Anesthesiology: Limitations and Importance of Professional Teamwork for Patient Care - Case Study Example

Anesthesiology - Work Limitations and the Importance of Professional Teamwork on Patient Care - Introduction Even though statistics show that the administering of anesthesia today is much safer today as compared to few decades ago (Thomas & Cooper, 2002), it remains a fact that patients can suffer from anesthetic death related to cardiac arrest, ineffective management of body fluid, and insufficient respiratory function (Hovi-Viander, 1980). For this reason, the ability of anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) to practice ‘safety’ and ‘effectiveness’ has been considered the twin standards regardless of whether these professionals work in a team or an independent practice. For this study, the contradicting beliefs of the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) on the ability of nurse anesthetists to perform technical functions related to the provision of anesthesia services on patients without any assistance coming from the anesthesiologists including the development and implementation of anesthesia care plan among others will be thoroughly discussed in relation to the importance of professional teamwork for patient care. Contradicting Beliefs of ASA and AANA AANA believe that nurse anesthetists have sufficient knowledge and skills needed to perform a good quality outcome regardless of whether they work as partners with anesthesiologists or work as an independent anesthesia provider with surgeons and/or other health care physicians (Nurse Anesthetists and Anesthesiologists Practicing Together, 1996). Contrary to the belief of AANA, ASA argued the educational curriculum for nurse anesthesists is not designed to enable them to practice independently outside the supervision of anestiologists. Back in late 1970s, ASA intentionally developed the hierarchy of anesthesia care team in such a way that the job of nurse anesthetists is to assist the anesthesiologists in the process of delivering anesthetic care to patients (Blumenreich, 2004). In other words, anesthesiologists and nurse anesthetists are expected to work as a team rather than allowing nurse anesthetists to work independently. Despite the benefits of work hierarchy as proposed by the ASA, a very few health care providers follow ASA’s work hierarchy. Up to the present time, there is really no universal operating procedure when it comes to the provision of anesthesia. The only thing that is certain is that every state in the U.S. considers it legal for nurse anesthetists to work with physicians rather than with anesthesiologists as suggested by the ASA. (Blumenreich, 2004) Because of the possible shortage of anesthesiologists, there are also some states that strictly require the nurse anesthetists to work under the supervision of a physician whereas other states do not require the presence of physicians (Greaves & Eastland, 2007). Very few studies show have tried analyzing whether there is a significant differences on the quality and safety outcome when qualified anesthesiologists or nurse anesthetists deliver the provision of anesthesia to patients. (Pine et al., 2003; Silber et al., 2000) Upon examining the surgery outcomes of patients whose anesthesia was delivered by a professional anesthesiologists and a health care professional who is not supervised by a professional anesthesiologists, Silber et al. (2000) concluded that there is a lower mortality rate in case a professional anesthesiologists were allowed to direct the anesthesia care to patients. On the contrary, the study that was conducted by Pine et al. (2003) found no significant difference on mortality rate given that the provision of anesthesia on patients is given by anesthesiologists alone, an independent CRNA, or anesthesia care team. Due to lack of concrete clinical evidences, it is difficult to prove whether or not there is really a significant difference between the work performance of anesthesiologists and nurse anesthetists. In line with this matter, it would be very costly on the part of the Department of Health to implement a universal rule when it comes to the provision of anesthesia. Given that it is not easy to convince highly competitive anesthesiologists to work in rural areas, health care providers that are based in rural or remote areas have no other choice but to allow nurse anesthetists to administer anesthesia on patients. Importance of Teamwork, Collaboration, and Inter-professionalism With regards to the limited number of available health care professionals, most of the healthcare providers have acknowledged the importance of teamwork, collaboration, and inter-professionalism in order to maximize the available healthcare professionals and meet the healthcare demands of the people. This concept applies in the administering of anesthesia. Through the promotion of teamwork and inter-professionalism, healthcare professionals will be able to utilize the knowledge and skills of each worker. For this reason, it is important to train the health care professionals with regards to the importance of teamwork (Wilson et al., 2005). Basically, strengthening the practice of teamwork within the healthcare organization increases the chance that the health care professionals will deliver a better work performance outcomes related not only with productivity but also the safety of the patients. Aside from maximizing the work efficiency of the available healthcare professionals through teamwork and collaboration, practicing a two-way communication among the anesthetic team is also necessary to prevent anesthetic death caused by miscommunication among the healthcare workers (Smith et al., 2005). In line with this matter, Reader et al. (2007) explained that one of the most common factors that contributes to poor quality patients’ safety is highly associated with the poor communication between the intensive care unit (ICU) nurses and the physicians. Conclusion Back in 1970s, the ASA developed the work-related hierachy designed for anesthesia care team which gives the anesthesiologists the right to guide the nurse anesthesists in the process of delivering anesthetic care to patients. Because of environmental changes which are highly associated with the insufficient number of qualified anesthesiologists combined with the high costs of health care services, the role of nurse anesthetists has gradually changed over time. Partly due to the increasing health care demand and the possible shortage of anesthesiologists, every state in the U.S. considers it legal for nurse anesthetists to work with physicians rather than with anesthesiologists as suggested by the ASA. (Blumenreich, 2004) Since each state has its own work requirements with regards to nurse anesthetists’ work-related scope and limitations, nurse anesthetists should exert an effort to be familiar with the standard of anesthetic care in each state to avoid facing legal problems in the future. References: Blumenreich, G. A. (2004, April). American Association of Nurse Anesthetists . Retrieved October 7, 2008, from Legal Briefs: Standards of care and the ASA medical direction statement. 2004. 72: 91 - 94: http://www.aana.com/resources.aspx?ucNavMenu_TSMenuTargetID=54&ucNavMenu_TSMenuTargetType=4&ucNavMenu_TSMenuID=6&id=2293 Greaves, J., & Eastland, P. J. (2007). The role of nonmedical staff in the delivery of anaesthesia service. Current Opinion in Anaesthesiology , 20:600 – 604. Hovi-Viander, M. (1980). Death associated with anaesthesia in Finland. British Journal of Anaesthesia , 52(5):483 - 489. Nurse Anesthetists and Anesthesiologists Practicing Together. (1996). In: Professional Practice Manual for the Certified Registered Nurse Anesthetist. Position Statement No. 1.9. Park Ridge, Illinois: American Association of Nurse Anesthetists. Adopted August 1996. Revised November 1996 . Pine, M., Holt, K., & Lou, Y.-B. (2003). Surgical mortality and type of anesthesia provider. AANA Journal , 71(2):109 - 116. Reader, T., Flin, R., Mearus, K., & Cuthbertson, B. (2007). Interdisciplinary communication in the intensive care unit. British Journal fo Anesthesia , 98(3):347 - 352. Sliber, J., Kennedy, S., Even-Shoshan, O., & al., e. (2000). Anesthesiologist direction and patient outcomes. Anesthesiology , 93(1):152 - 163. Smith, A. F., Pope, C., Goodwin, D., & Mort, M. (2005). Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence. Canadian Journal of Anesthesia , 52:915 - 920. Thomas, T., & Cooper, G. (2002). Maternal Deaths from anaesthesia. An extract from Why Mothers Die 1997 - 1999, the Confindential Enquiries into Maernal Deaths in the United Kingdom. British Journal of Anaesthesia , 89(3):499 - 508. Wilson, K., Burke, C., PRiest, H., & Salas, E. (2005). Promoting health care safety through training high reliability teams. Quality and Safety in Health Care , 14:303 - 309. Read More