Change—it does not come easily, and it is something we resist when we are in our comfort zone. But some 60 million people did not resist, and took “change” into their own hands when they voted a new and untested politician as President of the United States. I am not suggesting that this was a healthy change, nor that we should embrace changes of such magnitude in our lives; I am merely suggesting that we pay heed to the words of physicist William G. Pollard. He said, “Without change there is no innovation, creativity, or incentive for improvement. Those who initiate change will have a better opportunity to manage the change that is inevitable.” The Society of Cardiovascular Anesthesiologists (SCA) should have a hand in managing that inevitable change in medicine.
The Society has a number of upcoming initiatives whose descriptions, on the surface, may sound daunting. These initiatives are the first step toward ensuring that cardiovascular anesthesiologists remain in step, if not ahead, of the practice. We note that the ways in which we practice medicine, teach medicine, and are compensated for delivering medical care are all experiencing radically transformative times. Rather than have the perspective that our current ability to practice and deliver high-quality medical care may be threatened by change, we will embrace change, teach to the changes, teach the teachers, and manage the results. We must respond by leading, not following. We will be involved in directing these new paths, leading the way when feasible, and collaborating when appropriate. A few of these new initiatives will be discussed in this current article and others in next month’s issue.
- Ultrasound. Ultrasound is the stethoscope of the present. Mastery of medical ultrasound is being taught early in medical school, and graduates entering residency programs have an expectation for comprehensive ultrasound training. Many residents start training with more ultrasound expertise than some of their teachers. Many health systems, in an effort to enhance quality and perhaps get a jump on insurers’ next moves, are mandating that ultrasound programs and laboratories be accredited and practitioners be certified. SCA will sponsor educational programs that teach perioperative ultrasound to interested anesthesiologists, those who are learning de novo, and those who already practice and wish to hone their skills. Our newest educational offering, Perioperative Ultrasound, is a hybrid course led by Dr. Josh Zimmerman with program associate directors Drs. Bradley Coker and Nick Markin, leaders of ultrasound education in their respective institutions. This course offers more than 100 hours of online education plus an opportunity to practice hands-on techniques in face-to-face workshops. Transthoracic echocardiography and critical care echocardiography will be showcased, along with lung ultrasound, gastric ultrasound, and vascular evaluation. An electronic log with supervisor feedback will allow you to enter your own cases and work toward a certificate of completion. The course will be available after the New Year. Please visit www.scahq.org/2017PUC for more details.
- Quality and Performance Measures. In the United States, clinician performance is increasingly being used as a tool to determine quality of care and to gauge (or limit) reimbursement. The larger the number of performance metrics for which anesthesiologists can be held accountable, the more value we offer as members of the care team. The American Society of Anesthesiologists (ASA) has been working through its Committee on Performance and Outcomes Measurement to create specialty-specific metrics; in collaboration with cardiovascular anesthesiology leaders from SCA, a number of new measures have been discussed. Many of these new measures are based information gathered from on the Society of Thoracic Surgeons (STS) database, which has been the cornerstone upon which quality metrics have been designed. In the future, SCA may be well-served to share accountability for some of the more common STS-defined outcome measures. Another very close partnership with STS has been in the STS/SCA Blood Conservation Guidelines. Blood conservation truly is a shared accountability in the cardiac operating room. Data support that a blood conservation strategy and fewer transfusions will lead to improved outcomes.1-2 Using this premise, a performance measure was created that assesses adherence to the Class I recommendations from the STS/SCA Blood Conservation Guideline3, such as antifibrinolytic agent use and minimization of hemodilution. ASA publicly posted and professionally distributed the measure for comment. After revisions, the House of Delegates approved the composite measure; it was then sent to the Centers for Medicare and Medicaid Services for government approval. It is called “Adherence to Blood Conservation Guidelines for Cardiac Operations using Cardiopulmonary Bypass (CPB).”
Let’s embrace change with a positive vision and a proactive contribution to its imminent arrival. SCA plans to continue these and other initiatives so that we continue to identify ourselves as valuable, subspecialty-practicing physicians, collaborating to effect positive change.
Linda Shore-Lesserson, MD
- LaPar DJ, Crosby IK, Ailawadi G, et al. Blood product conservation is associated with improved outcomes and reduced costs after cardiac surgery. J Thorac Cardiovasc Surg. 2013;145(3):796-803; discussion 803-794.
- Ferraris VA, Hochstetler M, Martin JT, Mahan A, Saha SP. Blood transfusion and adverse surgical outcomes: The good and the bad. Surgery. 2015;158(3):608-617.
- Society of Thoracic Surgeons Blood Conservation Guideline Task Force. 2011 Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines. Ann Thorac Surg. 2011;91(3):944-82.