How are anesthesiologists leaders in the medical field?

How Anesthesiologists Are Leaders in Medicine

Anesthesiologists serve as leaders in healthcare transformation by leveraging their unique position across the entire perioperative continuum to drive value-based care, coordinate multidisciplinary teams, and implement data-driven quality improvement initiatives that reduce complications, mortality, and costs. 1, 2

Strategic Leadership in Value-Based Care Transformation

Anesthesiologists must work as integrated units with hospital and surgeon leadership to become leaders themselves, focusing on providing better care at decreased cost through standardization, clinical pathways, quality metrics, and data-driven iterative improvement. 1 This leadership role represents not an expansion but a rediscovery of the specialty's value to the healthcare community. 1

Unique Positioning for Leadership

Anesthesiologists occupy an unparalleled position to drive perioperative transformation because they:

• Interact with patients across the entire surgical continuum and possess expertise in acute physiology, risk assessment, and crisis management that spans preoperative, intraoperative, and postoperative phases. 2
• Have direct knowledge of complications, perioperative mortality, and performance metrics that affect a hospital system's and insurance payor's ability to compete in value-based systems. 1
• Serve as the first touchpoint to reengage patients in their own healthcare, coordinating with multiple stakeholders to improve outcomes while reducing costs. 2

Preoperative Leadership and Risk Stratification

Anesthesiologists 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. 2

Key preoperative leadership functions include:

• Directing risk stratification programs that identify high-risk patients requiring a "surgical pause" to mitigate modifiable risk factors before nonurgent procedures. 2
• Coordinating shared decision-making with surgeons, primary care providers, and specialists to reset patient and family expectations about postoperative outcomes based on realistic surgical risk assessments. 2
• Partnering with surgeons to present a united front when counseling patients about realistic expectations, particularly for high-risk patients whom surgeons may feel pressured to operate on despite poor candidacy. 2

Data Analytics and Information Technology Leadership

Anesthesiology departments can use their perioperative domain knowledge to build or partner with hospitals' information technology groups in creating scalable and validated clinical and financial data marts and dashboards to implement value-based care initiatives. 1

Critical data leadership roles include:

• Implementing clinical decision support systems within electronic health records or as standalone applications that interface with EHRs to enable clinical pathway implementation and compliance monitoring. 1
• Identifying clinical comorbidities that can be used to risk-adjust value-based payments. 1
• Using healthcare data analytics as required platforms for any sustainable performance improvement initiative, leveraging data as an advantage to help departments and organizations compete more effectively. 1

Clinical Pathway Development and Standardization

Anesthesiologists establish clinical pathways and quality metrics that create vertical and horizontal integration across surgical service lines, ensuring disease states and treatment methodologies that cross all services are guided by the same evidence-based tenets. 1

Specific pathway leadership includes:

• Establishing pathways for opioid prescribing at discharge, determining who receives opioids and appropriate quantities. 1
• Implementing multimodal intervention strategies to prevent postoperative delirium, particularly in elderly high-risk patients. 2
• Advocating for evidence-based postoperative protocols including early mobilization, multimodal opioid-sparing analgesia, and timely removal of urinary catheters. 2

Research and Evidence Generation Leadership

Perhaps one of the most important contributions anesthesiologists can make is to directly involve themselves in research to assess and develop evidence-based approaches, as data are not generated without studies and deep dives into patient care issues. 1

Patient Safety and Quality Improvement Leadership

The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in care processes. 3 These efforts have dramatically reduced patient harm, with anesthesia-related mortality decreasing from 20 deaths per 100,000 anesthetics in the early 1980s to less than one death per 100,000 currently. 4

Critical Care and Extended Perioperative Leadership

Anesthesiologist-intensivists provide leadership and clinical guidance towards improving patient outcomes when working outside their usual environment, playing multiple roles within multidisciplinary teams. 4 Their understanding of physiology, pharmacology, and resuscitation skills positions them optimally to manage critical care units and provide extended postoperative care. 5

Common Pitfalls to Avoid

• Do not confine practice solely to the operating room when anesthesiologists' expertise in acute physiology and risk management can add value throughout the perioperative continuum. 2
• Avoid task fragmentation during critical periods, as fragmentation doubles medication errors; implement automated electronic record systems and appropriate workload ratios. 2
• 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. 2
• Do not assume all anesthesiologists will participate in these new leadership activities, but a subset must do so and should be supported by colleagues in their efforts. 1