Key elements of perioperative medicine: gradual change or paradigm shift?
RESTRUCTURING OF PERIOPERATIVE MEDICINE IS ESSENTIAL TO IMPROVING OUTCOME AFTER SURGERY
J Rigg
University of WA, Perth, WA
The practice of anaesthesia and surgery is constantly changing. Many changes recently introduced or recommended are changes that clinicians may not like, may feel powerless to influence and about which they have had no, or minimal, consultation. We have to accept that change will continue to occur.
This presentation will argue that the best outcomes for patients undergoing surgery, or any procedure that requires anaesthesia or ‘sedation’, will be achieved if stakeholder clinicians work together more effectively and provide the leadership required to make procedural care more effective, efficient and safe. Key stakeholder clinicians for creating a new paradigm of the peri-operative medicine component of surgical care are surgeons, anaesthetists and nurses. The term ‘anaesthetists’, used in this abstract, includes intensive care and pain medicine specialists.
Hundreds of recent publications can be cited to support the view that health care is less safe than it could be, and that the impetus for change is strong and is coming from many directions; eleven are cited here 1-11. Equally, many publications also attest to the fact that health care standards are uniformly very high in Australia, by any international comparisons. (6,7,12,13)
Nearly two years ago, in the June 2004 Presidents Report in the ANZCA Bulletin, reference was made to ‘forces that threaten our professionalism and the quality and safety of our care’, citing in particular ‘workforce shortages’ and the spectre of ‘nurse anaesthetists’. The latter is a ‘solution’ that many wish to impose on the profession to solve the perceived problem of the former. I believe the best approach for the profession to avoid the imposition of an unwelcome ‘solution’ is to have a pro-active interdisciplinary group working together to achieve clinically and economically superior alternative methods of procedural care delivery.
This presentation will outline specific clinical problems known to present to anaesthetists pre-operatively, intra operatively and post operatively. I will propose that local problems can be solved by local interdisciplinary leadership that promotes enhanced clinical responsibility for ‘clinical nurse anaesthesia specialists’ who have completed a course of specialist training which provides the skills necessary to safely execute the advanced responsibilities of these new clinical roles.
Anaesthetists, nurses and surgeons must work together closely to define, precisely, such roles and the detailed curriculum for the training of nurses to the level that they are deemed competent to fulfil these advanced clinical responsibilities.
Local solutions are required for local problems, because the range of problems differs widely among different geographic locations. What is required is that government, colleges and the health insurance and indemnity industries support anaesthetists, surgeons and nurses working together to achieve greater work practice flexibility, and new effective, efficient and safe approaches to peri-operative care. This presentation will enumerate the problems and suggest processes to enable stakeholders to work progressively towards effective local solutions.
Time of Presentation
Saturday 13 May 2006 - 1330-1500
References
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2. WILSON RM, RUNCIMAN WB, GIBBERD RW et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471
3. WILSON RM et al. An analysis of causes of adverse events from the Quality in Australian Health Care study. Med J Aust 1999; 170: 411-415
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6. Australian and New Zealand College of Anaesthetists, 2006. Safety of Anaesthesia in Australia: a review of anaesthesia related mortality, 2000-2002. Editor: N Gibbs.
7. Western Australian Audit of Surgical Mortality, WAASM annual report, 2004. Crawley: The University of Western Australia 2004
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Lancet 2002; 359:1276-1282
