Anesthesia Alert: The Collaborative Model of Anesthesia Care

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CRNAs and MDs team up to benefit the healthcare system and patients.


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.

Flattening the hierarchy

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.

United approach

The CAT model is quite different from the Anesthesia Care Team (ACT) model, which, according to the American Society of Anesthesiologists, involves anesthesia care provided personally by an anesthesiologist or by a non-physician anesthesia practitioner directed by an anesthesiologist. This, in my opinion, inherently limits value-based care by limiting CRNAs from their full contribution to caring for patients. CAT, on the other hand, encourages all anesthesia providers to use their entire skillset — and expand it — to the benefit of patients. Teams don't limit value — they maximize value. With a value-based approach, we don't utilize concepts like "supervision," but instead allow professionals to focus on patient outcomes.

I believe the ACT model also limits the privileges of CRNAs and their ability to practice (or potentially, compete effectively) in the future. This is a scarcity approach that inherently drives up costs from duplicative services. When everyone is maximizing value at the local level, more broadly, costs of care decrease and access to care increases.

Using interprofessional collaboration in anesthesia isn't new. However, we see the need to formalize the concept so that hospital and ASC administrators can more easily understand how the model increases value for their facilities.

Anesthesiology services are changing, and providers must work to increase value while lowering costs. During and after COVID-19, the country needs all anesthesiology professionals to make their full contribution to patient care. That's what maximizes value. Collaborative anesthesiology teams — whatever their makeup — are the future. OSM

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