As an anesthesiologist working with resident physicians and anesthesiology assistants (AAs), I’m held accountable for the following seven steps of medical direction. In many cases, payers require documentation of these elements (even with I’m working alone). Electronic health records have (fortunately) streamlined many parts of this process through formal attestations in the medical record.

  1. Perform a pre-anesthesia examination and evaluation with appropriate documentation.
  2. Prescribe the anesthesia plan – general anesthesia, monitored anesthesia care (MAC), peripheral nerve blocks, neuraxial techniques, etc.
  3. Personally participate in the most demanding procedures of the anesthetic plan, including induction and emergence. In cardiac anesthesia, this includes weaning from cardiopulmonary bypass and discussing relevant intraoperative transesophageal echocardiography (TEE) findings with my surgical colleagues.
  4. Ensure that any procedures in the anesthetic plan that I do not perform personally are performed by a qualified individual
  5. Monitor the course of anesthesia administration at frequent intervals
  6. Remain physically present for critical portions and available for immediate diagnosis and treatment of emergencies
  7. Provide indicated post-anesthesia care

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