By Patrick E. Benedict, M.D.
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Patrick E. Benedict, MD |
We are all saddened by the departure of Dr. Narayan Baliga from the Department of Anesthesiology. He has been a favorite of residents, faculty, and staff since he first arrived as a cardiac fellow several years ago. I would like to join everyone in wishing him the very best as he begins his new practice in Indiana. His departure has, however, opened up a great new opportunity for me as I assume responsibility for the department’s Anesthesia Preoperative Assessment Clinic. Dr. Baliga has done a wonderful job in shaping the Preop Clinic into the formal entity that exists today. I do believe, however, that measures can be taken to improve the Clinic’s activities in all three areas of the University of Michigan’s health care mission: patient care, research, and education. It is with great enthusiasm, therefore, that I look forward to the opportunity of implementing changes that will improve not only perioperative care but also patient satisfaction.
Our first priority in the clinic is the patient. For this reason, I eagerly anticipate the implementation of the MorCARE computerized record system. Problems and concerns that physicians have regarding output generated by the Preop Clinic often parallel complaints and concerns voiced by patients. For example, work-ups obtained in the Clinic are sometimes misplaced, much to the dismay of the person(s) actually providing the anesthetic. This error leads to unnecessary and time-consuming duplication of work, culminating in patient dissatisfaction and, possibly, compromised patient care. MorCARE will potentially solve these sorts of problems. More efficient workflow, fewer day-of-procedure cancellations, and improved inter-clinic communication are but a few of the other benefits of such a system. As I learned at a recent conference on computerized patient records, implementation of this sort of database can be tumultuous. In completing my first few practice work-ups, however, it became convincingly clear that this sort of endeavor would actually work. As the adage goes, “She who hesitates is lost.” Like it or not, computers are here to stay. I’m proud to say that ours is the first department in the University to realize this fact. I therefore feel it is imperative that we all patiently support this project while our department readies itself for the 21st century.
MorCARE will not only lead to dramatically improved efficiency and patient satisfaction, it will also facilitate my second major goal as I assume responsibility as director: data acquisition for research purposes. A wealth of perioperative patient data has existed for years now in the Preop Clinic sitting idly untapped. Our records indicate that patient visits to the clinic have steadily increased over the past several years and we anticipate evaluation of about 4000 patients in 1999. We have used the Perioperative Quality Assurance Database to take advantage of this power in numbers and it has performed admirably in recent inquiries concerning perioperative events. I hope to similarly compile and utilize MorCARE data to learn from our experiences and improve our capabilities as perioperative physicians. I am particularly concerned about such areas as obesity, rheumatoid arthritis, drug metabolism, and efficiency of preop test ordering. Our projection of an increased patient load combined with computerized record keeping should greatly facilitate this scientific analysis.
Last of all, residents in the Preop Clinic have access to tremendous education and research opportunities. I was highly encouraged when a CA1 expressed an interest in presenting an analysis of our patient care at the Midwest Anesthesia Residents' Conference in Columbus, Ohio this spring. I hope to involve residents in both presentations and peer-reviewed publications resulting from patient data we accumulate. With respect to the educational objectives of the preop clinic, my hope is to emulate the U-M Obstetric Anesthesiology rotation put together by Dr. Norah Naughton, Director of Obstetric Anesthesiology and Quality Assurance. Because anesthesiologists are perioperative physicians, I believe it is vital that our residents master such key concepts as stress tests, perioperative pulmonary optimization, and rational lab test ordering. To this end, I hope to increase the formal didactic teaching in the clinic in the form of both faculty and resident presentations. In summary, I feel very fortunate to assume responsibility for the Anesthesia Preoperative Assessment Clinic at this very exciting yet challenging juncture. Once again, I look forward to implementation of MorCARE and firmly believe it is the technological tool we need to carry us into the next century.