Anesthesiologists' Role in Interdisciplinary Teams
Anesthesiologists should function as clinical leaders and integrators within interdisciplinary perioperative teams, expanding beyond the operating room to coordinate preoperative optimization, intraoperative care, and postoperative management through collaborative relationships with surgeons, internists, geriatricians, and other specialists. 1
Core Leadership Functions
Anesthesiologists occupy a unique position to drive value-based perioperative care because they interact with patients across the entire surgical continuum and possess expertise in acute physiology, risk assessment, and crisis management. 1 The American Society of Anesthesiologists emphasizes that anesthesiologists should use the surgical experience as the first touchpoint to reengage patients in their own healthcare, coordinating with multiple stakeholders to improve outcomes while reducing costs. 1
Preoperative Phase Coordination
Lead multidisciplinary preoperative assessment clinics that provide comprehensive evaluation beyond traditional cardiopulmonary assessment, including frailty measurement, cognitive status, nutrition, chronic pain management, substance use screening, and mental health evaluation. 1
Direct risk stratification and optimization programs that identify high-risk patients requiring a "surgical pause" to mitigate modifiable risk factors before nonurgent procedures. 1
Coordinate with surgeons, primary care providers, and specialists in shared decision-making approaches, resetting patient and family expectations about postoperative outcomes based on realistic assessments of surgical risk. 1
Implement multimodal intervention strategies to prevent postoperative delirium, particularly in elderly patients who are at highest risk. 1, 2
Intraoperative Team Integration
Maintain critical surgeon-anesthesiologist dyad relationships as the most essential element of overall team performance, recognizing that dysfunctional relationships can promote unsafe conditions and contribute to adverse outcomes. 3
Serve as integrators of clinical needs and organizational logistics during surgery, combining patient-centered care with operational efficiency rather than viewing these as competing priorities. 4
Pre-assign specific tasks to each team member during surgical pauses or team briefings, ensuring every member understands their designated responsibilities during routine and emergency situations. 5
Postoperative Care Leadership
Establish anesthesiology-led perioperative outreach services that provide proactive daily review and management of high-risk surgical patients on surgical wards, enabling early detection and treatment escalation for deteriorating patients. 6
Collaborate routinely with internal medicine, surgery, and geriatric medicine teams on postoperative wards, implementing specific screening pathways for complications like myocardial injury after noncardiac surgery. 6
Advocate for evidence-based postoperative protocols including early mobilization, multimodal opioid-sparing analgesia, and timely removal of urinary catheters. 2
Specific Interdisciplinary Collaborations
With Surgeons
Partner in reducing mortality and complications by presenting a united front when counseling patients about realistic postoperative expectations, particularly for high-risk patients whom surgeons may feel pressured to operate on despite poor candidacy. 1
Address negative stereotypes each profession holds about the other through open communication and mutual respect, recognizing that well-functioning relationships are conducive to safe, effective care. 3
With Geriatricians
Support expanded roles for senior geriatricians in coordinating perioperative care for elderly patients, with input from senior anesthesiologists to ensure integrated care pathways that are individualized to each patient. 1
Implement age-appropriate protocols that address the higher risk of postoperative delirium, underappreciated pain (especially in cognitively impaired patients), and the need to maintain continuity of community care during hospitalization. 1, 2
With Primary Care and Specialists
Engage multidisciplinary teams comprised of primary care providers and physician specialists working in concert with patients through shared decision-making, particularly in preoperative optimization clinics. 1
Ensure reciprocal information flow between patients, relatives/caregivers, and primary and secondary care services to maintain care continuity. 2
Value-Based Care Transformation
Anesthesiologists must lead the transition from fee-for-service to value-based care by demonstrating how redesigned perioperative care improves clinical outcomes and efficiency. 1 This requires:
Implementing data-driven, evidence-based best practices that provide structure allowing patients to return to optimal functional, cognitive, and psychological health. 1
Segmenting patients based on complexity and risk to personalize and standardize care delivery appropriately. 1
Focusing on cost avoidance through reduced complications and improved discharge disposition, which increases profit margins despite potentially reducing revenue in fee-for-service systems. 1
Beyond the Operating Room
Anesthesiologist-intensivists increasingly play multiple roles within multidisciplinary teams outside traditional environments, providing leadership in performance improvement, perioperative assessment, sedation services, mechanical support, and rapid response teams. 7
Participate in code and rapid response teams where critical care expertise enables early intervention for deteriorating patients. 7
Lead quality improvement initiatives and outcomes research specifically involving surgical patients to strengthen the evidence base for perioperative care. 1
Common Pitfalls to Avoid
Do not ration surgical or critical care based on age alone, but actively participate in discussions about the utility of surgery and resuscitation for individual patients. 1
Avoid confining practice solely to the operating room when anesthesiologists' expertise in acute physiology and risk management can add value throughout the perioperative continuum. 1
Do not assume elderly patients lack mental capacity to make treatment decisions; presume capacity exists unless clearly demonstrated otherwise, and ensure good communication to facilitate informed decision-making. 1, 2
Prevent task fragmentation during critical periods by implementing automated electronic record systems and appropriate workload ratios, as fragmentation doubles medication errors. 5
Recognize that supervising more than two operating rooms simultaneously creates an 87% probability of being unable to intervene in short cases and 40% in long cases, compromising patient safety. 5