636

LETTERS TO THE EDITOR

ANESTH ANALG 1992;75:63?-46

References 1. Greene NM. Anesthesiology journals, 1992. Anesth Analg 1992;74:116-

20. 2. Keats AS. Anesthesia mortality in perspective. Anesth Analg 1990;71: 113-9. 3. McCormick J . Point of view: the academic task. Lancet 1988;ii:326. 4. Duncan PG, Cohen MM. The literature of anaesthesia: what are we learning. Can J Anaesth 1988;35:494-9. 5. Hamilton DP. Publishing by-and for?-the numbers. Science 1990;250: 1331-2. 6 . Various authors. New journals. Lancet 1990;336:990-1. 7. Sommer SS. TG or not TG? Nature 1991;353:468. 8. Matthews D. New journals. Lancet 1990;336994. 9. Wakelam MJO. Growing pains. Nature 1990;34758&5. 10. Halvorsen KT. Combining results from independent investigations: meta-analysis in medical research. In: Bailar JC 111, Mosteller F, eds. Medical uses of statistics. Boston: Massachusetts Medical Society, 1986: 392416. 11. Black N. Research, audit, and education. Br Med J 1992;304:698-700. 12. Wyatt J. Use and sources of medical knowledge. Lancet 1991;338:13& 73. 13. Maddox J. Why the pressure to publish. Nature 1988;333:493

Anesthesiologist’s Interactions With Other Medical Departments Outside the Operating Room To the Editor: We read with interest the article by Cheng et al. (1). Their survey has formally called to our attention a problem that affects many institutions and, to a great extent, directors of departments of anesthesia. As the representative of the American Society of Anesthesiologists to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Hospital Professional and Technical Advisory Committee (B.S.E.), and as Vice President for Research and Standards, JCAHO (P.M.S.), we have been confronted with questions about the issues addressed by Cheng et al. and believe that some of their statements and interpretations need clarification. On page 274, second paragraph, they state that, “the director of anesthesia services is responsible for daeloping [italicized for emphasis] approaches to effectively monitor and evaluate the quality and appropriateness of anesthesia care provided by individuals in any departmentlservice in the hospital, including but not necessarily limited to, the ambulatory care, dental, etc., . . . Later, on the same page, they state that, “we believe this should not be used as an excuse to avoid participating [italicized for emphasis] in the evaluation of the quality and appropriateness of the use of anesthetic drugs outside the operating room.“ Further, on page 275, they state that, ”as the JCAHO is advocating the active participation of anesthesiologists in monitoring and evaluating anesthetic care in hospital departments outside the operating room, neglecting this responsibility may put the anesthesiologist at risk for litigation problems in the future.” JCAHO standards do not require that the director of the organized anesthesia departmentlservice develop “approaches to effectively monitor and evaluate . . . etc.,” but rather that he or she participate in their development. The director is not required to assume responsibility for administration of anesthesia for those over whom he or she has .’I

no authority. To clarify the entire issue, the Intent of the standards has been published (2) in the Scoring Guidelines of the 1992 Accreditation Manual for Hospitals, Volume 11, Surgical and Anesthesia Services chapter, page 7. The following is the exact wording of the scoring guidelines: INTENT The director of the organized anesthesia departmentkervice, or a designee(s), directly participates with individuals from all other departmentslservices in which anesthesia services are provided in the development of mechanisms or processes to provide services that are consistent with patient needs and current practice, for monitoring and evaluating anesthesia services, and for establishing guidelines for the safe administration of anesthesia. These standards do not prevent other directors from assuming responsibility for anesthesia services provided in their department/service. If the director of organized anesthesia service objects to a policy established by an individual department/ service director and the disagreement cannot be resolved, it should be brought to the medical staff for resolution through appropriate established channels (for example, the medical staff executive committee). The director of each department/service in which anesthesia services are provided is responsible for the monitoring and evaluation of the quality of patient care provided in the departmentlservice, consistent with current knowledge of anesthesia practice. The director of the organized anesthesia department/service facilitates and provides consultation on the monitoring and evaluation of the quality of anesthesia services provided in hospital departmentdservices. Burton S. Epstein, MD Department of Anesthesiology The George Washington University Medical Center 901 23rd Street, N W Washington, DC 20037

Paul M. Schyve, MD Joint Commission on Healthcare Organizations 1 Renaissance Boulevard Oakbrook Terrace, 1L 60181

References 1. Cheng EY, Nimphius N, Kampine JP. Anesthetic drugs and emergency departments. Anesth Analg 1992;74:272-5. 2. Joint Commission on Accreditation of Healthcare Organizations. Joint Commission Accreditation Manual for Hospitals, Volume 111. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations, 1992.

In Response: Anesthesiologist’s interactions with medical departments outside the operating room are often limited. The intent of our survey and analysis (1) is to call the attention of anesthesiologists to the frequent use of anesthetic drugs by nonanesthesiologists and to point out that as a specialty,

Anesthesiologist's interactions with other medical departments outside the operating room.

636 LETTERS TO THE EDITOR ANESTH ANALG 1992;75:63?-46 References 1. Greene NM. Anesthesiology journals, 1992. Anesth Analg 1992;74:116- 20. 2. Kea...
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