We commend Dr. Groudine for a thoughtful comment on competing interests in delivering institution-specific quality care. One goal of our article was to evaluate associated postoperative outcomes and expended nursing resources based on the anesthetic techniques used. Another purpose of our manuscript was to review the economic (time) impact of performing blocks in the holding area. These blocks were performed (most commonly) by a resident who was assigned for 6 weeks on a regional anesthesia resident rotation. This staffing detail was integral to our published discussion because we deemed that there was little use in describing a care process that did not comply with established care guidelines. However, we did not use the discussion as a forum to address the issue of compliance with such guidelines.
Indeed, the intent of our article was not to advise health care systems regarding compliance to guidelines established by Medicare or the Health Care Financing Administration as they relate to regional anesthesia care delivery. However, Dr. Groudine astutely notes that such issues were less relevant in the patient population of our article, as noted by the patients’ mean age of just less than 27 yr. Each institution should examine its own compliance with regard to Health Care Financing Administration regulations and personnel issues as they relate to the specific patient populations for which the institution provides care.