Care Team Approach Cited as Possibly Safer

L. Andrew Rauscher, M.D.

To the Editor

I am delighted to see the relationship between anesthesia patient safety and the anesthesia care team begin to be documented through the efforts of the Foundation and your readers’ correspondence. There are few situations where the presence of a second brain and pair of hands is not helpful in an anesthetizing location, if only to ensure the expeditious placement, accuracy, and documentation of required physical monitoring techniques.

The aeronautic analogy to anesthesia is well founded in clinical practice, and the presence of a co pilot is dictated by demands of the system. The primary care-giver, whether anesthesiologist or anesthetist, is always occupied by constant vigilance of available clinical and physical data, and is in a poor position to analyze long-term trends. The secondary care-giver is in a much better position to see the forest rather than the individual fix2s or the destination of the flight rather than the altitude, ground speed, and fuel status of the aeroplane. Many clinical situations demand a joint, synergistic relationship between two providers, especially since we are dealing with increasing numbers of elderly, complex patients. Unlike routine flights, every patient procedure is a journey into the unknown.

Many of the arguments against a very fulfilling team relationship between anesthesiologists and anesthetists have been facile turf battles with a strong economic bias and have largely ignored the right of the patient to the best possible care. The leadership of the two professional organizations purporting to represent the interests of the specialty of anesthesia have so antagonized each other that those of us who have invested a great deal of effort in budding the anesthesia care team concept have little faith in their perception of the real world of anesthesia. As Dr. Mundy suggested in his September letter, we must study the differences in safety between solo physician and team care anesthesia. Economic arguments have no place in dictation of standards of care.

L. Andrew Rauscher, M.D., Chief, Department of Anesthesiology, The Mary Imogene Bassett Hospital, Cooperstown, New York.