Letter to the Director
Security and efficiency of health care models based on anesthetist nursing: Time to move on
Seguridad y eficacia de los modelos asistenciales basados en enfermería de anestesia: time to move on
I. Dieguez
, A. Goma, E. Rivas, G. Martinez-Palli
Corresponding author
Servicio de Anestesiología y Reanimación, Sección del Institut de Malalties Digestives, Hospital Clínic de Barcelona, Barcelona, Spain
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"apellidos" => "Echevarría Moreno" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935623000853" "doi" => "10.1016/j.redar.2022.11.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935623000853?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192923001002?idApp=UINPBA00004N" "url" => "/23411929/0000007000000006/v3_202310300659/S2341192923001002/v3_202310300659/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Security and efficiency of health care models based on anesthetist nursing: Time to move on" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "367" "paginaFinal" => "368" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Dieguez, A. Goma, E. Rivas, G. Martinez-Palli" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Dieguez" "email" => array:1 [ 0 => "dieguez@clinic.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Goma" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Rivas" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Martinez-Palli" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Sección del Institut de Malalties Digestives, Hospital Clínic de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seguridad y eficacia de los modelos asistenciales basados en enfermería de anestesia: <span class="elsevierStyleItalic">time to move on</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We were delighted to read the article by Monsma-Muñoz et at.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> (<a href="https://doi.org/10.1016/j.redar.2021.05.010">https://doi.org/10.1016/j.redar.2021.05.010</a>) on the implementation of a programme in which 2 nurse anaesthetists (NA) administered sedation in patients scheduled for gastrointestinal endoscopy under the supervision of an anaesthesiologist. Ten years have passed since our group published a study in this journal reporting our experience with a similar series of over 12,000 patients, including ASA 3 and 4, undergoing simple and advanced endoscopic procedures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Both studies show the efficacy and safety of nurse-led anaesthesia in different settings.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The exponential increase in the number and complexity of minimally invasive non-operating-room diagnostic and/or therapeutic procedures requiring anaesthesia or sedoanalgesia in the past 10 years has raised the need to design and implement new working models. In our opinion, anaesthesiologists should spearhead initiatives to meet this growing demand, bearing in mind the need to adapt each model to the characteristics and resources required by each procedure. Out-of-operating-room procedures must, of course, meet the highest quality and safety standards,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> although this does not mean systematically implementing the same procedures used during surgery. By this we mean, without detracting from the importance of this type of procedure, that the duration and type of anaesthesia administered in the out-of-operating room setting does not require the continuous presence of an anaesthesiologist if adequately trained nurses are available. Under the provisions of Act 44/2003 on the Organisation of Healthcare Professions (BOE 280, 22 November 2003), an anaesthesiologist can delegate his or her duties in an appropriately trained nurse, provided this is fully protocolized and an anaesthesiologist is on-call in the Unit.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our model has evolved considerably since we published our study in 2011. Our nurse anaesthetist/anaesthesiologist ratio is currently 3:1, making it possible for 4 teams (4 anaesthesiologists and 12 nurses) to simultaneous attend to 6 endoscopy rooms in the morning and 6 in the afternoon, which means that we can perform approximately 16,000 endoscopic procedures with sedation per year without compromising anaesthesiology safety and quality standards.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our experience has taught us that the key to the success of this model lies in: 1) structured nurse training in both the theory and practise of administering sedation; 2) protocolized of anaesthetic procedures (we recommend the use of target controlled infusion systems); 3) performance of thorough pre-anaesthesia evaluation to identify the presence of anaesthesia risk factors and 4) performing anaesthesia under the supervision of an anaesthesiologist.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We are pleased to see that other groups of anaesthesiologists in Spain have undertaken to implement a system that far from being a threat to the specialty, allows us to maintain our leadership in the field of out-of-operating room sedation. The anaesthesia team model is an opportunity to raise awareness of the role of the anaesthesiologist, and is essential in other specialties and for the population as a whole. The efficacy, safety, and efficiency of this model discourages the hospital management, and even other specialists, from interfering in these units. The challenge now is to convince the entire anaesthesiology community of the advantages of this model and drive the development and official recognition and approval of this approach.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This manuscript has not received any funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors acknowledge that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio observacional retrospectivo sobre la seguridad de la sedación para colonoscopias en pacientes ASA I y II realizada por enfermería y tutelada por anestesiología" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Monsma-Muñoz" 1 => "E. Romero-García" 2 => "F. Montero-Sánchez" 3 => "J. Tevar-Yudego" 4 => "I. Silla-Aleixandre" 5 => "V. Pons-Beltrán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2022" "volumen" => "69" "paginaInicial" => "319" "paginaFinal" => "325" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recomendaciones de seguridad del paciente para sedaciones en procedimientos fuera del área quirúrgica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Arnal Velasco" 1 => "E. Romero García" 2 => "G. Martínez Palli" 3 => "L. Muñoz Corsini" 4 => "M. Rey Martínez" 5 => "S. Postigo Morales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2016" "volumen" => "63" "paginaInicial" => "577" "paginaFinal" => "587" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consolidación de un modelo asistencial basado en un equipo de anestesia: Experiencia en más de 12.000 casos en una Unidad de Endoscopia Digestiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Martínez Palli" 1 => "M. Ubré" 2 => "E. Rivas" 3 => "A. Blasi" 4 => "X. Borrat" 5 => "R. Pujol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0034-9356(11)70103-7" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Anestesiol Reanim" "fecha" => "2011" "volumen" => "58" "paginaInicial" => "406" "paginaFinal" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22046861" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000007000000006/v3_202310300659/S234119292300094X/v3_202310300659/en/main.assets" "Apartado" => array:4 [ "identificador" => "66474" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000007000000006/v3_202310300659/S234119292300094X/v3_202310300659/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234119292300094X?idApp=UINPBA00004N" ]
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