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Smartflow Anesthesia Modernization
Share PrintTo decrease a facility’s expenditure on anesthesia gases, providers can lower their fresh gas flow during an anesthetic. This approach is completely safe for patients and reduces risks of surgical site infections caused by hypothermia. This solution can be easily taught through methodical, clear, and consistent education. However, health care providers are understandably resistant to change, especially when the necessary behavior change seems complicated. Through an educational approach, providers will be asked explicitly to stop using desflurane and nitrous oxide, and to decrease their fresh gas flows to under 2 liters.
Origin:
April 2022, Richmond VA Medical Center (Richmond, Virginia)
Adoptions:
6 successful, 1 in-progress
Awards and Recognition:
iNET Seed Investee, iNET Spread Investee, Quality on Parade People's Choice Winner 2023, VA Lean Yellow Belt awardee: January 2024, VA Strong Practice Forum: February 202, Featured ... iNET Seed Investee, iNET Spread Investee, Quality on Parade People's Choice Winner 2023, VA Lean Yellow Belt awardee: January 2024, VA Strong Practice Forum: February 202, Featured Innovation on Diffusion Marketplace Newsletter: February 2024, Entrepreneur in Residence: Innovation Ecosystem Fellowship FY2025
Partners:
Anesthesiology, Diffusion of Excellence, Healthcare Innovation and Learning, iNet Seed-Spark-Spread Innovation Investment Program, Innovation Ecosystem, Nursing, Surgery, VHA Innovators Network
Recent Updates
Overview
Problem
Over the course of the investm ... There are exorbitant costs in health care. ORs often find great difficulty in cost cutting because of the urgency and fragility of patient health in that setting. Anesthetics, a necessary tool in surgeries, are often overused. This increases costs and adds risk to patient health through potential infections via hypothermia.
Over the course of the investment cycle, a prototype educational series was delivered to various anesthesia provider groups, feedback was sought from these groups, and the iterative process was completed. Through this process of iteration, a program was developed that met most of the users' needs without complicating the material excessively.
Prototyping allowed me to pivot quickly and refine the program to assist in the distillation of the message. Health care providers are typically inundated with new information, research, and procedures. It is incredibly important to ensure messaging accounts for this, thus achieving a true human-centered design approach. See more
Videos
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Solution
Videos
Respiratory gas conditioning is important to protect the lungs and is a universal standard of care. Cold and dry respiratory gases reduce ciliary activity in the respiratory epithelium. The reduction of mucociliary clearance can lead to atelectasis and infections, conditions referred to as postoperative pulmonary complications. Various studies demonstrated, that protective ventilation approaches allow the reduction in incidence of postoperative pulmonary complications (PPC). Warming and humidifying the respiratory gases using low-flow anaesthesia can reduce these negative effects on the respiratory epithelium.
Anesthesia providers can set targets for end-tidal oxygen (EtO2) and end-tidal anesthetic agent (EtAA), and the Et Control software2 will automatically and efficiently adjust fresh gas concentrations to quickly achieve and maintain these targets, even with changes in the patient’s hemodynamic and metabolic status. Providers can switch to manual fresh gas control at any time. Safety mechanisms help maintain targets, so providers can practice low-flow anesthesia with confidence.
The ecoFLOW feature shows how much anesthetic agent is being consumed and shows the anesthetic agent costs associated with each case. This features allows providers to track agent costs, helps support low-flow anesthesia practices and may help hospitals achieve their sustainability goals in reducing greenhouse gas emissions
The Circle Breathing System Explained in under 2 minutes.
- Printable methodology for performing low flow anesthesia with Sevoflurane Low Flow with Sevofluranve
- Printable methodology for performing low flow anesthesia with Isoflurane Low Flow with Isoflurane
- Comprehensive list of pertinent research articles and informational white papers. References
- Memo about Desflurane elimination, eliminating use of pipeline Nitrous Oxide, and transitioning practice to low flow. Memo from Assistant Under Secretary for Health for Clinical Services
- Gas Man® is the answer for teaching, experimenting and planning anesthesia administration on the computer before trying it in the operating room. Gas Man® is used by hundreds of practicing anesthesia providers and dozens of medical and veterinary teaching programs around the world. GasMan: Uptake and Distribution
Files
Links
Results
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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1-3 months
Process buildout-identify champions/early adopters at local facilities-engage section and executive leadership for support-provide implementation guide-train anesthesia providers on low flow-provide local marketing materials-ongoing support -
3-6 months
-monitor for adoption process locally-engage site champion, support as needed -
6-12 months
Metrics-monitor local purchasing data-monitor national purchasing data-highlight trends and celebrate wins
Departments
- Quality Management
- Anesthesia
- Pharmacy
- Biomed
- Purchasing and supplies
Core Resources
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Files
- In this review article, comprehensive information is given about the theory and basics of low flow anesthetic techniques. Mainly, however, practical aspects of low flow anesthesia are discussed to enable the reader to perform this technique safely in clinical practice, Low Flow Theory
- CO2 absorbents were introduced into anesthesia practice in 1924 and are essential when using a circle system to minimize waste by reducing fresh gas flow to allow exhaled anesthetic agents to be rebreathed. For many years, absorbent formulations consisted of calcium hydroxide combined with strong bases like sodium and potassium hydroxide. When Sevoflurane and Desflurane were introduced, the potential for toxicity (compound A and CO, respectively) due to the interaction of these agents with absorbents became apparent. Studies demonstrated that strong bases added to calcium hydroxide were the cause of the toxicity, but that by eliminating potassium hydroxide and reducing the concentration of sodium hydroxide to <2%, compound A and CO production is no longer a concern. Carbon Dioxide Absorption During Inhalation Anesthesia: A Modern Practice
- Clinical techniques for use with rebreathing systems. Low-flow, minimal-flow and metabolic-flow anaesthesia
Links
- However, extensive research has found no evidence of harm in humans due to sevoflurane use with low FGF. Notably, countries of the European Union never introduced minimal FGF restrictions and routinely use low FGF in practice. Furthermore, purposeful selection of CO2 absorbent can eliminate any remaining safety concerns surrounding low flow sevoflurane. ASA Statement on the Use of Low Gas Flows for Sevoflurane
Risks and mitigations
Risk | Mitigation |
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Low adoption rate | Leadership can mitigate this risk with support of practice change. The reason behind low adoption should be explored and mitigated. Often, motivation and awareness are quite frequently the underlying reason. |
Comment
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