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

fellowship affairsPrivate practice:improving patient careContinuedACT AnaesthesiaACT Anaesthesia Pty Ltd is based inCanberra and was established in 2003,the first private practice group in that city.Originally comprising four anaesthetists,the practice now has seven anaesthetistswho work across all specialties. Thebusiness operates as a service companycharging fees to the doctors on a perpatient basis.The main practice aims atestablishment were:1. The provision of high quality clinicalcare through good information collectionand use. We were particularly mindfulof the changing nature of our specialtyand the increased emphasis on patientthroughput. We were keen to mitigatewhere possible any adverse effectsthat this could have on patient care(and anaesthetist stress levels!)2. To create a service that would handlebilling and other administrativefunctions such as leave cover andlist management. In particular, wewanted a systematic approach topre-operative informed financialconsent whenever possible.3. To create a refuge away from the hospitalenvironment. We hoped to create aphysical place that would serve severalpurposes: to see our patients in a calmrooms environment; to facilitate andconsolidate our educational endeavoursand to have a forum to regularly discussany relevant professional issues.We specifically did not want to make ourlives more complicated or to increase ournon-clinical and out of hours workload.At inception we agreed to employboth nursing and administrative staffand to run two separate but interlinkedpractice domains. The nursing staff collectpreoperative clinical information frommultiple sources including the patients(via telephone), the surgeon’s rooms - whoprovide our patients with our practiceinformation – and GPs and hospitals. Oneof our major challenges was to establishpositive relationships and networks withall these groups unaccustomed to our moreproactive approach.Protocols have been developed to aidour staff in determining what informationis collected and how it is presented andused. In general the information includes:a completed perioperative questionnaire,relevant specialist and past medical oranaesthetic information. The consolidatedclinical information includes a summaryof financial information, which hasbeen provided to the patients by ouradministrative staff, and is available tothe anaesthetist at all times via a secureweb-based calendar system.Patients identified by any means,including direct referral, as requiringadditional preoperative input are seen inrooms consultation or managed by othermeans as necessary. The patients seen inthe rooms vary according to doctor practiceand preference. At least one consultant alsosees selected patients as house calls. Thesepatients are generally frail and elderly orhave mobility problems. The majority ofpatients receive a post-operative reviewtelephone call from the nursing staff.While establishing the office we hadto deal with issues such as practiceindemnity, IT security and medical recordsmanagement. Our communication flowwas based on readily available Internettechnologies to collect, manage anddistribute information amongst staffand doctors. We also use this to employstaff working remotely using VOIP andServer based technologies. Some of theless technologically inclined doctors nowappreciate the greater utility and realtime provision of information thissystem allows.Even if we could achieve a perfectweb-based environment we acknowledgethe need for a physical office. At the officethe practice members attend one regularcombined session per month for continuingeducation and addressing practiceadministrative issues. Attendance andactive participation at this meeting is seenas a vital part of maintaining the integrityof the group. Clinical and administrativestaff report to the meeting and providerelevant feedback or suggestions. We haverun several clinical practice audits andgenerally include a journal discussion aspart of the meeting. At the meeting wealso receive our collated monthlypost-operative reports. We view thecompleted information we receive foreach clinical episode very positivelyboth in terms of individual feedbackand also for its value in risk management.Six years on we feel we have progressedsignificantly towards our aims. We striveto ensure our practice is responsive to everchangingdemands. As a group we also paytribute to our staff who strive to translateour mission into reality.Dr John Ellingham(ACT Anaesthesia: Dr J Ellingham, Dr T Lo,Dr D Lu, Dr P. Martin, Dr C McInerney, Dr PMorrissey, Dr M Wilson)32The ANZCA Bulletin June 2009