Many have pointed out how anesthesiologists have reduced malpractice via systems to reduce medical error. Can this model be applied to primary care? Medical Economics takes a look:

Even those who say that such safety strategies are applicable elsewhere acknowledge that anesthesiologists did start out with certain . . . well, advantages.

A major one is the “controllability of the environment” in which they generally work, says anesthesiologist Allan S. Frankel, director of the office of patient safety at Partners HealthCare, in Boston, and a faculty member of the Institute of Healthcare Improvement, a research and educational organization in Cambridge, MA. “Anesthesiologists take care of one patient at a time in a very controlled setting,” says Frankel. That limited focus, in effect, enables them to zero in on environmental problems in a very precise way.

The “limited-focus” factor also benefits the specialty in another way, Frankel says: Unlike other medical disciplines that “have to know a ton of stuff about a lot of different diseases,” anesthesiologists “have to know a lot about a few things.” That intense-but-narrow focus makes solving clinical problems easier than it might otherwise be.

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  • Anonymous

    The difficult airway algorithm anesthesia has ends a caveat something like “consider cancelling the case”

    I luxury the EM physician does not have.

  • Anonymous

    From the article:
    “Unlike other medical disciplines that “have to know a ton of stuff about a lot of different diseases,” anesthesiologists “have to know a lot about a few things.” That intense-but-narrow focus makes solving clinical problems easier than it might otherwise be.”

    I do believe it may be hard to extrapolate anesthesia’s success to such disciplines as internal medicine, family medicine, and emrgency medicine where the knowledge base needs to be much wider. Additionally, anesthesiologist’s typically have much more control of outcomes in their specialty than the above mentioned specialties.

  • gasman

    The petulant whine of the ER doc.

    Of course the Difficult Airway Algorithm has a caveat to consider cancelling the case. Because the majority of the patients presenting to the OR are there electively; it is perfectly reasonable to revive a patient while they are still revivable rather than forge ahead needlessly. Regroup, reconsider, and resume care when a new plan is crafted. The culture that makes this work is important. Machismo is not rewarded. We do give accolade to our peers who subjugate their impulses to prove that they can get the airway if they just do this one more thing, and choose to save the patient over their ego. The opposite of this culture is typified by surgical mentality that can declare the operation a success even if the patient later dies.

    Too often our EM colleagues forge ahead in airway management themselves when indicators suggesting greater than normal difficulty are obveous. Once shit has hit the fan they page us stat, documenting how many minutes it takes for us to arive, but not documenting how many minutes they fiddled about before paging us.

  • Anonymous

    Typical gas from a gasman. Why the offense? It is not really a stab at you. In fact a bit of jealousy that you can take your time and devote to one patient at a time. I am caring for usually no less than ten patients at time. Respiratory failure can’t be cancelled or postponed.

    “The petulant whine of an ER doc”

    How often do you get paged stat to the ER? In ten years of practice I called for anesthesia help with an airway (which incidently never came). Nevertheless, I wouldn’t save my ego over saving a patient given other alternatives available.

    I usually enjoy your posts because they are usually thoughtful. I am surprised to see you so ruffled and looking down your nose.