Anaesthesia the Scandinavian way. The anaesthesia team model

Anaesthesia the Scandinavian way. The anaesthesia team model The organization of anaesthesia in Scandinavia. The departments of anaesthesiology are headed by an anaesthesiologist who is responsible for the medical treatment. Most departments run an intensive care unit and many have pain clinics and out-of-hospital acute medicine either with helicopter or ground ambulance. The main workforce consists of anaesthesiologists, nurse anaesthetists and intensive care nurses. The anaesthesia team The anaesthesia team is always headed by an anaesthesiologist. The team consists of anaesthesia residents, junior specialists, nurse anaesthetists and assistants taking care of cleaning and equipment. The different tasks are attributed to those most suited. Preoperative evaluation including setting up an anaesthesia plan is the duty of the anaesthesiologist. In general, the case is induced by a doctor and a nurse anaesthetist. The complexity of the patients’ medical condition and the complexity of surgery will decide the duties given to the nurse anaesthetist. All units have post-anaesthesia units where the patient care is done either by intensive care nurses or nurses with job-training depending on the selection of cases. The influence of the anaesthesia team on the esteem and practice of anaesthesia in Scandinavia The arguments presented in Table 2 should not be neglected. In the US where it for the most part has been a doctor’s service the recruitment to the specialty has been dangerously low. In Scandinavia where we have the anaesthesia team model, the recruitment to anaesthesia has been good. In fact, a survey from 1991 a period where the expansion of jobs was very high and the demand from the hospitals for specialists was massive, doctors ranked anaesthesiology as the 4th most prestigious speciality only after neurosurgery, cardiology and thoracic surgery and above general surgery, orthopaedics and paediatrics. Other health personnel also regarded anaesthesiology as being between the top 6 . In conclusion, we regard our anaesthesia team as a good model which provides the best opportunities for the anaesthesiologist and best care for the patient. It should be regarded not as a cost saving system, but as a model where personnel are given duties adequate for their training. TABLE 1. Basic concepts in the Scandinavian model • Anaesthesiology is a medical profession • A trained anaesthesiologists is the team leader • Responsibility cannot be delegated • Tasks and work can be delegated • Performing anaesthesia (medical tasks) can be delegated to nurses • A doctor should survey the delegated tasks • Nurses are responsible for the quality of the tasks they do • Not all medical work needs to be performed by top specialists • Training is essential for quality • Nurses can be trained to do specialized work and observations TABLE 4 . Areas where non-doctors perform delegated medical work • Blood pressure measurements • Sampling of blood tests • Resuscitation in Coronary Care Units and elsewhere • Acute medicine / ambulance (paramedics) • Echo / sonography (technicians / midwifes):  Obstetrics  Cardiology • X-ray technicians • Endoscopy screening  gastroscopy  colonoscopy • Heart failure policlinics (evaluating patients, follow-up) • Surgery (scrubnurses)  Suturing of wounds at the end of surgery  Harvesting veins for coronary grafts • And many more