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Smartflow Anesthesia Modernization

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To 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.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

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

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Overview

Problem

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 investm
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Videos

In the US, the very same blood test can cost $19 at one clinic and $522 at another clinic just blocks away -- and nobody knows the difference until they get a bill weeks later. Journalist Jeanne Pinder says it doesn't have to be this way. She's built a platform that crowdsources the true costs of medical procedures and makes the data public, revealing the secrets of health care pricing. Learn how knowing what stuff costs in advance could make us healthier, save us money -- and help fix a broken system.

Solution

To decrease a facility’s expenditure of 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. Through an educational approach, pro ... See more

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.

    Files

    Links

Results

Richmond VAMC experienced a cost avoidance of approximately $10,000 with the lowering of fresh gas flows. Additionally, avoidance of Desflurane saved an additional $5000.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

There are no unsuccessful adoptions for this innovation.

Implementation

Timeline

  • 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

Resource type Resource description
PEOPLE
  • CRNA or Anesthesiologist Champion 1-2 hours per week for 3-4 months to establish program and support implementation
PROCESSES
  • Facility would receive training on low flow anesthesia
TOOLS
  • QR-linked sticker for anesthesia machine
  • Marketing materials to support practice implementation in local facility

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
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.

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About

Origin story

This innovation was developed after watching an unsuccessful deployment of a similar practice in the private sector; however, I saw some opportunities for refinement and meaningful engagement with the most important stakeholder in this conversation, the anesthesia provider. To truly create meaningful and lasting practice change, I had to engage providers by ... This innovation was developed after watching an unsuccessful deployment of a similar practice in the private sector; however, I saw some opportunities for refinement and meaningful engagement with the most important stakeholder in this conversation, the anesthesia provider. To truly create meaningful and lasting practice change, I had to engage providers by influencing their feelings.