Anesthesiology, and indeed all of US health care, is influenced
currently by two dominant trends. First, the passage of the Patient
Protection and Affordable Care Act (PPACA) of 2010 codified the US
commitment to broad-based access to health care, and it underscored that
such care must be more efficient and cost effective. Second, the emphasis on
quality and safety in health care has gained even greater momentum.
Together, these trends emphasize the concept of value in health care. These
trends are not unique to the United States. Rather, they represent global
trends in health care policy and practice. We believe they will be dominant
themes for many years to come and thus they are guiding principles in the
second edition of this text.
Fortunately, the
specialty of anesthesiology is well positioned to lead these initiatives.
Anesthesiology is already recognized as the pioneering leader in patient
safety and we see no reason why anesthesiologists should not be leaders in
efficiency and value in health care as well. Indeed, we believe that
continuing to position our specialty at the forefront of these initiatives
is a key strategy for both the current and future success of anesthesiology
and its practitioners.
In 2000, the Institute of
Medicine (IOM) published its landmark analysis of American health care, "To
Err is Human," a treatise that emphasized the fallibility of even highly
motivated humans, and emphasized that systems of safe care must be
constructed to protect patients from potential harm. That report
specifically cited anesthesiology as a leader in the patient safety movement
and urged other disciplines to follow, which many have done subsequently. A
subsequent IOM publication, "Crossing the Quality Chasm; A New Health System
for the 21st Century" (2001) described the attributes of a model health care
system that is safe, timely, efficient, effective, patient centered and
equitable to all. The PPACA legislation underscored these principles and
subsequent regulations translated them into operational policies and
practices. We agree with these principles and have worked diligently to
adopt them in our own practices and departments, for they are guideposts to
the professional and ethical practice of medicine and anesthesiology.
Further, we have designed this text around the concepts of safe, effective,
efficient, and patient-centered care, and we urge others to approach their
practice with a similar commitment to these principles.
Our goal is to provide the practitioner with a single
resource that captures the essence of the full spectrum of anesthesia
practice. There are multiple sources of information about anesthesiology but
many ignore the full breadth of the practice. Further, there are numerous
focused texts that delve into specific subdisciplines in great detail; often
more detail than the trainee or practitioner desires or needs. In this text,
we have focused on what is truly important for the clinical practice of
anesthesiology in all its dimensions, while being efficient in the
presentation of this essential material. Throughout, we have asked "What is
important?" "Why is it important?" "When should it be applied?" and "How
should it be applied?" Our goal was to write for practitioners, not
physician scientists. That said, this is not a users' manual of anesthesia
care, but rather a text that constantly builds on the concepts of safe,
effective (ie, evidence-based), efficient, and patient-centered care,
distilled in a manner that facilitates easy access to the key scientific
concepts that underpin the rationale for that practice. Thus one finds Key
Points and Key References in each chapter, while an extensive reference list
is provided for those who seek in-depth research-based documentation.
Throughout, we embrace an encompassing view of modern
anesthesiology practice, including especially perioperative medicine,
critical care medicine, and pain medicine, each of which improves patient
care and enhances the value of anesthesia care within the overall health
care process. We have emphasized important trends in both the specialty and
in health care in general, to ensure that the reader is not required to go
elsewhere for additional information to support the mainstream of their
practice. These trends include the expanded use of regional anesthesia, the
remarkable explosion in pain medicine practice, and the expanded need for
practitioners who are skilled in the practice of critical care medicine. No
careful observer of the specialty could miss these trends, and no text could
be considered "comprehensive" if it did not embrace them as full components
of the modern practice of anesthesiology.
Further,
we have woven the concepts of quality, safety, cost effectiveness, and value
into the text by emphasizing that anesthesia care is one system of care
within a larger system of care that focuses on overall patient outcomes, not
independent events by individual practitioners working in isolated clinical
disciplines.
We have approached these and other
key "drivers" of contemporary and future anesthesia practice with care,
commitment, and enthusiasm for the future of the specialty. We trust that
you share this enthusiasm and hope our efforts will serve you well as you
continue to translate your knowledge and skills into safe, effective,
efficient, and patient-centered care; our patients want nothing less and our
surgical and medical colleagues are looking to anesthesiology to continue to
set the example for implementation of these principles. We are honored to
serve you through our efforts here.
David E.
Longnecker, MD
David L. Brown, MD
Mark F. Newman, MD
Warren M. Zapol, MD