CHAIR OF ANESTHESIA

---

REQUIRED QUESTIONS

Skip to Optional

1. Is safety the top priority in the anesthesia department?
2. Is there open and effective collegial communications between your department and other departments?
3. Does the department medically direct or appropriately supervise all CRNA/AA practice?
4. Quality of Care: As the Chief/Chair of Anesthesiology, you must be able to demonstrate that:
   1. The facility has a medical director or governing body that establishes policy and is responsible for the activities of the facility and its staff. The medical director or governing body is responsible for ensuring that facilities and personnel are adequate and appropriate for the type of procedures performed.
   2. Policies and procedures exist for the orderly conduct of the facility and are reviewed on an annual basis.
   3. The medical director or governing body ensures that all applicable local, state, and federal regulations are observed.
   4. Policies exist to require that all personnel involved in direct patient care hold valid licenses or certifications to perform their assigned duties.
   5. All operating room personnel who provide clinical care are qualified to perform services commensurate with their levels of education, training, and experience.
   6. Your department participates in ongoing quality improvement and risk management activities.
   7. There is recognition, in the form of written policy, of the basic human rights of your patients, and that this policy is available for patients to review.
5. Patient and Procedure Selection: As the Chief/Chair of Anesthesiology, you must be able to demonstrate that:
   1. Procedures to be undertaken are within the scope of practice of the health care practitioners and the capabilities of the facility.
   2. Procedures to be undertaken are of a duration and degree of complexity that will permit the patient to recover and be discharged from the facility.
   3. Patients, who by reason of pre-existing medical or other conditions may be at undue risk for complications at your facility, are referred to an appropriate facility for performance of the procedure and the administration of anesthesia.
6. Perioperative Care: As the Chief/Chair of Anesthesiology, you must be able to demonstrate that:
   1. Anesthesiologists adhere to the "Basic Standards for Pre-anesthesia Care," "Standards for Basic Anesthetic Monitoring," "Standards for Post-anesthesia Care," and "Guidelines for Ambulatory Anesthesia and Surgery" as currently promulgated by the American Society of Anesthesiologists. (Link opens in new window.)
   2. Anesthesiologists are physically present during the intra operative period and immediately available until the patient has been discharged from anesthesia care.
   3. The decision to discharge patients is made by a physician and documented in the medical record.
   4. Personnel with training in advanced resuscitative techniques (i.e. ACLS, PALS) are immediately available until all patients are discharged home.
7. Monitoring and Equipment: As the Chief/Chair of Anesthesiology, you must be able to demonstrate that:
   1. All anesthetizing locations have a reliable source of oxygen, suction, resuscitation equipment and emergency drugs. (See specific reference in the ASA "Statement on Non-operating Room Anesthetizing Locations") (Link opens in new window.)
   2. There is sufficient space to accommodate all necessary equipment and personnel and to allow for expeditious access to the patient, anesthesia machine (when present,) and all monitoring equipment.
   3. All anesthesia equipment is maintained, tested, and inspected according to the manufacturer's specifications.
   4. Back-up power sufficient to ensure patient protection in the event of an emergency is available.
   5. In any location in which anesthesia is administered, there is appropriate anesthesia apparatus and equipment that allow monitoring consistent with ASA "Standards for Basic Anesthetic Monitoring"
   6. In any location where anesthesia services are to be provided to infants and children, the required equipment, medication, and resuscitative capabilities are appropriately sized for a pediatric population.
8. Are protocols for the ASA Difficult Airway algorithm, latex allergy, and Malignant Hyperthermia readily available in ever anesthetizing location?
9. Are policies or guidelines in place for management of perioperative glycemic control, including the availability of bedside glucose testing equipment?
10. Do all anesthetizing and regional anesthesia placement locations have immediate access to emergency drug and airway supplies and equipment?
11. Would you allow any member of the anesthesia department to anesthetize you or a family member?
12. Are all physicians Board certified by the ABA or are they in the certification process?
13. Are all CRNAs certified or are they in the certification process?
14. Are departmental members certified in ACLS and/or PALS?

Back to Top

OPTIONAL QUESTIONS

1. Are policies or guidelines in place to provide management recommendations for patients with sleep apnea?
2. Are cardiopulmonary emergency drills (mock codes) and malignant hyperthermia drills practiced regularly?
3. Are policy and/or guidelines in place to provide appropriate, age-specific NPO standards?
4. Are anesthesiologists and CRNSAs in a regular simulation/CRM program (as per MOCA requirements?)
5. Is an evidence-based pre-anesthetic testing matrix in place and used routinely?
6. Is blood product availability satisfactory? Is there a massive transfusion protocol? Is it employed and effective?
7. Is there a protocol for patients at high risk for PONV?
8. Is there a management protocol for patients with chronic pain, or is there easy access to pain management specialty preoperative consultation?
9. Is there a policy to preclude having medical, AA, or CRNA students in a room alone with an anesthetized patient?
10. Are radios or other music sources allowed in the OR? Is there a policy? Does the anesthesiologist have veto power to turn music down or off?
11. Is there an effective cell phone or other two-way pager system in place to locate key people in larger (> 6 room) surgical suites? If so, is it used and effective?
12. In any area where large-volume local anesthetics are administered, is there Intralipid™ and a protocol or its use available?
13. Does the department participate actively in the teaching of trainees (students, interns, residents, SRNAs?)
14. Is there a hospital/department policy describing the anesthesia department's role and responsibility in responding to codes/traumas throughout the facility?
15. Does the department/group provide adequate time and resources for members to participate in CME activities?
16. Do department members consistently support colleagues' decisions regarding scheduling, anesthetic choice, need for additional tests, and/or case cancelling decisions?
17. Is ultrasound routinely recommended and available for central line access?
18. Does the department have a policy to address wellness/family/support/diversion issues?
19. Does the department provide Continuous Professional Performance Evaluations?
20. Does the department track: Start time delays, turnover times, unexpected ICU admissions, PACU backlog/stay-overs, and unplanned admissions?
21. Does the department have sufficient anesthesia technician support?
22. Are the anesthesia techs ASATT certified or on track to be certified?
23. Does the facility have the ability to provide chronic pain care or is there a relationship with another entity to provide such service?
24. Are acute pain service patients seen daily and their care documented?
25. Does the acute (postoperative) pain order set provide for adequate pain assessment, monitoring (if necessary,) and supplemental pain coverage?
26. Are consults to the department performed in a timely fashion(i.e., < 24 hours,) and is documentation of the consultation promptly recorded in the medical record?
27. Does the anesthesia department/service encourage and support membership involvement in organized medicine (Membership/participation in local, state, and national medical and/or specialty societies?)
28. Can the department demonstrate an awareness and commitment to involvement in governmental and legislative affairs?
29. Does the department have processes in place to allow for feedback from patients, nurses, surgeons, and/or administrators (i.e., surveys, peer review evaluations, 360° feedback?)
30. Is ultrasound used in the placement of regional anesthesia blocks?
31. Do a significant number of the department members share in administrative responsibilities and serve on hospital committees?
32. Is there a culture of professionalism in the department?
33. Are anesthesiologists involved in the interviewing/hiring of key perioperative nursing leadership positions?
34. Is there evidence of leadership development within the department (i.e., mentorship?)
35. Is there a management structure in your anesthesia group?
36. If the department cares for pediatric patients, is there a separate pediatric cart containing routine equipment for all sizes/ages?
37. Do you have a designated group leader who is elected or selected by the group on a termed basis?
38. How regularly does the group membership meet? Is attendance greater than 75%?
39. Does your group have a designated quality officer or program within the department?
40. Does your group have a designated compliance officer?
41. Does your group have a policy for evaluation and hiring of new physicians (i.e., probationary period or orientation protocol?)
42. Are group members willing to accept leadership actions and/or support leaders in their decisions?
43. Do you track perioperative temperature management as part of the SCIP process (if applicable?)
44. If you care for children, are anesthesiologists and CRNAs PALS certified?

Back to Top