Peer Review for Anesthesia and Emergency Care

Abstract

SUMMARY Within a very short time, all 50 states in the United States will have enacted dental anesthesia and sedation acts. It is reasonable to have standardized implementation of the oral/maxillofacial surgery peer review as the standard of care for surgeons and all other professionals providing anesthesia. Watered-down versions of the examination neither protect the public's welfare nor ensure safe and sane anesthesia provided by competent doctors. If a doctor does not perform satisfactorily during the examination, provisions are made for a re-examination. Compliance with both the initial examination and the re-examination has been high because of the new vertical orientation of the component state societies in the AAMOS and the legal action by the state board of dental examination in states where his evaluation is mandatory. Unlike other one-time examinations of competency, anesthesia evaluations need to be on the forefront with considerations for re-examination after 5 years. All who practice anesthesia on a day-to-day basis have seen pharmacology changes as well as an explosion in monitoring technology. It behooves all who practice anesthesia in either an inpatient or an outpatient facility to keep abreast of these changes. Although this article discusses only the involvement of oral and maxillofacial surgeons in the examining process, the National Institutes of Health has adopted a Consensus Statement on Anesthesia that includes a directive concerning anesthesia training for the use of conscious sedation techniques.4 The American Dental Association and the American Dental Society of Anesthesiology have been supportive of this increased training for dental students, general dentists, and other dental specialists. At one time there was a movement for dental anesthesiology residencies, but, for a variety of political, economic, and practical reasons, these programs are few in number. An adjunct program that helps the anesthesia assistant in the office setting has been the development of the Oral and Maxillofacial Surgery Anesthesia Assistants' Program (OMAAP), founded in 1988. This program consists of a 6-month home-study course with five different areas of emphasis that in large part parallel the anesthesia evaluation sections. The five basic study modules consist of basic sciences, drugs, anesthetic techniques, monitoring, and medical emergencies. The surgeon works closely with the assistant, monitoring progress, giving quizzes, and being a resource person prior to the final examination. This is administered by the American College Testing Program (ACT) and is given periodically throughout the United States and Canada. Because this is not a pass or fail examination, it is meant to be used as an learning and evaluating instrument for the assistant. One further developing trend that augments the anesthesia evaluation is accreditation by the Accreditation Association for Ambulatory Health Care (AAAHC). In a recent article in an AAOMS publication,1 this accreditation process is viewed as a means of establishing an oral and maxillofacial surgery office as an appropriate facility for the delivery of outpatient surgery similar to an am-bulatory surgical center. AAAHC was founded in 1979 to assist ambulatory health care facilities in achieving accreditation for compliance with their guidelines. These standards include quality assurance, medical record evaluation, clinical and pharmaceutical services, environmental safety, and administration and professional development. Although AAAHC was founded to help standardize and measure performance of outpatient surgical facilities, AAOMS became a corporate member in November of 1989 with the expectation that some private practice offices might like to participate in an evaluation for accreditation. Unlike the office an-esthesia evaluation, this process is entirely voluntary. The cost of the examination, which takes an average of 1.5 days, is paid by the examinee and can run between $4000 and $4500. Because this alliance is new, the trend of the examination is not known. Finally, the field of oral and maxillofacial surgery has been blessed with foresighted visionaries who correctly determined and guided the future of the safe practice of anesthesia in the office setting for the benefit of patient and doctor. This “win-win” situation has helped practitioners control their professional destinies and serves as a reminder of the necessity for involvement as an organized and united group.