The anaesthetic team

I read with great interest Dr Morgan's Editorial (Anaesthesia 2000; 55: 1–3) concerning his examination of anaesthesia development, and would like to take up two points. Firstly, what does Dr Morgan mean by the phrase –‘We have been fortunate in this country in that anaesthesia has been a physician-only speciality’? Fortunate for whom? The patient or the doctor? I presume that Dr Morgan is making a reference to the issue of the nonphysician anaesthetist that is common with our North American and European colleagues. This issue has been debated for a number of years in the UK, and there has been recent agreement by Medical and Nursing organisations that this would do little to solve the anaesthetic manpower crisis or help develop the provision of anaesthesia in the NHS [1, 2]. One hopes that this issue is now finally laid to rest. However, there are valuable lessons that can be learnt from the US and European approach to anaesthesia, specifically in the development of the anaesthetic team. It is not uncommon in the US for a team of an Anaesthesiologist, Nurse Anaesthetist and Assistant to utilise a case management approach for the peri-anaesthetic period. A hybrid of this model transferred into the UK context could improve patient care, and develop and foster collaborative working practices with greater professional understanding. If in the UK an anaesthetist, anaesthetic nurse and recovery nurse were to jointly consider the plan of care for a patient undergoing surgery it would go a long way to providing a total peri-anaesthetic care package. The added benefits of this would reduce risks associated with communication errors, and provide seamless continuity from admission to discharge. My second point is one of addition to Dr Morgan's historical review. One can only concur with the sentiments that the technological advancement in anaesthesia has indeed reduced morbidity and mortality considerably. This has led to the position today where it is thankfully rare for unexpected intra-operative complications to occur. However, despite these changes the postoperative period still frequently presents challenges to the medical and nursing staff. Indeed, the importance of effective and skilled recovery was highlighted within the first two decades of ‘modern anaesthesia’ in 1846. From Flemings' original idea in 1923 at the Medical Institute of Birmingham, the concept of an integral recovery unit has been reinforced continually since [3]. It has been suggested that it is the development of recovery units that have proven most effective in reducing deaths from anaesthesia in the last 150 years [4]. I believe that the RCA use the availability of the post anaesthetic recovery units as a benchmark for accessing a hospital's suitability for training of junior anaesthetists.