The Annual Meeting of the American Society of Anesthesiologists convened in Chicago last week, hosting more than 16,000 attendees, with the CSA represented by over 40 officers, delegates and members. The meeting featured great educational offerings—and some sobering, yet forward-thinking reflections on the future of anesthesiology.
The only contested election was for the office of First Vice President, won by Dr. Jane Fitch, Chair of the Department of Anesthesiology at the University of Oklahoma. She defeated Dr. Robert Johnstone, Professor of Anesthesiology at West Virginia University and ASA Vice President for Professional Affairs. Both candidates gave articulate and compelling speeches to the House of Delegates and the Western Caucus, but many CSA delegates were impressed with Dr. Fitch’s background as a former nurse anesthetist who later became an anesthesiologist.
Before she went to medical school, “I didn’t know how much I didn’t know,” Dr. Fitch told the Western Caucus. She promised to be a strong advocate for California in our ongoing legal efforts to overturn the state’s “opt-out” of physician supervision requirements for nurse anesthetists.
California’s own Dr. Patricia Kapur, Chair of the Department of Anesthesiology at UCLA, took the spotlight to deliver the annual Emery A. Rovenstine Memorial Lecture. In a message that challenged current practice models, she urged each anesthesiologist to practice “at the top of the license,” and focus on coordination of care, not hands-on delivery, except in the most high-risk cases. She embraced the concept of the “surgical home,” where anesthesiologists manage the entire continuum of preoperative, intraoperative, and postoperative care of surgical patients.
Dr. Kapur’s talk met with some resistance from private practice anesthesiologists in the audience, who question how readily the “surgical home” concept can be implemented and generate income in a state where the majority of anesthesiologists still work in M.D.-only groups. But the CSA partnered enthusiastically with UCLA to celebrate Dr. Kapur’s many accomplishments in an elegant evening reception at the Hyatt Regency Chicago.
One of the most contentious proposals that the House of Delegates considered was the “Deep Sedation for Non-Anesthesiologists Education Program.” The genesis for this program was the directive from the Centers for Medicare and Medicaid Services (CMS) for anesthesia departments to provide oversight for all providers of sedation and analgesia services anywhere in the facility. The demand for training programs in sedation has mushroomed and has led to the creation of many programs of questionable quality.
The Committee on Quality Management and Departmental Administration was charged with developing a training program in deep sedation for non-anesthesiologist physicians in order to compete in this market. Testimony for and against this product in Reference Committee was impassioned. Proponents argued that the ASA has a responsibility to train practitioners of deep sedation in the emergency room, the GI lab, the cardiac cath labs and other areas in the interests of patient safety. Opponents argued that deep sedation is hazardous, is indistinguishable in many cases from general anesthesia and properly should be the domain only of anesthesia providers. After vigorous debate, the measure was referred back to committee for further work.
The Committee on Performance and Outcomes Measures (CPOM), chaired by Dr. Lee Fleisher of the University of Pennsylvania, submitted three new quality measures that were approved by the House of Delegates:
- Post-anesthetic transfer of care: This measure would monitor transfer of care to the ICU, looking for a post-anesthetic formal transfer of care protocol or checklist.
- Continuation of anti-platelet agents in patients with drug-eluting coronary stents: This measure would look for administration of aspirin within 24 hours of surgery start time, or documentation why it is contraindicated.
- Participation in a systematic database for anesthesia care: This measure would track hospital participation in a multicenter, multi-practice data collection and feedback program that provides peer-group benchmarking on the quality and efficiency of anesthesia care.
Dr. Kenneth Pauker, CSA President, represented California’s interests on CPOM.
Surgeon and author, Dr. Atul Gawande presented remarks to an overflowing audience at the meeting’s Opening Session. He discussed the values of teamwork and humility in the operating room and put forward the advantages of checklists in improving surgical safety. His talk focused on many of the concepts developed in his best-selling book, “The Checklist Manifesto.” A more complete summary of his address appears in the ASA “Page 2” blog: Teamwork, humility and generosity: Opening session with Atul Gawande, M.D. An interview with Dr. Gawande regarding "The Checklist Manifesto" can also be found in the CSA Bulletin here.
The ASA is partnering with Lifebox, a nonprofit organization whose goal is to lower surgical mortality to less than 1% worldwide, and place a pulse oximeter in every operating room around the world. Spearheaded by Dr. Gawande, Lifebox raised nearly $15,000 at the ASA as anesthesiologists donated pulse oximeters at a cost of $250 each. For more information and to make your tax-deductible contribution, please click here.
In other election news, CSA former president Dr. Linda Mason was re-elected ASA Assistant Secretary. Dr. Jerry A. Cohen was sworn in as President; Dr. John M. Zerwas is President Elect; Dr. Arnold J. Berry is Vice President for Scientific Affairs; and Dr. Norman A. Cohen is the newly-elected Vice President for Professional Affairs.