Anesthetist for all procedures?

Our hospital provides anesthesia coverage on GI patients requiring general anesthesia or propofol drip. All other GI cases (about 90%) are aptly handled by GI nurses. Anesthesia is not reimbursed for cases in GI so they discourage propofol use.

Thursday 2-9-06, the Oregon Board of Nursing Unanimously agreed that sedation with propofol is both safe and effective when given by RN's in the procedural arena. I would like to extend my thanks to all those who supported us during this turbulent time. We are seeing evidence based nursing in practice.

I am lucky enough to be in a hospital based endo unit that has anesthesia coveage about 99% of the time. We are all trained and do provide sedation when necessary. I actually like doing sedation, however I do not like the fact that I am taking on more liability for no additional pay. So, since anesthesia gets paid much more than I do, they are welcome to it. Our state does not allow RN's to push propofol except for Rapid Sequence Intubation or a mechanically ventilated pt. Since hopefully nothing like that is happening in the GI Lab, we cannot use propofol. Our anesthesia is reimbursed by approx 80%-85% of the billing that is done. Our hospital did a study to find out if it was feasible to keep anesthesia in GI Lab. Because you cannot bill for RN sedation, the money they lost by not having anesthesia was about $190,000 in possible charges lost. We just have one room running 8 hours a day. Think if you had multiple rooms? Financially it was a good decision for the facility. In the 7 years I have been in this GI Lab, I can remember 2 months that we lost money. Definitely worth it!

Thanks for the information-

Would you mind sharing what state you are in?

We actually do charge a "conscious sedation" code for the RN delivering conscious sedation by the way...I am going to look into reimbursement codes now to make sure that we are doing what is proper.

Would you mind sharing the CPT code # that anesthesia is using to get that reimbursement?

Thanks for sharing the information-

Kathy

Hi, I'm in South Florida. I've worked endo for about 3 years, first in a hospital & now in the outpatient setting. When I first started we were using demerol/versed but some of the docs had started using Diprivan given by anes. Now all of our GI guys use Diprivan nearly 100% of the time. The very rare exception is when the patient doesn't have insurance & doesn't want to pay for anesthesia, or if a patient doesn't want sedation at all. I feel so much safer doing procedures this way. Before, we had to sedate & monitor the pt, & assist with the procedure, not to mention charting everything. It could get a little hairy if there was a lot of polyps or a bleed or something. Now we have a CRNA or anesthesiologist to give diprivan & monitor the pt. I can focus on assisting. Not to mention the pts tolerate the procedure better & wake up quicker. As for reimbursment, medicare does pay for anesthesia for endo procedures. Most if not all of our patients are medicare. Oh btw I LOVE LOVE LOVE the outpatient setting. (The hospital endo dept. I worked in had little support from our manager & the highest staff turnover of anyplace I've ever worked)

Before, we had to sedate & monitor the pt, & assist with the procedure, not to mention charting everything. It could get a little hairy if there was a lot of polyps or a bleed or something. Now we have a CRNA or anesthesiologist to give diprivan & monitor the pt. I can focus on assisting.

The first statement violates every Conscious Sedation rule that I have EVER seen. By definition, the RN sedating the patient has no other duties related to the event. This is a good example of how doc manipulate the system and put RNs in a compromising situation. The physicians don't want to add another person in the room for the sake of the almighty $$ and add additional responsibilities to the most important person in the room - the sedating RN.

How in the world are you supposed to administer sedation, monitor the VS, collect samples, run the wires, inject saline or drugs. Would you honestly want your loved one or significant other to be done in this manner? Simple answer is NO.

That practice is utter crap and should be reported to JHACO ASAP.

I am not jumping the RN here people, just the physician / practice that encourages it.

The first statement violates every Conscious Sedation rule that I have EVER seen. By definition, the RN sedating the patient has no other duties related to the event. This is a good example of how doc manipulate the system and put RNs in a compromising situation. The physicians don't want to add another person in the room for the sake of the almighty $$ and add additional responsibilities to the most important person in the room - the sedating RN.

How in the world are you supposed to administer sedation, monitor the VS, collect samples, run the wires, inject saline or drugs. Would you honestly want your loved one or significant other to be done in this manner? Simple answer is NO.

That practice is utter crap and should be reported to JHACO ASAP.

I am not jumping the RN here people, just the physician / practice that encourages it.

It had nothing to do with the doctor, everything to do with the hospital & our manager. Yes money was a factor, I'm sure. Not from the GI Doc's perspective, my pay doesn't come from his pocket, but from the hospital (for profit hospital, Tenet) which is NOT run by doctors but by corprorate types. First of all we didn't have enough staff to have a 2nd RN in the room. The turnover was so high, we just couldn't keep nurses... including myself! I left after only 1 year, & only stayed that long so I could tell myself I'd given it a fair shot. For a while we tried having a tech in the room to assist the endoscopist, but our techs weren't very good so that didn't work out. FWIW some of the docs WERE asking to have a second RN in the room but they were told no. We were supposed to have 2 nurses for Bronchs & ERCPs, but that didn't always happen either. By the time I left most of the docs were using anesthesia (diprivan) so that helped a lot. Now we RN's could focus on assisting. Now I'm in an outpatient center & let me tell you it's a endo nurse's dream. The attitude there is so different. We are supported by our manager. The place is owned by the docs. The stress level is not even on the same chart as it was at the hospital. Yes we're very busy, but at least you know it's going to end & you won't get called back in the middle of the night! And on the rare occasion that we do moderate sedation, yes we get 2 nurses!

Virginia

ETA: as far as billing goes, anesthesia bills seperately & it is covered.

It had nothing to do with the doctor, everything to do with the hospital & our manager. Yes money was a factor, I'm sure. Not from the GI Doc's perspective, my pay doesn't come from his pocket, but from the hospital (for profit hospital, Tenet) which is NOT run by doctors but by corprorate types. First of all we didn't have enough staff to have a 2nd RN in the room. The turnover was so high, we just couldn't keep nurses... including myself! I left after only 1 year, & only stayed that long so I could tell myself I'd given it a fair shot. For a while we tried having a tech in the room to assist the endoscopist, but our techs weren't very good so that didn't work out. FWIW some of the docs WERE asking to have a second RN in the room but they were told no. We were supposed to have 2 nurses for Bronchs & ERCPs, but that didn't always happen either. By the time I left most of the docs were using anesthesia (diprivan) so that helped a lot. Now we RN's could focus on assisting. Now I'm in an outpatient center & let me tell you it's a endo nurse's dream. The attitude there is so different. We are supported by our manager. The place is owned by the docs. The stress level is not even on the same chart as it was at the hospital. Yes we're very busy, but at least you know it's going to end & you won't get called back in the middle of the night! And on the rare occasion that we do moderate sedation, yes we get 2 nurses!

Virginia

ETA: as far as billing goes, anesthesia bills seperately & it is covered.

Good for you for finding an environment that is safe for patients and isn't burning you out. Not a good calling card for Tenet..

The first statement violates every Conscious Sedation rule that I have EVER seen. By definition, the RN sedating the patient has no other duties related to the event.

At our hospital, that is part of the policy. The RN administering sedation is to have no other job than to tend to monitoring and caring for the needs of the sedated pt. However, that is not the case in all hospitals. It is a hospital's policy that dictates the resposibility of the sedation RN. I agree that the RN should have no other responsibility, but that is not always the case.

Jackie