Anesthesia Alert: The Collaborative Model of Anesthesia Care

Our group of anesthesia providers came up with a patient care delivery model that involves MDs and CRNAs playing important roles in its overall success. The Collaborative Anesthesiology Team (CAT) capitalizes on the competence and expertise of individual practitioners — not their licensure and education — and ensures the right provider is available at the right time for the right patient.

CRNAs and MDs offer an overlapping scope in services, and our provider group respects and appreciates providers who are members of these professions. Instead of emphasizing their differences, we focus on interprofessional collaboration among the two groups.

There's been no shortage of professional tension between organizations representing the two professions, but our model's focus is on value-based care, not politics.

CAT is based on local resources, which we take into consideration when compiling teams of providers for individual facilities: the skills and expertise of available anesthesia professionals; the facility's case mix; the clinical needs of the patients; and the types of providers the facility's surgeons and staff are accustomed to working with.

Depending on the facility, our provider group often employs an anesthesia coordinator role that is available to "run the board" — make assignments, assist in emergencies, place blocks, offer breaks and help out with other patient care tasks. In facilities where patient acuity is high, the coordinator plays an important role in safe care and must be filled by an experienced individual with a broad array of clinical skills and knowledge.

Coordinators require strong interpersonal and communication skills, as they facilitate patient flow and work directly with surgeons and OR staff. To be judicious with our group's professional resources, we usually utilize coordinators in facilities that run at least five ORs. Physicians who are ideally suited for the coordinator position fill the role or dedicate their time to direct patient care if their services would be more valuably spent in the OR, which is often the case during subspecialty cases. The coordinator's role is ultimately not limited by profession; the goal is to always maximize value.

Anesthesiology services are changing, and providers must work to increase value while lowering costs.

There are many ways to structure CAT in an outpatient setting, depending on a facility's resources and needs. We've implemented teams comprised totally of CRNAs, providers (MD or CRNAs) working independently in individual ORs, or an anesthesia coordinator supporting the entire group. Each of these options are deserving of their own conversation. However, whatever the makeup of the providers, the concept is the same: a team focused on outcomes rather than hierarchy.