Anesthesia Care Teams make all the difference

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With the introduction of Anesthesia Assistants things have changed in the OR.

To address the shortage of anesthesiologists in Ontario, the provincial government introduced Anesthesia Care Teams (ACTs) into Ontario hospitals in 2007. A big part of this announcement incorporated a new emerging health profession, the Anesthesia Assistants (AAs) – trained health professionals who provide technical and operational support to anesthesiologists.

ACTs are made up of many health-care professionals who work with patients before, during and after anesthesia is administered. An ACT is lead by an anesthesiologist and supported by an AA, together with additional health-care providers such as acute pain practitioners and post anesthesia care unit nurses. This focused team works interprofessionally to make sure all patient anesthetic needs are met.

To become an AA, a health-care practitioner has to be a registered respiratory therapist (RRT) or a registered nurse (RN) with at least two years of critical care experience in the last four years. Practitioners go through basic and advanced training, followed by a clinical placement.

AAs are specially trained health professionals who participate in the care of stable surgical patients during general, regional or local anesthesia under the supervision, and immediate availability, of an anesthesiologist.

At St. Joseph’s Health Care Centre in Toronto, AAs have been in place for a little over a year. In just one year of working with AAs Dr. Winston Wong, Chief of Anesthesia at St. Joseph’s, has already seen a difference in induction times, among other things. “When AAs are present in the OR we see a decrease in start time for complex cases from 45 to 30 minutes, leading to a more efficient use of OR time,” says Dr. Wong. “Also, there is less stress put on the anesthesiologist when there is an AA on site because an AA is able to direct attention to items such as patient positioning, protecting the eyes and administration of antibiotics.”

Having worked in the OR before and after the introduction of AAs, Grant Mawhinney, an RRT for over 23 years and now an AA at St. Joseph’s, has also seen a change in patient induction times since graduating from the AA program in February 2007. “Induction time has definitely decreased. Before, the anesthesiologist had to prepare the patient alone. With the help of an AA cases can be started faster and the time it takes from when a patient enters the room to when the surgeon makes the first incision is greatly reduced,” he explains.

Mawhinney’s responsibilities have also changed and evolved into something he is excited about since becoming an AA. His role has progressed from one that was more technical with some clinical, to one that is highly clinical, while still giving technical support. “My role now is very dynamic. I assist with all major cases including IV and arterial line insertion, assisting with spinal and epidural placement, assisting in induction and monitoring patients while they go under and emerge from anesthesia,” says Mawhinney.

The ACT model is still being piloted in many hospitals around Ontario, but both Mawhinney and Dr. Wong believe this model will have a positive effect on anesthetic care in the province. “The introduction of AAs and ACTs has definitely improved work life for anesthesiologists,” Dr. Wong says. “I believe time will prove the ACT model is a good one.”

Hospitals originally chosen to test ACTs in Toronto were Sunnybrook Health Sciences Centre, Toronto East General Hospital and the University Health Network, but since then many Toronto hospitals have integrated ACTs into their ORs with great success.

Only three schools in Ontario offer the Anesthesia Assistant Graduate Certificate, one of them being The Michener Institute for Applied Health Sciences in Toronto. The Michener Institute created the AA program in partnership with the Ontario government in 2005, and began the program in January 2006.

With 24 graduates from Michener’s program so far, and another 70 students set to finish the advanced course in 2008, the position of anesthesia assistant is well on its way to being an important role in Ontario hospitals.

For more information visit: www.michener.ca/ce/.