To the Editor

Quality Assurance and Risk Management is a hot item for discussion and review in every aspect of today’s medical cam I personally experience great deal of frustration m the interpretation of what constitutes quality care. It seems that quality care is quite often limited by available finances or personnel, or both. In the military medical system, budgets are developed based upon production. The number of patients seen or the number of surgical procedures performed seem to take precedence over assuring quality cam I do not mean to discredit the military Quality Assurance Program. It does provide a solid basis for improving patient cam We do depend upon standards of care from both the military and civilian community to help establish many of our programs.

The Anesthesia Department to which I am currently assigned, administers between 200-225 anesthetics each month. There are five anesthesia providers, two anesthesiologists and three nurse anesthetists. We have a four-bed recovery room, staffed, with one registered nurse and one medical technician. In order to accomplish this work load along with the many extra duties assigned, all anesthesia providers are involved in the administration of anesthesia throughout the day. As a department, we have tried to limit the number of rooms opened on any one day to one less than the number of anesthesia providers available. The obvious or not so obvious reasons are to have available a provider for emergency procedures, primarily Cesarean sections, participation in resuscitation procedures, assistance to the recovery room staff with any patient complication, assistance to any other provider with patient problems, and the giving of breaks in order to prevent provider burnout and improve attentiveness. The department has not been able to accomplish our goal because of what this would do to production. I must also admit that so far we have been lucky and always seem to have someone free when emergencies appear.

My purpose in writing this letter is to gather information that will either support our efforts or demonstrate that the anesthesia community has not yet established a “float” during the O. R. work day as standard of cam I My realize that not every hospital will have or need an anesthesia practitioner assigned to be free to help out. Does data support the premise that a hospital of our size and case load have available a floating assistant? I would certainly appreciate any input the APSF or its members might have on this topic. If statistics are not available, might you have a suggestion?

Richard D. Baker; U. Col., USAF NC Senior Nurse Anesthetist Brandon. FL