ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

Leading the debate onthe future of anaesthesia:the College’s roleDr Leona WilsonIt is timely to consider where the specialtyof anaesthesia is heading and how theCollege can provide leadership or support.Recent events, such as the formation ofthe College of Intensive Care Medicineof Australia and New Zealand and thehealthcare reforms being contemplatedin both Australia and New Zealand havehighlighted these questions for us.What is anaesthesia? Does it start whenthe patient is attached to the monitorsin theatre and end with extubation? Ifwe consider the mortality reports andresearch on outcomes from anaesthesia,there is a significant contribution tooutcome from pre-operative assessmentand preparation, and post-operativemanagement, as outlined by Alan Merryin this feature. Our patients expect morethan “simple” technical expertise fromtheir anaesthetists. They expect to be ableto make a fully informed choice abouttheir treatment after being providedwith the necessary information in a waythat supports their sense of their ownautonomy. They expect to have a goodoutcome despite suffering significantillnesses. At the same time, those whofund healthcare are trying to contain costs,and one way is bringing our patients in tohospital “just in time” for their procedures.Garry Phillips outlines some of thegovernment expectations of changesin healthcare delivery.If we are to fulfil our commitment tothe provision of safe and high qualityanaesthesia, then we need to incorporatethese aspects within our care, andanaesthesia become peri-operativemedicine. If we don’t, then in my opinionwe run the risk of being sidelined. VanessaBeavis has advocated for anaesthetiststaking a full role in the peri-operativeprocess. I know that peri-operativemedicine is concerning to some becauseof the changes in work practices that mayensue, especially for those in privatepractice, and during the post-operativephase of peri-operative medicine. Inthis edition of the Bulletin there arefour different examples of how thepre-anaesthesia phase is managedexcellently in private practice anda description of an anaesthetist-ledperioperative care unit by Paul Myles.Michael Cousins has outlined theimportant role of pain medicine, especiallythat of the acute pain teams, in perioperativemedicine. The College hassupported research into how peri-operativemedicine would work and await the results.It is important that we do this researchbecause if we don’t, others will and willmake statements about anaesthesia thatdisplay a lack of understanding of ourspecialty. However, the final outcomeof this challenge (is anaesthesia perioperativemedicine?) will be determinedas much by how anaesthetists shape theirwork in the workplace as by the decisionsthat our College makes. I would like toacknowledge the excellent work of Su-JenYap in leading the Peri-Operative Medicinetaskforce, which developed into thePeri-Operative Medicine Committeeof the College.And so, what is the College’s role indetermining the future of anaesthesia?The College was founded in 1952 toserve the community by fostering safe andhigh-quality patient care in anaesthesia,intensive care and pain medicine, withthe main areas of focus being education,standard setting and support for research.This should be our starting point inconsidering the future of anaesthesia.How do we go about meeting that aim? Theconstitution outlines in more detail theobjects of the College; these include:• promote and encourage the study,research and advancement of the scienceand practice of anaesthesia, intensivecare medicine and pain medicine;• promote excellence in healthcareservices and cultivate and encouragehigh principles of practice, ethics andprofessional integrity in relation tomedical practice, education, assessment,training and research;• determine and maintain professionalstandards for the practice of anaesthesia,intensive care medicine and painmedicine in Australia and New Zealand;But first, we need to consider how anew model of care is developed. Whoserole is it? The College’s, the hospitalDepartments of Anaesthesia, theindividual anaesthetist’s, the institutionsin which anaesthetists work, governmentsor other stakeholders’? Or is it all of them,interacting in a fluid manner? How do wemake sure we take advantage of new andinnovative ideas from “outside the loop”?Once such models of care are developed,the College’s role in supporting researchinto the safety and quality of such careis obvious, and such work is alreadyunderway. For instance, a grant has beengiven in support of the REASON (researchinto elderly patient anaesthesia andsurgery outcome numbers) study.The College’s role of standard setting is acore function: there are standards alreadydeveloped in the pre-operative setting andthe post-operative phase, and as the modelof care changes, then these will need tobe amended, and others developed asneeded. Education, both of trainees andspecialists is the third core function, andperi-operative medicine is an essential partof both the pre-Fellowship curriculum andassessment, and continuing professionaldevelopment program.The increasing focus on perioperativemedicine as part of the futureof anaesthesia is an exciting directionfor anaesthesia, and the College willbe providing support for research,development of standards of practice,and education of trainees andcontinuing education of specialistsin peri-operative medicine.Dr Leona WilsonANZCA PresidentReferences:PS7: Recommendations on The Pre-AnaesthesiaConsultation Guidelines on Consent forAnaesthesia or SedationPS3: Guidelines for the Managementof Major Regional AnalgesiaPS4: Recommendations for the Post-AnaesthesiaRecovery RoomPS15: Recommendations for the PerioperativeCare of Patients Selected for Day CareSurgeryPS41: Guidelines on Acute Pain ManagementThe ANZCA Bulletin June 2009 21