthesia patients?

    In recently published research from the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, Georgia, Jennice Gist, DNP, CRNA; Lisa Muirhead, DNP, APRN-BC, ANP, FAANP, FAAN; and Kelly L. Wiltse Nicely, PhD, CRNA, FAANA sought to explore nurse anesthetists’ practice and encounters with ambulatory surgery patients who experienced transportation difficulties after receiving anesthesia.

    High stakes

    Patients’ inadequate access to transportation to health services appointments can mean missed medical interventions, a reduction in patient compliance, and may result in subsequent poorer outcomes.  Additionally, transportation directly impacts patient utilization of health care services.  If transport is unavailable or unreliable, patients often cancel appointments thus missing out on prescription adjustments and postponing changes in therapeutic regimens.  In some cases, the authors write, the literature reflects that untreatable or late-stage diagnoses have been attributed to transportation disparities.

    Getting a ride from surgery can be tough

    Presently, the majority of discharge plan policies and guidelines for surgical facilities make it mandatory for patients to be discharged and escorted home by a responsible adult following procedures involving anesthesia.  However, the authors observe that this requirement may present considerable challenges and significant burdens for many patients who lack a support system—from making patients feel like a burden to others, to fear of the economic impact for those driver designees’ having to take time off from their work to accompany them.  Other patients may have recently just relocated to a new area or reside in rural areas which entail long distances and extended travel time to the healthcare facility.

    Asking CRNAs

    The researchers’ project, published in the Journal of PeriAnesthesia Nursing, canvassed 2,827 CRNAs practicing in outpatient facilities using an 11-item survey comprised of multiple-choice questions and open text for narrative responses.  They inquired CRNAs about the frequency in which they encounter patients experiencing transportation difficulties post-anesthesia, their views on policies for rideshare options, and their perceptions and professional practices in the workplace concerning patients’ transportation-challenged situations.

    The response rate to the survey was 17% (N = 491) with the majority of CRNA respondents employed by an anesthesia group that provides service for hospital settings.  Most had greater than 10 years of experience and provided anesthesia care in suburban areas.

    Transport troubles and implications

    CRNAs (32%) expressed strong agreement about safety concerns when discharging patients using rideshare services.  However, within the 12 months prior to the completion of the survey, 17% of the responding CRNAs indicated they had encountered at least 6 patients who were scheduled to receive anesthesia care and did not have an approved discharge transportation plan.  As a result, nearly 56% of survey participants’ patients were rescheduled or cancelled for not having approved transportation arrangements.

    While most (43%) of the CRNA respondents work in a clinical practice in which patients have the option of being discharged in a rideshare service if accompanied by an adult, 51% do not ask patients about their discharge transportation plan during the preanesthetic assessment.  The majority of CRNAs surveyed (51%) were unsure of barriers in their primary practice that prevented the implementation of a discharge policy that incorporates rideshare options.  When asked if CRNAs “lack authority regarding a patient’s choice of transportation at discharge,” 44% agreed and 43% disagreed.

    Importantly, some respondents noted narratively that the degree of transportation options was limited in rural settings as Uber and Lyft were not available in their respective areas.

    Transportation translates to access

    The researchers state that their survey “helped to assess the landscape of transportation issues encountered by CRNAs in the ambulatory surgical care setting.”  Based on the responses, nearly 75% of CRNAs encountered patients experiencing transportation issues often resulting in the delay or cancellation of surgical procedures until a facility-approved transportation plan was established.  They conclude that these findings support that transportation is a critical determinant of health that has direct impact on access to surgical services.  Additionally, last-minute cancellations due to a lack of transportation have implications for clinical operations and an economic impact to facilities, providers, staff, and patients which bring a cascading, ripple effect on patient accessibility to timely surgical care.

    In summary, the authors hold that the detrimental impact of transportation access on patient care in an era of burgeoning rideshare service options merits a reexamination of current policies and discharge procedures for patients undergoing outpatient surgical procedures requiring anesthesia.  “Assessing and addressing plans and needs for transportation cannot be overstated,” they write.  “It is an important step in achieving health equity and improved health outcomes.”

    Don’t miss the 1-page infographic the authors have created as a resource for practicing CRNAs which addresses transportation through all 5 phases of care for patients undergoing out-patient procedures involving anesthesia.  That and their full paper, “Could Your Patient be Taking Uber or Lyft Post-Anesthesia? A New Era for Transportation Policy and Practice Considerations,” can be found here.

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