Anesthesia.... you are never closer to death

[bulgethetwine]

“STATEMENT ON GRANTING PRIVILEGES FOR DEEP SEDATION TO NON-ANESTHESIOLOGIST SEDATION PRACTITIONERS

(Approved by the ASA House of Delegates on October 20, 2010)”.

It is available for download at their website:
http://www.asahq.org/For-Members/Clinical-Information/Standards-Guidelines-and-Statements.aspx

In this document anesthesiologists discuss how they would regulate all deep
sedation by others (including emergency physicians), with mandatory
credentialing and supervised testing administered by them. They even are
asking for ACLS and PALS certification! Despite our airway skills,
emergency physicians are treated no differently than dentists or podiatrists
-- we are all generic “non-anesthesiologists”. Your residency/fellowship
training can only qualify you for deep sedation if completed within the last
2 years, and then only with a supporting letter from your program director!

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[bulgethetwine]

Funny how a specialty that gave away the inherent value of their specialized training to mid-levels wants to be obstructive to EM, and regulate our specialty.


Professional arrogance at its finest (shrug).

"STATEMENT ON GRANTING PRIVILEGES FOR DEEP SEDATION TO NON-ANESTHESIOLOGIST SEDATION PRACTITIONERS

(Approved by the ASA House of Delegates on October 20, 2010)".

It is available for download at their website:
http://www.asahq.org/For-Members/Clinical-Information/Standards-Guidelines-and-Statements.aspx

In this document anesthesiologists discuss how they would regulate all deep
sedation by others (including emergency physicians), with mandatory
credentialing and supervised testing administered by them. They even are
asking for ACLS and PALS certification! Despite our airway skills,
emergency physicians are treated no differently than dentists or podiatrists
-- we are all generic "non-anesthesiologists". Your residency/fellowship
training can only qualify you for deep sedation if completed within the last
2 years, and then only with a supporting letter from your program director!

 

[WilcoWorld]

But I only ever perform moderate sedation...on purpose.

 

[Tiger26]

Maybe we should come out with a policy statement saying all deep/general anesthesia hospital-wide should require a physician to be present during the entire case . . . .

 

[bulgethetwine]

But I only ever perform moderate sedation...on purpose.

Well, yes, that's what we all do. But this will make use of profofol de facto deep sedation.

 

[docB]

We get into this fight with them every few years. In the past they back down when it gets pointed out that if they really want to screw with us on this they will have to be on call to come to the ER 24/7 for the no pay patients for every shoulder, bartholin's, pedi LP, etc. That usually chills them out.

The reason this latest round has gained traction is they think they are going to start a sedation credentialing course and charge us all to take it every few years (same as we let ourselves get hosed by the ACS and their ATLS silliness). I think the way we'll get out of this is the fact that they don't have a course ready to go and even if they did they can't get everyone who does sedation credentialed in a reasonable time frame (like say 2 years). The hospitals don't want to hear that we started admitting everyone for shoulder reductions or I&Ds just because of this foolishness. The surgeons won't stand for it either.

So I don't think they'll get far with it. But they will keep trying since they think they can get some $$$ out of it.

 

[Zanegray]

On what basis do they propose this? Bad outcomes in other settings? Has anybody compared outcomes in the two settings? Plus they are totally different- what about emergent airways? Ridonkulous!

 

[docB]

On what basis do they propose this? Bad outcomes in other settings? Has anybody compared outcomes in the two settings? Plus they are totally different- what about emergent airways? Ridonkulous!

They make a lot of head way out of bad incidents in office settings with docs who aren't comfortable with airway. In hospital problems in cath lab and the GI suite also feed the fire. In all honesty there are events with sedation in EDs as well.

The problem is that when administrators and regulators start looking for ways to address these issues they start with anesthesiologists because they're the experts in this. The problem is that they have no concept at all of how the EDs work or what sort of volume and time issues we are working with.