As anesthesiologists, sometimes it seems our identity has already been chosen for us – we are often considered the “second-most” specialty. We are required to be conversant in multiple specialties. When working with an obstetrician, they expect us to have a working understanding of preeclampsia, placenta previa, placental abruption and fetal monitoring. A neurosurgeon wants to work with a clinician who understands intracranial compliance and interventions to modify intracranial volume without compromising cerebral perfusion pressure.
We also have to have a robust understanding of cardiology, including coronary anatomy, pacemaker/implantable cardioverter defibrillators, valvular disease and the difference between systolic and diastolic failure, and are frequently expected to place and interpret a transesophageal echocardiogram probe. General surgeons want us to understand the physiology of a perforated viscus and to institute appropriate transfusion decisions in trauma patients. And of course, we have to understand internal medicine – rheumatoid arthritis and diabetes cause anatomic and physiologic derangements that anesthesiologists must understand and anticipate.
There are many more examples. Anesthesiologists are the utility players of medicine, capable of pinch-hitting for a number of other specialties in a way that could not be reciprocated, and we can take pride in this.
Leveraging Active Digital Technology and Goal-Directed Therapy for Best Perioperative Outcomes
Then there is the need to harness ever-changing technology to drive improvements in care quality and patient outcomes. Gone are the days when medical devices simply provided measurements for clinicians.
Maxime Cannesson, MD, PhD, professor of anesthesiology at the University of California, Los Angeles (UCLA), reported at the American Society of Anesthesiologists’ INSIGHTS + INNOVATIONS 2017 Conference, the combination of physiologic observation and technology to redesign care processes is exemplified by Prof. William Shoemaker’s work with trauma patients at the University of Southern California in the 1980s. Dr. Cannesson noted that this is where the concept of goal-directed therapy was born.
Building on this research, Emanuel Rivers, MD, introduced the concept of early goal-directed therapy in the management of severe sepsis and septic shock, and between 2000 and 2015, sepsis-related mortality decreased from approximately 35% to 20%. Dr. Cannesson pointed out, “We are trying to achieve similar results with anesthesia and surgery: the whole team working together, quickly and efficiently, to improve patient outcomes.
”Despite improvements, Dr. Cannesson said the OR still consists largely of devices that do not communicate with one another and the EHR has replaced the monitor as the technological hub. “That’s where all the data are. The EHR is becoming increasingly important for quality improvement initiatives because we can only change things if we measure them.”
Once the EHR is working properly, providers can move from decision support to closed-loop systems. “Systems like this place physicians in a position where we can orchestrate care and supervise the machine delivering care,” Dr. Cannesson said. “Everything is working independently, with the physician setting the target and checking protocol.”
The issue of whether physicians can take over in the event of system failure is vitally important. In the international standard for closed-loop control systems, it’s written that the operator must be provided enough information to take over safely if the system fails.
At the rate technology changes, there is no room to be complacent when it comes to “keeping up with the times” in our multiple specialties.
Stinson, MD, David. Anesthesiologists – the Utility Players of the Medical Team, anesthesiologynews.com
Doyle, Chase. Digital Quality Improvement: Leveraging Active Technology for Best Perioperative Outcomes, anesthesiologynews.com