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| EDITORIAL |
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| Year : 2013 | Volume
: 7
| Issue : 3 | Page : 291-293 |
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Post-operative anesthesia rounds: Need of the hour
Sukhminder Jit Singh Bajwa1, Mohamad Said Maani Takrouri2
1 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
2 Professor of Anesthesia, Consultant Anesthesiologist at KFMC, Residency program director, Head of Neuroanesthesia Section, Administration of Anaesthesiology and Operating Rooms, King Fahad Medical City, Riyadh, Saudi Arabia
| Date of Web Publication | 18-Dec-2013 |
Correspondence Address:
Sukhminder Jit Singh Bajwa
Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0259-1162.123205
How to cite this article:
Bajwa SS, Takrouri MM. Post-operative anesthesia rounds: Need of the hour. Anesth Essays Res 2013;7:291-3 |
Anesthesiology has made huge advancements in the last two decades that has resulted in greater patient care and surgeon's satisfaction. However, post-op period can be stormy at times which can be attributed to various surgical and anesthetic complications. In majority of the health set-ups throughout the globe, post-op care is usually provided by the surgeons and that somehow eclipses the significant peri-op role of anesthesiologists.
Satisfaction among post-op patients can be considered as an important quality indicator of anesthesia healthcare. [1],[2] Patient satisfaction is being given priority throughout the world nowadays to improve the healthcare services. [3] However, measuring the degree of satisfaction is confronted with numerous challenges owing to non-availability of universally applicable guidelines, methods, and scores. The various scoring systems such as LOWA and many others suffer from various one or the other potential limitations including, but not limited to, differences in ethnicity, culture, race, geographic, literacy, intellectual levels, and economic and social backgrounds. [4 ]
Various studies have been carried out with an emphasis on post-op anesthesia services satisfaction, but none of these studies has conclusively established the anesthesia satisfaction among patients. [2],[5],[6],[7],[8] In one of the major studies carried out to assess the patient satisfaction with modified LOWA score, it was observed that larger efforts are required to translate and modify the scaling parameters so as to successfully apply such scoring systems to a population of different races, ethnicities, and religions. It was also observed that during peri-op and post-op period, satisfaction scores achieved were much higher among male patients as compared to female patients. [9 ]
As per the Accreditation Council for Graduate Medical Education (ACGME) requirements published in July 2011, post-graduate anesthesia residents have to get an experience of 0.5 month in patient care immediately after anesthesia, which includes, but is not limited to, direct care of patients in the postanesthesia-care unit and responsibilities for pain management, hemodynamic changes, and emergencies related to the postanesthesia-care unit. The council further asserts that the clinical responsibilities in the postoperative care unit be limited to the care of postoperative patients, with the exception of providing emergency response capability for cardiac arrests and rapid response situations within the facility. Designated faculty must be readily and consistently available for consultation and teaching.
However, there does seem to exist a wide virtual gap between the perception among patients of developed and developing nations regarding information, awareness, significance, and quality of anesthesia care. [2],[5],[6],[7],[8] Literacy and intellectual level, economic constraints, health infrastructure, and numerous other factors are responsible for a perceived variance among such patients. The concept of "continuity of care," that is, pre-anesthetic evaluation, performance of anesthesia, and post-op care by the same anesthesiologist, is difficult to practice in majority of health set-ups. [10] Surprisingly, even the available data from developed nations have shown that there is a growing deficiency in "continuity of care" by the anesthesiologists. [11],[12] Delivery of anesthesia services by different anesthetic personnel at pre-anesthetic check-up clinic (PAC), operation theater, and post-op ward further adds to the poor rapport between patients and the anesthesiologists. Moreover, the practice of post-op visit by anesthesiologists is not universally followed, and in majority of the institutions, there are no established protocols for post-op anesthesia rounds. The degree of difficulty is further enhanced as there are no established universal guidelines regarding post-op care by the anesthesiologists, except for a vigilant care in post-op anesthesia care unit.
A single visit by an anesthesiologist can be extremely satisfying for the patient, as compared to no visit at all, as has been observed by few studies. [5],[6],[7],[8] Even if the same anesthesiologist who administers anesthesia visits the patient, it is possible that patient may not be able to recognize him, as has been observed by various survey studies. [11] One possible reason for this is the interaction of patient and the anesthesiologist occurs during a stressful period when the patient is already under the influence of premedication and anxiolytics. As such, it has been established that prolonged patient contact is an essential prerequisite for patient satisfaction. [11],[13] Further, more than one visit by the anesthesiologist has failed to successfully establish higher satisfaction scores among patients. [14] On the contrary, multiple visits and interaction by the surgeons lead the patient to believe that the surgeon is the "only" treating doctor. Such perceptions and behaviors are few of the important factors which can hinder the advancement and popularity of the anesthesiology disciple.
Also, how much satisfaction a patient can derive from the visit of anesthesiologist depends upon the literacy, intellectual level, and socioeconomic status of the patient. [11] Post-op visits can contribute directly or indirectly to advancement in surgical outcome, which is considered as an important component of healthcare ergonomics. [15] The first-hand feedback from patient gives an immense scope for consolidation of the existing good services and improvement of future services. However, developing a reliable, comprehensive, and valid questionnaire is a difficult task, and one should take into consideration various local factors prevalent so as to obtain unbiased feedback. [9] The planning for the post-op visit should be done during pre-op evaluation and explanation of the procedure to the patient. [16] During the post-op period, any complication related to anesthesia, which might have occurred, is managed and clearly explained to the family members.
Assessment of pain and its relief is the main benefit of such post-op visits. It is the best time to ask from the patient about the overall anesthesia experience. The various surveys and studies related to patient satisfaction can best be carried out during this period only if anesthesiologist himself visits the patients, rather than getting a questionnaire answered by them. Other pertinent queries which can be elicited during these visits include any evidence of awareness during surgery. During such visits, anesthesiologist can also inquire about any incidence of side effects during post-op period resulting from the anesthesia procedures, so as to treat them in appropriate manner. These visits can possibly help in developing pre-op and intra-op protocols to possibly minimize such adverse effects during post-op periods. A significant number of patients are admitted to intensive care unit (ICU) for postoperative care after emergency surgical procedures whenever cardiac and respiratory support is indicated. Majority of the ICUs throughout the globe are managed by anesthesiologists. As a result, these specialists have become well versed with the art of post-op management of patients as well as any complication arising thereof.
The ideal time for post-op visit is 12-24 h as the effect of anesthesia almost terminates by this time. The interaction between anesthesiologist and the patient is most fruitful during this period and patient can also respond to any queries during this period. The label of peri-operative physician does not do justification to clinical reputation of anesthesiologist if he is unable to make post-op visits and thorough assessment of the post-op status.
In contrast, patients undergoing day care surgeries demand maximum attention from the anesthesiologists as they are discharged on the same day. Most of the responsibility related to post-op complications lies with anesthesiologist. However, with the advent of modern anesthetics and drugs, the day care surgery and anesthesia has advanced tremendously. In addition to post-op visit, the best way to follow such patients is by giving the contact number of the attending anesthesiologist and the surgeon. Besides, anesthesiologist is the most suitable physician to manage these immediate post-op complications during recovery from anesthesia.
Post-op anesthesia visits have become a necessity in modern-day anesthesiology practice for sustaining the progress and scientific advancements, especially in the developing nations. It is further emphasized that quality assurance, cost containment, and patient safety in anesthesia can be achieved by prioritizing the individual patient's preference. The post-op anesthesia visits can be extremely useful if three essential variables of anesthesia satisfaction are taken care of, that is, adequate pre-operative patient's information, anxiety management, and bringing quality and efficiency in post-op care. [9],[16]
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