Sedationists

Started by cittykat
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cittykat

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New wave of sellouts. Why are anesthesiologists promoting and advocating for sub-CRNA level “sedationists” with even less training? We are our own worst enemy.


“We believe the best staffing models include anesthesiologists, CRNAs and sedationists, making your life easier, not harder.“



Reminds me of this.



“I have seen Corewell West replace anesthesiologists with emergency medicine and intensive care unit doctors, particularly for endoscopy procedures like colonoscopies, and they are not always informing patients,” said Dr. Kathryn Wladischkin, an anesthesiologist and the present of West Michigan Anesthesia(WMA). “While my physician colleagues are highly trained doctors, they lack the expertise that uniquely qualifies anesthesiologists to manage challenges to a patient’s airway and other complications that could occur during or after anesthesia.”

MSA is warning patients about the dangers that come with this change and encouraging them to ask questions about the medical professionals administering their anesthesia during surgery and procedures.

“Anesthesiologists are the physicians in charge of keeping patients safe when they are under anesthesia, and if a patient flatlines, has a seizure, heart attack or stroke during surgery, it’s the anesthesiologist who leads the team to save the patient’s life,” said Dr. Matt Dellaquila, president-elect for MSA. “Every patient should ask clearly: ‘Will a board-certified anesthesiologist be part of my care team?’ That question can protect lives.”

To amplify this message, MSA has launched a billboard and digital campaign in West Michigan reminding patients of their right to transparency.

“Corewell West has been sidelining anesthesiologists and replacing them with emergency medicine doctors to sedate patients for endoscopies,” said Dr. Ashley Agerson, an anesthesiologist with WMA. “No one can replace an anesthesiologist in the moments that matter most. Leaving patients unaware that an anesthesiologist is not on their team undermines both trust and safety.”

Without an anesthesiologist leading the care team, the unique capability to make split-second decisions and manage challenges and complications is missing, often without the patient’s knowledge. Non-anesthesiology medical programs cannot prepare their graduates to provide the level of expertise of a board-certified physician anesthesiologist. Patients must be told when that level of protection is missing.

“Any attempt by hospitals and healthcare providers to remove anesthesiologists from overseeing the delivery of anesthesia puts a patient’s life at additional, unnecessary risk,” said Dr. David Salama, secretary and treasurer at MSA. “Patients have a right to expect the very best healthcare provider to oversee their care while under anesthesia, and they have the right to know exactly who is providing their care and what qualifications their providers have. Transparency is essential to trust, and trust is essential to safety.”
 
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At a previous job of mine they wanted the RNs to sedate people for bronchs. I guess the theory was if they loose the airway the pulmonologist could intubate. However, they wanted the anesthesiologist to weigh in if they were appropriate for RN sedation. Idk where it was going to be documented that one of us said yes but we weren’t being asked to do an official preop or sign in on the case but I’m sure it would have been documented that we said okay. I of course said no. If the pulmonologist wanted to supervise the RNs they could decide if they needed anesthesia or not. The RNs decided that they would (in their mind) be safe doing Asa 1-3 but not 4… I pointed out that was a terrible way to decide these things and neglected important information like history of difficult airway, etc. I got blank stares and the retort that this was why they needed us anesthesiologists to weigh in. In case you want to condemn my former group - This wasn’t an anesthesia group policy it was the hospitals answer to not enough anesthesia people to go around.
They just don’t get that they have to pay us more…. Or hurt patients in the process. You get what you pay for…
Another topic the ASA is ineffectual on….
 
At a previous job of mine they wanted the RNs to sedate people for bronchs. I guess the theory was if they loose the airway the pulmonologist could intubate. However, they wanted the anesthesiologist to weigh in if they were appropriate for RN sedation. Idk where it was going to be documented that one of us said yes but we weren’t being asked to do an official preop or sign in on the case but I’m sure it would have been documented that we said okay. I of course said no. If the pulmonologist wanted to supervise the RNs they could decide if they needed anesthesia or not. The RNs decided that they would (in their mind) be safe doing Asa 1-3 but not 4… I pointed out that was a terrible way to decide these things and neglected important information like history of difficult airway, etc. I got blank stares and the retort that this was why they needed us anesthesiologists to weigh in. In case you want to condemn my former group - This wasn’t an anesthesia group policy it was the hospitals answer to not enough anesthesia people to go around.
They just don’t get that they have to pay us more…. Or hurt patients in the process. You get what you pay for…
Another topic the ASA is ineffectual on….
Kafka-esque
 
Kafka-esque
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Of course they have it backwards. The highest risk
At a previous job of mine they wanted the RNs to sedate people for bronchs. I guess the theory was if they loose the airway the pulmonologist could intubate. However, they wanted the anesthesiologist to weigh in if they were appropriate for RN sedation. Idk where it was going to be documented that one of us said yes but we weren’t being asked to do an official preop or sign in on the case but I’m sure it would have been documented that we said okay. I of course said no. If the pulmonologist wanted to supervise the RNs they could decide if they needed anesthesia or not. The RNs decided that they would (in their mind) be safe doing Asa 1-3 but not 4… I pointed out that was a terrible way to decide these things and neglected important information like history of difficult airway, etc. I got blank stares and the retort that this was why they needed us anesthesiologists to weigh in. In case you want to condemn my former group - This wasn’t an anesthesia group policy it was the hospitals answer to not enough anesthesia people to go around.
They just don’t get that they have to pay us more…. Or hurt patients in the process. You get what you pay for…
Another topic the ASA is ineffectual on….
Absolutely nuts. Let’s give sedition nurses some of the sickest patients in the hospital and try to keep them alive, with an unsecured airway while the pulm guy tries to choke and drown them. These cases routinely suck and desaturate quickly. In fact I’ve taken to placing an LMA and giving some roc (cue the haters) in the majority of these cases and the pulmonologists now love it. “That was great sedation doc🙄…
 
At a previous job of mine they wanted the RNs to sedate people for bronchs. I guess the theory was if they loose the airway the pulmonologist could intubate. However, they wanted the anesthesiologist to weigh in if they were appropriate for RN sedation. Idk where it was going to be documented that one of us said yes but we weren’t being asked to do an official preop or sign in on the case but I’m sure it would have been documented that we said okay. I of course said no. If the pulmonologist wanted to supervise the RNs they could decide if they needed anesthesia or not. The RNs decided that they would (in their mind) be safe doing Asa 1-3 but not 4… I pointed out that was a terrible way to decide these things and neglected important information like history of difficult airway, etc. I got blank stares and the retort that this was why they needed us anesthesiologists to weigh in. In case you want to condemn my former group - This wasn’t an anesthesia group policy it was the hospitals answer to not enough anesthesia people to go around.
They just don’t get that they have to pay us more…. Or hurt patients in the process. You get what you pay for…
Another topic the ASA is ineffectual on….
Our cardiologists are generally excellent at making this call. They use nurses for sedation for nearly all caths, nearly all pacemakers/defibrillators, and all kinds of ablations other than a fib. The times they request anesthesia, either they tried before and could not get the patient to lie still despite large amounts of meds, or patient has comorbidities that they feel their nurses cannot handle (usually airway/OSA/morbid obesity related). We are virtually never called to rescue their patients (I actually have never seen it happen, but I don't want to say never, because it probably does happen rarely and I just don't hear about it).
 
Our cardiologists are generally excellent at making this call. They use nurses for sedation for nearly all caths, nearly all pacemakers/defibrillators, and all kinds of ablations other than a fib. The times they request anesthesia, either they tried before and could not get the patient to lie still despite large amounts of meds, or patient has comorbidities that they feel their nurses cannot handle (usually airway/OSA/morbid obesity related). We are virtually never called to rescue their patients (I actually have never seen it happen, but I don't want to say never, because it probably does happen rarely and I just don't hear about it).

The sedation you refer to is conscious sedation, not the deeper sedation/ga that non anesthesiologists and non anesthetists are trying to do by pushing the limits
 
The sedation you refer to is conscious sedation, not the deeper sedation/ga that non anesthesiologists and non anesthetists are trying to do by pushing the limits
I agree they are generally targeting mild-moderate sedation, while they will obviously be achieving deep sedation from time to time as well. Not the same, but just sharing that these guys do a decent job of knowing when to ask for help.
 
Our cardiologists are generally excellent at making this call. They use nurses for sedation for nearly all caths, nearly all pacemakers/defibrillators, and all kinds of ablations other than a fib. The times they request anesthesia, either they tried before and could not get the patient to lie still despite large amounts of meds, or patient has comorbidities that they feel their nurses cannot handle (usually airway/OSA/morbid obesity related). We are virtually never called to rescue their patients (I actually have never seen it happen, but I don't want to say never, because it probably does happen rarely and I just don't hear about it).

I had the opposite experience at a quaternary care center with our interventionalists. We rescued or coded a patient every few weeks or so. Unfortunately, our staffing didn’t allow for consistent cath lab sedation coverage, so it kept happening because they were horrible at triaging/waiting.
 
I had the opposite experience at a quaternary care center with our interventionalists. We rescued or coded a patient every few weeks or so. Unfortunately, our staffing didn’t allow for consistent cath lab sedation coverage, so it kept happening because they were horrible at triaging/waiting.
Yet they are consistently great at being late to start and going over scheduled time.