Our Approach to Ambulatory Anesthesiology
Montefiore Einstein Ambulatory Anesthesiology specializes in providing comprehensive patient-centered perioperative anesthesia care for adults and children undergoing same-day outpatient surgeries at our state-of-the-art Hutchinson Ambulatory Surgery Center. These surgeries include:
- General
- Head and neck
- Orthopedic
- Plastic and reconstructive
- Ophthalmologic
- Podiatric
- Vascular
- Urologic surgeries
Our team of world-renowned board-certified anesthesiologists and certified registered nurse anesthesiologists (CRNAs) collaborate closely with specialists from the Departments of Surgery, Orthopedic Surgery, Urology, Otorhinolaryngology–Head and Neck Surgery, Ophthalmology, Cardiothoracic and Vascular Surgery and Medicine, to offer comprehensive and personalized care. With expertise in complex cases, we provide anesthesia for more than 15,000 annual ambulatory surgeries at our Hutchinson campus, ensuring safety and comfort throughout the perioperative process. Using the most advanced anesthetic techniques and technologies, we provide multimodal analgesia to help our patients recover faster and more completely after surgery. We are committed to providing the highest quality care, efficient operating room utilization, ideal surgical conditions and rapid recovery with minimal negative side effects to help our patients recover safely at home.
State-of-the-Art Care
Equipped with the latest and most advanced technologies, our state-of-the-art patient-centered Hutchinson Ambulatory Surgery Center comprises 16 modern operating rooms and postsurgical recovery units with more than 30 beds, allowing for advanced surgeries, including robotic and minimally invasive procedures, and patient discharge in less than 24 hours. We use artificial intelligence (AI)-driven preoperative assessments to screen patients’ medical records to avoid unnecessary visits. We have also implemented a new ambulatory care model for anesthesia services, staffing our full-time anesthesia providers at our Hutchinson campus and further strengthening our focus on patient-centered care.
At the Forefront of Pediatric Ambulatory Anesthesia
In addition to caring for our adult patients, we also provide exceptional ambulatory care for pediatric patients (ages 1 year and older) at the Hutchinson campus. Our team of board certified pediatric anesthesiologists has expertise in perioperative care for the most complex pediatric ambulatory cases. They understand the differences in disease processes, physical development and drug metabolism in children, as well as the need to address the distinct psychosocial needs of our young patients and their families.
We are committed to enhancing comfort, ensuring patient safety and providing the highest quality patient- and family-centered care. Our nursing colleagues are also specially trained and experienced in pediatric perioperative care, from preoperative to postanesthetic care unit (PACU) care. We have also enlisted the help of the Children's Hospital at Montefiore Einstein's Phoebe H. Stein Child Life Program to optimize the patient experience.
Advanced Techniques & Technologies
We use the latest anesthesiology techniques and technologies to help improve patient safety and provide the highest quality of care for adults and children undergoing ambulatory surgery procedures. We utilize AI and analytics for health events and risk prediction and to facilitate personalized care plans. We employ the most advanced monitoring techniques and use point-of-care diagnostic tools, such as point-of-care ultrasound (POCUS), to guide treatment plans and ensure optimal outcomes.
Our anesthesiologists are experts in providing multimodal analgesia, including the use of state-of-the-art technology for ultrasound-guided regional anesthesia techniques. We specialize in performing peripheral nerve blocks and neuraxial anesthesia (spinal and epidural anesthesia) with single-injection or continuous catheter techniques, as well as intravenous regional anesthesia. Our multidisciplinary team works closely with our surgical specialists to deliver comprehensive and personalized care, ensuring the best outcome for each patient. We are committed to maintaining constant vigilance throughout each procedure to help ensure optimal safety and comfort.
Ambulatory Anesthesiology Research
We are leading collaborative research and spearheading numerous studies and clinical trials, some of which are funded by the National Institutes of Health (NIH). Our physician-scientists have been focused on optimizing patients for ambulatory surgery and reducing same-day case cancellations by using a case cancellation bundle intervention.
Through our Digital Health Laboratory, our researchers have gathered and thoroughly verified large sets of past surgery-related data that are utilized in a range of research projects. With a strong peer-reviewed publication record, our digital health team has carefully studied and published research on reducing same-day case cancellations. Surgery cancellations, particularly within 24 hours of planned elective surgery, may have negative consequences as they can prolong patients’ untreated health conditions and often result in unnecessary costs.
As part of a multidisciplinary collaborative project, our Digital Health Laboratory created a groundbreaking automated prediction tool to help determine which patients are at a high risk of case cancellation. By identifying patients at a high risk of canceling their surgery in advance, our preoperative evaluation team can provide interventions such as a telehealth psychology visit with our Department of Psychiatry and Behavioral Sciences colleagues or round-trip transportation on the day of surgery.
Our digital health researchers recently conducted a prospective cohort study, published in Anaesthesia, to evaluate the impact of a bundle intervention on same-day cancellations for outpatient otorhinolaryngological procedures. The intervention included communication tools to improve patient engagement and new screening methods to identify high-risk patients before surgery. Over a nine-month period, the cancellation rate decreased from 12.3% to 8.4%.
Our researchers created and validated a machine learning American Society of Anaesthesiologists (ASA) score based on preoperatively available data in the electronic health record to identify candidates for comprehensive preoperative screening and risk stratification. Providers can utilize the machine learning-derived ASA physical status to appropriately screen patients. The ability to identify high-risk patients early in the preoperative process, independent of the provider’s decision, is a part of the process we use to standardize the stratified preoperative evaluation of patients scheduled for ambulatory surgery. We also developed and validated a preoperative prediction tool for prolonged length of stay in the PACU following ambulatory surgery. This tool can be used to guide scheduling in ambulatory surgery to optimize PACU use during regular work hours, particularly in settings with no limitations on PACU bed availability.
Your Ambulatory Anesthesiology Team
Adela Aguirre-Alarcon, MD
Adam S. Yedlin, MD
Our team of board certified anesthesiologists and CRNAs collaborates closely with surgical and medical specialists to enhance patient safety and provide the highest quality of care for our adult and pediatric patients undergoing ambulatory procedures. We develop comprehensive and personalized treatment plans to ensure the best care is provided throughout the perioperative and periprocedural periods.
