Do you want to be sedated (for surgery)? Anesthesia assistants could help reduce waiting times
Black art of the white coat26:30Meet the people who help you sit
A solution to a critical deficiency of anesthesiologists in Canada could reside in increasing the ranks of the anesthesia assistants, supporters say.
“In a situation in which we have a serious … access to the problem of surgical care, we must think of creative solutions to go on and bring to people the treatments they need,” said dr. Sally Bird, pediatric anesthesiologist and chief of pediatric anesthesia at the Iwk Health Center in Halifax White coat, black art.
Although many Canadians may not yet be familiar with their work, The profession of anesthesia assistant was established More than 50 years ago in Quebec and about 15 years ago in most of the other provinces. However, they are not yet available everywhere.
As the name suggests, Anesthesia assistants (AAS) work under the direct supervision of anesthesiologists.
Rob Bryan, a veteran AA of Mackenzie Health in Richmond Hill, in Ontario, north of Toronto, said that “the role of an anesthesia assistant is to extend the care and service of the medical specialist under anesthesia in the Department of Anesthesia”.
“A doctor is always responsible for the patient’s care,” said Bryan, who worked in an endoscopy room providing anesthesia for colonoscopy patients on the day White coat, black art visited the hospital.
On the contrary, specially trained nurses called nursing anesthesiologists It can practice anesthesia independent of doctors in the United States, but have not been able to do it in Canada since the end of the Second World War.
Nursing anesthesiologists, also called certified registered nursing anesthesiologists, can have their own practice similar to the way a nurse can provide primary care in the absence of a family doctor. This means that they can fill a gap in the rural and remote areas of the United States, for example, providing sedation in places where otherwise it would not be possible to get an epidural for labor and childbirth.
AAS’s duties vary between the provinces
Canadian anesthesiologists say that it makes no sense to launch a new program to certify nursing anesthesiologists, given that Canada already has a consolidated system with AA that could be reduced, not only in number but in the reach of the practice.
“We work as well as a team as well, and there is already a high level of trust,” Bird of Iwk said.
This is also the official position of the Canadian company of anesthesiologists, who it came out with a declaration of position The last time there has been a push in British Columbia to introduce nursing anesthesiologists, saying that the organization “firmly refuses” nursing anesthesiologists in Canada. Instead, it is Plan to face surgical waiting times It includes, among other things, to increase the number and availability of trained AAs.
Most anesthesia assistants have backgrounds as respiratory therapists (RT), although some come from the ranks of recorded nurses and all have additional anesthesia formation.
Bryan by Mackenzie Health has a designation called Certified clinical anesthesia assistantor CCAA, given by the Canadian Society of Respiratory Therapists to RT like him who received that additional training. In Canada, not all anesthesia assistants are CCAA like him.
While what the anesthesia assistants are authorized to make varies from Province to Province, they are becoming part of the anesthesia teams in more and more parts of Canada.
New data from the Canadian Institute for Health Information show that patients in all provinces are waiting for longer than the pandemic for a certain orthopedic priority and cancer interventions, but they are not all bad news – on the whole more surgical interventions are performed than ever.
“Rather incredible people with a lot of competence”
Dr. Jerod Gollant, head of the Department of Anesthesiology of Mackenzie Health, said that before AAS he joined the hospital staff, he had to usually give up the procedures because there were not enough anesthesiologists.
This does not happen now, he said, because anesthesia assistants have allowed the department to be more efficient and see more patients.
For example, having more AAs who work in the endoscopy unit under the supervision of an anesthesiologist allows another anesthesiologist to be freed to work elsewhere in the hospital, said Gollant.
“So we are able to provide diagnostic endoscopic procedures and therapeutic screening for our whole community without canceling surgical interventions on the top floor in the main operating room.”
At Halifax’s IWK, the scope of the practice for AAS gradually expanded starting from 2021, said Bird, head of pediatric anesthesia of the hospital.
“Initially, when they started, they would have done things how to help us put patients to sleep, help in the recovery room,” he said. “But slowly we realized that these are rather incredible people with many skills to offer, and therefore our anesthesia assistants now, in collaboration with us, are making independent procedural sedations.”
Sami Jreige is one of the certified clinical anesthesia assistants who works with Bird.
“We are a bit unique in terms of what AAS can do …. we can provide deep sedation to patients to make procedures that otherwise would require an anesthesiologist to do,” he said.
“This is probably my favorite part of my work is to be able to go out and delete a waiting list or plan specific elective cases for AA, where we can do things in a more timely and efficient way.”
Limited training capacity
An editorial in Canadian Journal of Anesthesia In September 2024 he said that not only is there a relative lack of awareness of the profession as a career option, but the training capacity is too low.
The editorial stresses that there are Only four AA training programs accredited to Canada – Two in Ontario and two in British Columbia, as well as a provisionally accredited program in Alberta.
“I don’t think we are a well -known profession, to tell the truth,” said Jreige, observing that even among the health workers, those who do not work in the operating rooms or with anesthesia departments may not have heard of AAS.
Carolyn McCoy, director of professional practice for the Canadian Society of Respiratory Therapists, who represents certificates of clinical anesthesia, said that it takes one or two years to complete the additional training necessary to become a CCAA.
“In general, because education to become an anesthesia assistant is not financed, in order to pay the bills … The vast majority continues to work full time while they are taking this additional education on the side.”
The editorial of the Canadian Journal of Anesthesia said that training subsidies could be part of the increase in the number of AA, as it could pay better. A more robust supply of AA trained is also the key to avoiding the burnout among the existing anesthesiologists, he said.
Bird said he firmly believes that AAs can create a stronger anesthesia workforce in Canada, above all since anesthesia assistants are already taking place in many hospitals.
“With … a little more tutoring and training, they could do much more, which would benefit everyone in the system: patients, health workers and anesthesiologists.”
