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1.   AIM

These recommendations on staffing of Departments of Anaesthesia are made to ensure that vocational trainees in Anaesthesia are trained with appropriate supervision, and in Departments with appropriate Educational and Quality Assurance Programs.

2.   INTRODUCTION

2.1   “Staffing” refers to the numbers of senior and junior medical staff, nursing staff and technical staff in the various areas of clinical activity, and also the numbers of departmental management and clerical staff.

2.2   Participation in personal education, teaching, quality assurance, research and other activities is fundamental to the provision of high quality and safe clinical anaesthesia, and requires appropriate staffing levels.

2.3   In training institutions, appropriate staffing is necessary to provide a satisfactory environment in which trainees can acquire the knowledge, experience and support necessary to fulfill the requirements for the award of Fellowship of the College.

3.   PRACTICE OF SENIOR MEDICAL STAFF IN TRAINING HOSPITALS

3.1   Different industrial awards and enterprise agreements have given rise to widely varying weekly work patterns, often resulting in staff spending less time in the training hospital.

3.2   Differentiation of staff into either full-time or visiting medical specialists is not relevant in the context of their input to trainee education and welfare. The contribution of specialist anaesthesia staff to trainee education should be considered in terms of the number of hours or sessions per week that the specialist spends in the training institution.

3.3   A core of staff who spend all or most of their professional time in the institution is important in order to ensure continuity of training programs, cohesion and corporate memory.

4.   DUTIES OF SPECIFIC STAFF

4.1   Medical Staff

The duties of specialist anaesthetists are outlined in College Professional Document TE6 Guidelines on the Duties of an Anaesthetist. In institutions accredited by ANZCA for training, the duties are the same but with a greater focus on all aspects of training.

Time free from clinical duties must be set aside for the other professional duties of the Department and its members. Such activities include organisation and participation in teaching programs for anaesthesia trainees and other professional groups, administration, research, continuing medical education, quality assurance and audit, participation in maintenance of professional standards programs, and in programs directed at maintaining the health and welfare of professional colleagues. (College Professional Documents TE9 Guidelines on Quality Assurance in Anaesthesia and PS16 Statement on the Standards of Practice of a Specialist Anaesthetist.)

In order to provide time for other professional duties, clinical work should not exceed an average of 0.7 of specialists’ workload. This discretionary time should be allocated to staff by the Department Director in such a way as to ensure that all the Department’s goals are achieved and individuals’ expertise is best utilised, while still guaranteeing that all staff have adequate allocated time for professional development.

Medical staff duties are as follows:

4.1.1   Director of Anaesthesia

The Director has a primary responsibility to ensure that the Department functions safely and efficiently. Administration and personnel management comprise a significant part of the workload. Approximately 40% of the Director’s workload should be allocated to clinical activities. If the Director is a part-time appointee, appropriate time must still be available for managerial duties as well as other professional activities. This may result in a clinical commitment of less than 40%.

4.1.2   Deputy Director of Anaesthesia

In large Departments, a Deputy Director should be appointed to assist the Director with administrative tasks. Approximately 40% of the combined workload of both the Director and Deputy Director should be allocated to clinical duties.

4.1.3   Supervisor of Training

Supervisors of Training are the College’s representatives for training in anaesthesia in its approved hospitals. They provide liaison between Registered Vocational Trainees and Hospital Authorities regarding matters related to training as well as with Regional Education Officers and the central administration of the College. (College Professional Document TE5 Policy for Supervisors of Training in Anaesthesia). The Supervisor is responsible for ensuring adherence to the College’s Policy on In-Training Assessment for trainees in anaesthesia. College Professional Document TE14 Policy for the In-Training Assessment of Trainees in Anaesthesia. At least one half day per week should be allocated to accomplish the necessary tasks. A greater period of time may be required in larger Departments.

4.1.4   Assistant Supervisor of Training

In larger institutions, an Assistant may provide useful support for the Supervisor of Training in his/her demanding and time-consuming role. An allocation of one half day is appropriate.

4.1.5   Module Supervisors

Module Supervisors have a broad understanding of, and experience in, the contents of the modules they supervise, and work directly with both trainees and the Supervisor of Training. There will be a variable number of Module Supervisors in any Department, depending upon the range of clinical experience available to the trainees. The Module Supervisors should have time allocated to fulfil their duties. (College Professional Document TE2 Policy on Vocational Training Modules and Module Supervision).

4.1.6   Specialist Anaesthetist

In addition to clinical activities, all specialist anaesthesia staff have obligations to teaching, some administrative duties, maintenance of professional standards and other non-clinical activities. The time made available for these activities must be assessed in the context of the other professional activities of all the Department members.

4.1.7   Trainee

The trainee is a specialist-in-training who requires clinical supervision as an essential component of the training process. A trainee can contribute to the clinical service of the Department to a limited degree after an initial period of Level 1 supervision. The extent of such service will be dictated by the educational needs of the trainee, the experience of the trainee, the mix of surgical specialties, subspecialty training requirements and the roster pattern, and may therefore vary significantly between institutions. The supervision of trainees must comply with the minimum requirements outlined in College Professional Document TE3 Policy on the Supervision of Clinical Experience for Trainees in Anaesthesia

Trainees should be assigned educational, quality assurance and administrative responsibilities appropriate to their level of training. Time must be allocated for these duties.

4.2   Non-Medical Staff

4.2.1   Assistant for the Anaesthetist

The presence of a trained assistant for the anaesthetist during the conduct of anaesthesia is a major contributory factor to safe patient management. The assistant may be a nurse or a technician.. Staff numbers must be sufficient to provide a dedicated assistant available both in-hours and after-hours for every patient who is being anaesthetised. (College Professional Document PS8 Guidelines on the Assistant for the Anaesthetist).

4.2.2   Nurses

Nurses may fill the role of the assistant for the anaesthetist and/or provide staffing for the Recovery Room.

For staffing of the Recovery Room, the ratio of nurses to patients needs to be flexible so as to provide no less than one nurse to three patients, and one nurse to each patient who has not recovered protective respiratory reflexes or consciousness. (College Professional Document PS4 Recommendations for the Post-Anaesthesia Recovery Room).

4.2.3   Technical Staff

Technicians may fill the role of the assistant for the anaesthetist and/or provide technical support for equipment maintenance and repair.

The required number will vary with each particular hospital and be dependent on the relative involvement of other groups (eg Biomedical Engineering Department) and external service contracts.

4.2.4   Secretarial Staff

Secretarial staff duties include support for individual anaesthetists, support for departmental administration and support for educational and quality assurance activities. The number of staff required will depend on the size and activity of the Department. Refer to College Professional Document TE7 Guidelines for Secretarial and Support Services to Departments of Anaesthesia.

5.   STAFFING NUMBERS

5.1   The Department of Anaesthesia must have (College Professional Document TE1 Recommendations for Hospitals Seeking College Approval for Vocational Training in Anaesthesia):

5.1.1   A minimum of one specialist anaesthetist who holds the Diploma of FANZCA

5.1.2   A minimum of two full time equivalent (FTE) specialist anaesthesia staff with qualifications acceptable to Council

5.1.3   At least one full-time equivalent (FTE) specialist anaesthetist for each trainee

5.1.4   No more than two non-specialist anaesthetists (including trainees) for each FTE specialist anaesthetist employed.

5.2   The calculation of the number of specialist anaesthesia staff required to provide all the required anaesthesia-related services is complex. The following matters must be fully understood in order to make a meaningful calculation:

5.2.1   Number of hours of clinical work provided per week by each staff member

5.2.2   Full extent of the weekly clinical services to be staffed

5.2.3   Full extent of out-of-hours clinical cover to be staffed

5.2.4   Leave of all types taken by clinical staff in weeks per year

5.2.5   Changing work practices and enterprise agreements

5.2.6   Need to ensure that staff are not expected to work when fatigued

5.2.7   Other factors specific to the individual hospital.

5.3   Assumptions underlying staffing workload calculations:

5.3.1   The calculations aim to ensure that there are adequate staff numbers to allow appropriate supervision of trainees.

5.3.2   The Director of the Department should have 40% of available time counted as contributing to the Department’s staffing of in-hours clinical work.

5.3.3   All specialists should have 70% of available time counted as contributing to the Department’s staffing of in-hours clinical work.

5.3.4   Supervisors of Training should have at least one session per week available for their duties.

5.3.5   Module Supervisors should have up to one session per week available for their duties.

5.3.6   Trainees in basic training should not have any time counted as contributing to the Department’s staffing of in-hours clinical work.

5.3.7   Trainees in advanced training should have 20% of available time counted as contributing to the Department’s staffing of in-hours clinical work.

5.3.8   Provisional Fellows should have 30% of available time counted as contributing to the Department’s staffing of in-hours clinical work

5.3.9   The number of weeks per year that staff are available should be calculated. This should account for the duration of all types of leave (annual, sick, bereavement, study, educational, and other). The number of weeks available for workmay be different for specialists and trainees.

5.3.10   There should be appropriate staffing to ensure that staff can be rostered off after overnight duties.

5.3.11   The number of weeks per year that the Department is working at full capacity should be calculated; this is often 50 weeks per year.

RELEVANT PROFESSIONAL DOCUMENTS

TE2 Policy on Vocational Training Modules and Module Supervision.

TE3 Policy on Supervision of Clinical Experience for Voctional Trainees in Anaesthesia

TE5 Policy for Supervisors of Training in Anaesthesia

TE6 Guidelines on The Duties of an Anaesthetist

TE7 Guidelines for Secretarial and Support Services to Departments of Anaesthesia

TE9 Guidelines on Quality Assurance in Anaesthesia

TE13 Guidelines for the Provisional Fellowship Program

TE14 Policy for the In-Training Assessment of Trainees in Anaesthesia

PS4 Recommendations for the Post-Anaesthesia Recovery Room

PS8 Guidelines on the Assistant for the Anaesthetist

PS16 Statement on the Standards of Practice of a Specialist Anaesthetist

COLLEGE PROFESSIONAL DOCUMENTS

College Professional Documents are progressively being coded as follows:

TE Training and Educational

EX Examinations

PS Professional Standards

T Technical

POLICY - defined as 'a course of action adopted and pursued by the College'. These are matters coming within the authority and control of the College.

RECOMMENDATIONS - defined as 'advisable courses of action'.

GUIDELINES - defined as 'a document offering advice'. These may be clinical (in which case they will eventually be evidence-based), or non-clinical.

STATEMENTS - defined as 'a communication setting out information'.

This document is intended to apply wherever anaesthesia is administered.

This document has been prepared having regard to general circumstances, and it is the responsibility of the practitioner to have express regard to the particular circumstances of each case, and the application of this document in each case.

Professional documents are reviewed from time to time, and it is the responsibility of the practitioner to ensure that the practitioner has obtained the current version. Professional documents have been prepared having regard to the information available at the time of their preparation, and the practitioner should therefore have regard to any information, research or material which may have been published or become available subsequently.

Whilst the College endeavours to ensure that professional documents are as current as possible at the time of their preparation, it takes no responsibility for matters arising from changed circumstances or information or material which may have become available subsequently.

Promulgated: 2000

Date of current document: April 2006

© This document is copyright and cannot be reproduced in whole or in part without prior permission.

College Website: http://www.anzca.edu.au/