Anesthesiology clinics of North America
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Anesthesiol Clin North America · Sep 2000
Outcomes in perioperative medicine and anesthesiology. Into the next millennium.
Although the development of outcomes research in perioperative medicine and anesthesiology has focused on traditional clinical outcomes, there seems to be a transition toward more global assessments of patient-related outcomes. Present trends in outcomes research and EBM may promise an improvement in individual patient and overall quality of care. New roles and opportunities in perioperative medicine and anesthesiology provide additional venues for outcomes research in this millennium.
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Anesthesiol Clin North America · Sep 2000
Critical care and perioperative medicine. How goes the flow?
The specialty of anesthesiology is at a crossroad. Do anesthesiologists stay in the illusionary safe harbor of the operating room and allow critical care anesthesiologists to float alone? How can in-fighting with other medical and nonmedical providers be avoided, while maintaining or expanding the historic and hopefully future roles of anesthesiologists as hospital-based physicians? A different tact is required to redefine the scope of the practice with broadened training to provide increased expertise in the evolving medical marketplace. This approach would include solid training in business, informatics, data management, and critical thinking on outcomes. ⋯ Regarding the question of turf and ownership of the ICU, the authors suggest pursuing the higher ground of an excellent scope of practice, which facilitates the care and activities of surgical and primary care colleagues. These colleagues, administrators, and governmental agencies will have to be re-educated to support training and provide equitable remuneration. Appropriately trained anesthesiologist-intensivists can complement many other care providers, while providing a wide range of services with an economy of care, whether in a semiclosed or closed ICU setting.
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Wider use of optimized multimodal accelerated postoperative recovery programs require that anesthesiologists step out of traditional operating room anesthesia roles and even beyond current pain management consultant roles. Development of optimal postoperative recovery services requires close collaboration between anesthesiologists, surgeons, nurses, physical therapists, administrators, and others involved in the management of patients after surgery. Optimization of perioperative care is an ongoing process enhanced by clinical investigation; however, making significant improvements to clinical practice does not have to wait for additional research data, but should proceed now, with broader application of techniques known to enhance rehabilitation and recovery. Based on existing data, the challenges of developing perioperative recovery services seem likely to be rewarded with improved patient outcomes and reduced cost.
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It has been widely suggested that the specialty of anesthesiology should alter its traditional focus on the technical aspects of intraoperative care toward an expansion of its responsibilities and promotion of the profession as the practice of perioperative medicine. At Vanderbilt University School of Medicine, a program and a practice of perioperative medicine is being developed that reflects the expectation that such activity constitutes appropriate evolution of the profession, improves patient care, improves specialty image, and increases the ability to attract high-quality house-staff.
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Anesthesiol Clin North America · Sep 2000
Preoperative preparation. Value, perspective, and practice in patient care.
Preanesthesia preparation will continue to stimulate creativity and debate. Strategies for process improvement will take various shapes and require tools previously unfamiliar to many medical managers. At UNC Health System, anesthesiologists currently are committed to the centralized preanesthesia clinic approach used in PreCare. ⋯ Electronic conveyance of medical information faces more legal and economic than technical hurdles. The penetration in US households of Internet services presently is less than 40%, whereas the penetration of personal computers is just over 50%. These figures are compared with penetration of corded telephones, televisions, and radios at levels greater tha