Anesthesia Care Teams: The Ottawa Hospital's Experience
/Dr. David Neilipovitz has long been an advocate for bringing team-based anesthesia care to Ontario. Back in the mid ‘00s, he played a key role in implementing the province’s original Anesthesia Care Teams (ACT), which successfully reduced the waitlist for cataract surgeries by incorporating certified clinical anesthesia assistants to assist with delivering care.
Now the Chair and Head of the Department of Anesthesiology & Pain Medicine at the University of Ottawa and at The Ottawa Hospital (TOH), Dr. Neilipovitz is busy leading the teams that have developed the next evolution of TOH’s ACT program.
We had a quick chat with Dr. Neilipovitz about how TOH is expanding its ACT initiative and what that means for patients and the future of anesthesia care in Ontario.
Q: Let’s start with a quick look at the history of ACT in Ottawa and how it’s evolved.
A: TOH was fortunate to be selected as one of the sites chosen for the original ACT program back in 2006, which provided sedation to ophthalmologic patients. Since that launch nearly 20 years ago, our ACT program has provided care to over 100,000 patients.
In 2023, our team started to evolve ACT beyond ophthalmologic patients to allow us to expand the care we could provide to our patients. Our priority is unwavering: Ensuring our patients receive the safest, timely and highest quality care, regardless of our resource constraints. To uphold this commitment, we chose to introduce this care pathway because our team was struggling, due to staffing and other challenges, to meet the clinical demand being asked of us.
What we created is essentially a form of what Ontario’s Anesthesiologists now refers to as team-based anesthesia care (TBAC). It’s not simply a staffing solution; it is part of our patient care strategy, allowing us to meet the clinical demands and responsibilities better, while protecting what matters most: the needs of our patients.
To deliver on that strategy, we developed several care models. The first model has an anesthesiologist working with two anesthesia assistants to provide care in two operating rooms. We also have a second model called High Intensity Turnover (HIT), whereby an anesthesiologist and an anesthesia assistant work together to reduce transition times from one case to the next. By implementing HIT, we saw a 30-50% increase in the number of surgeries we could complete.
Q: How has implementing team-based care benefited your hospital and its patients?
A: The obvious benefit is the increase in the number of patients who receive the care they require by increasing the number of cases we can participate in. But there are also added advantages, such as how it allows us to address sick calls better
Another benefit is that it helped to change the narrative at our centre. It demonstrated to our surgical and other hospital colleagues the anesthesia department's commitment to providing patient care and our willingness to adapt. How our department was perceived by these groups changed in a very positive fashion and helped improve the work environment.
It also helped us preserve our ability to provide non-clinical time (NCT) for our team. As we are an academic site with a residency training program and an active research program, it is vital that our NCT activity not be compromised and our team be able to complete essential academic, administrative, and other non-direct patient activities. By expanding our ACT program, we could better reach that goal.
Q: What’s one thing you want the public to know about ACT/TBAC?
A: We just completed a quality assessment of our entire program, and the results are very reassuring. It demonstrates the safety and effectiveness of the initiative. This review also showed that TBAC has not diminished the role of anesthesiologists but rather has enhanced our position as leaders in our perioperative program by providing much-needed flexibility.
Additionally, we want people to know that the anesthesia assistants and others involved with TBAC feel valued, and we are focusing on further enhancing not only their training, but also that of other health professionals involved with this program.
The ottawa hospital’s three campuses
Q: What’s next for team-based care in Ottawa?
A: We are continuing to strive to improve the program and evolve it, including finding roles for other health professionals, such as respiratory therapists. We are now working to create another model, tentatively called High Efficiency Turnover, that would potentially involve a small team providing anesthesia care for two to three operating rooms.
We are also planning on submitting the previously mentioned quality assessment of the program for peer-reviewed publication. We’re really proud of the work we’ve done, and we want to share our success with the world.
Q: What are your thoughts on expanding the TBAC model across Ontario?
A: Obviously, I am biased, but I believe this is the future of care. Our specialty needs to evolve. This is not a slippery slope or a path towards the use of nurse anesthetists, a concern I know that some people have. Quite the contrary; TBAC will insulate our specialty and enable us to continue being leaders in perioperative care. By demonstrating our willingness to evolve and ensure that care is provided to all patients in a safe and effective fashion, anesthesiologists' position of importance is elevated. In other words, it demonstrates our commitment to the Beyond the Mask principle yet again.