The recent announcement of the
Anesthesia Care Team (ACT) pilot project has been controversial
(see this paper's "Nurse
'gassers' sink standards: MDs," Vol 4, No 7, page
3). This model formally endorses two anesthesia-related
health care roles that will work under the supervision
of an anesthesiologist to address the critical shortage
of anesthesiologists in the province. Anesthesia Assistants
provide intraoperative technical and operational support
to anesthesiologists (similar to the Quebec model) and
Acute Care Nurse Practitioners will assume a perioperative
role in pre-admission centres, post-op pain management
and procedural sedation. This team-based model improves
working conditions for the consultant anesthesiologist,
enhances access to certain types of procedures and allows
the anesthesiologist to work more efficiently —
using their skills where they are most needed.
This approach does not create independent,
US-style Nurse Anesthetists — it provides a better
alternative. Anesthesiologists will lead these teams
and continue to be responsible for direction and quality
of care, patient safety and resource planning.
It's imperative that we recognize
that not all "medical acts" need to be performed by
doctors. There are significant risks to our specialty
if we don't engage the interprofessional movement. Competitive
and inefficient situations have arisen in ophthalmology
(optometry), obstetrics (midwives) and with US Nurse
Anesthetists partly due to protectionism and issues
of "turf". What is best for patients in the long run?
Implementing the ACT model in Ontario
won't diminish standards. It is a responsible use of
a limited resource. The team-based approach will free
up the specialist anesthesiologist to be available for
the really important things: your mother's hip operation,
your wife's epidural or your husband's AAA repair.
Dr Stephen Brown, Chair, OMA
Section on Anesthesiology, Chief, North York General
Hospital Department of Anesthesia
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