Scope of Practice

Medical practice, including its infrastructure and functional details, is changing and evolving rapidly in the United States (Eichhorn JH, Grider JS. Scope of practice. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Ortega R, Stock MC, eds. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013: 28–60). Traditionally, anesthesia professionals were minimally involved in the management of the many components of their practice beyond the strictly medical elements.

I. Administrative Components of all Anesthesiology Practices

Operational and Information Resources
- The American Society of Anesthesiologists (ASA) provides extensive resource materials to its members regarding practice management (www.asahq.org) (Table 2-1).
- These documents are updated regularly by the ASA through its committees and House of Delegates.
- The Web site for the Anesthesia Patient Safety Foundation (www.apsf.org) is useful in promoting safe clinical practice.
The Credentialing Process and Clinical Privileges
- The system of credentialing a health care professional and granting clinical privileges is motivated by the assumption that appropriate education, training, and experience, along with an absence of an excessive number of adverse patient outcomes, increase the likelihood that the health care professional will deliver high-quality care.
- Models for credentialing anesthesiologists are offered by the ASA.
- An important issue in granting clinical privileges, especially in procedure-oriented specialties such as anesthesiology, is whether it is reasonable to grant “blanket” privileges (i.e., the right to do everything traditionally associated with the specialty).

Maintenance of Certification in Anesthesiology

Anesthesiologists certified as diplomats by the American Board of Anesthesiology after January 1, 2000, are issued a “time-limited” board certification valid for 10 years. A formal process culminating in the recertification of an
anesthesiologist for an additional and then subsequent 10-year intervals is designated Maintenance of Certification in Anesthesiology (MOCA).

Table 2-1 Practice Management Materials Provided by the American Society of Anesthesiologists

The Organization of an Anesthesia Department
Guidelines for Delineation of Clinical Privileges in Anesthesiology
Guidelines for a Minimally Acceptable Program of Any Continuing Education Requirement
Guidelines for the Ethical Practice of Anesthesiology
Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders or Other Directives that Limit Treatment
Guidelines for Patient Care in Anesthesiology
Guidelines for Expert Witness Qualifications and Testimony
Guidelines for Delegation of Technical Anesthesia Functions for Nonphysician Personnel
The Anesthesia Care Team
Statement on Conflict of Interest
Statement on Economic Credentialing
Statement on Member’s Right to Practice
Statement on Routine Preoperative Laboratory and Diagnostic Screening

The MOCA program introduced in 2000 is subdivided into four components or modules that include professional standing, lifelong learning and self-assessment, cognitive examination, and practice performance assessment and improvement.

Professional Staff Participation and Relationships
- Medical staff activities are increasingly important in achieving a favorable accreditation status from The Joint Commission (JC).
- Anesthesiologists should be active participants in medical staff activities (Table 2-2).

Establishing Standards of Practice and Understanding the Standard of Care

American anesthesiology is one of the leaders in establishing practice standards that are intended to maximize the quality of patient care and help guide anesthesiologists make difficult decisions, including those about the risk–benefit and cost–benefit aspects of specific practices (Table 2-3).

The standard of care is the conduct and skill of a prudent practitioner that can be expected at all times by a reasonable patient.

Table 2-2 Examples of Anesthesiologists as Participants in Medical Staff Activities

Credentialing
Peer review
Transfusion review
Operating room management
Medical direction of same-day surgery units
Medical direction of postanesthesia care units
Medical direction of intensive care units
Medical direction of pain management services and clinics

Table 2-3 Materials Provided By the American Society of Anesthesiologists Designed to Establish Practice Standards

Standards (Minimum Requirements for Sound Practice)
Basic Standards for Preanesthesia Care
Standards of Basic Anesthetic Monitoring
Standards for Postanesthesia Care

Guidelines (Recommendations for Patient Management)

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