Every year, the CSA nominates active members as delegates—from northern and southern California, from private and academic practices—to represent California at the ASA House of Delegates. Every year the delegates dutifully go.
And every year, CSA members ask: So what really happened there?
The answer is, quite a lot. Sometimes there is drama, especially when there are contested elections of officers. But more of what goes on in the House of Delegates is simply the hard work of developing and updating the guidelines, policy statements, and other documents that represent the professional standards of American anesthesiology.
Here are some highlights from this year’s 67th ASA House of Delegates (HOD) meeting, which took place in New Orleans on October 15th.
First of all, California has reason to be proud—three of the ASA’s top officers hail from California. Daniel Cole, MD, a former CSA President, ascended from First Vice President to the position of President-Elect, and is expected to be President of the ASA next year. Stan Stead, MD, MBA, was reelected as Vice President for Professional Affairs, and Linda Mason, MD, another former CSA President, was reelected as Secretary. The CSA also congratulates our new ASA Director from California, Michael Champeau, MD, and Alternate Director, Linda Hertzberg, MD, who now sit on the ASA Board of Directors, and thanks our previous ASA Director, Mark Singleton, MD, for his dedicated six years of service.
In terms of clinical practice, it’s important to know that the HOD approved an updated “Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging”, and also approved updated “Practice Guidelines for Perioperative Blood Management”. Both documents are available on the CSA website (for members only) and are well worth your time to read.
Trauma Anesthesiology Directors for Level 1 Centers
The HOD discussed at length the report of the Committee on Trauma and Emergency Preparedness (COTEP), which proved to contain controversial opinions about anesthesia coverage of trauma. The final vote of the HOD approved the following recommendation:
“The Committee on Trauma and Emergency Preparedness recommends that for Level 1 trauma centers, there should be an in-house presence of a physician anesthesiologist trained in the management of trauma care and that every Level 1 trauma center have a designated director of trauma anesthesiology with the qualifications listed in ‘The Need for a Trauma Anesthesiology Director at Level 1 Trauma Centers.’ The qualifications would then be forwarded to the American College of Surgeons Committee on Trauma for inclusion in its guidelines.”
The qualifications of the Trauma Anesthesiology Director, COTEP said, should include:
- Current ATLS Provider or Instructor certification
- A minimum of 12 hours of ACCME Category I CME credit in trauma-related educational activities within the past three years
- Completion of a Trauma Anesthesiology fellowship or at least two years of post-residency experience in the perioperative care of major trauma patients in the operating room or intensive care unit.
Several ASA delegates spoke in favor of urging the American College of Surgeons and other surgical societies to collaborate with the ASA on the development of any future guidelines affecting the delivery of trauma care. The Reference Committee also supported the concept that the ASA should work with surgical societies to achieve “patient-centered parity” regarding guidelines for the availability of surgeons and anesthesiologists in Level 2 trauma centers.
Fatigue, Distraction, and the Internet
The HOD discussed the pros and cons of the Committee on Ethics’ newly developed “Statement on Fatigue”, and voted ultimately to approve it. The statement reads:
“Because fatigue may jeopardize patient safety and physician well-being, an anesthesiologist who becomes impaired by fatigue should not provide routine clinical care until this impairment has resolved.
Anesthesia departments and group practices should work within the medical staff structure to develop and implement policies to address fatigue-related provider impairment and its implications for staffing and delivery of safe patient care.”
Distractions in anesthesia practice have also been a controversial topic of discussion. The ASA’s Administrative Council of officers earlier this year gave preliminary approval to a statement regarding distractions (such as the use of smartphones) during the administration of anesthesia. However, the Board of Directors and the HOD decided instead to refer the statement back to a committee of the President’s choice for further consideration and revision.
The Committee on Electronic Media and Information Technology (EMIT), chaired by CSA Speaker of the House Christine Doyle, MD, tackled the difficult subject of network access in anesthetizing locations. The committee noted that the Internet has a greater role now than ever before in “providing resources that facilitate clinical education, clinical practice, and professional collaboration.”
But security remains a serious problem, both in terms of HIPAA compliance and in terms of outside technical attacks from spyware and computer viruses. Striking a balance is tough, as many hospitals attempt to allow professionally useful Internet access while securing clinical data. The Committee intends over the next year to work toward a finalized set of network access recommendations, weighing the need for ready information against security concerns.
The Committee on Global Humanitarian Outreach (GHO) made several recommendations, which the Board of Directors did not initially approve but attempted to refer to a committee of the President’s choice for further evaluation. However, the HOD overruled the Board and accepted the Committee’s recommendations:
- Expand the Lifebox program to provide pulse oximeters to countries in need in Central and South America.
- Continue the Rwanda Overseas Teaching Program, which supports six volunteers a year for one-month anesthesiology teaching terms, and expand its budget.
- Approve the Global Scholars Program, which would provide support for young leaders in the specialty of anesthesiology from low and middle-income countries to attend the 2015 ASA Annual Meeting.
- Support the Resident International Scholarship Program, establishing one-month resident scholarships to help CA1 and CA2 residents learn the international practice of anesthesia in a pediatric orthopedic hospital in Ethiopia.
Since last year, the HOD no longer has the power to approve funding decisions directly. The authority and fiduciary responsibility for budget decisions resides with the Board of Directors. Thus, funding of the GHO recommendations will become the obligation of the Board, since the HOD has directed that these programs go forward.