Rovenstine Lecture: Expand measurement

  • Emery A. Rovenstine Memorial Lecture: Quality Anesthesia: Medicine Measures, Patients Decide (SPE17)
  • 8-9:15 a.m. Monday
  • BCEC Ballroom East

Quality measurement in anesthesiology began in 1935 with the launch of the Anesthesia Study Commissions, and it has grown as quality has become linked to reimbursement. Still, there are gaps in measurement — and in the response to patient requests.

Lee A. Fleisher, M.D.

Monday’s Emery A. Rovenstine Memorial Lecture will examine those gaps and how anesthesiology can respond in a new age of consumerism in medicine. Lee A. Fleisher, M.D., will explore the links between measurement and quality, the role of anesthesiologists as leaders in perioperative care and how anesthesiologists should lead by responding to the needs of patients.

“We all want good quality. We know bad quality, but we rarely know what good quality is. We are still trying to define it,” said Dr. Fleisher, Chair of the Department of Anesthesiology and Critical Care, University of Pennsylvania.

The link between quality and measurement has been explored in anesthesiology since its early days, when mortality was more common during surgical procedures.

“We focused on it, we measured it and we got better. We were lauded for our work in reducing anesthetic mortality,” said Dr. Fleisher, who is also Robert Dunning Dripps Professor of Anesthesia at the University of Pennsylvania and Chair of the ASA Ad Hoc Committee on Brain Health Initiative. “But we have not measured everything we could get involved with.

“I challenge the anesthesia community to be engaged in improving all surgical outcomes. If you look at it, surgery has gotten safer in part because of our work, but we need to share accountability with our surgical colleagues for anything we think we could influence.”

For example, anesthesiologists could learn more about lung ventilation strategies to reduce pneumonias after surgery and they could be more engaged with prehabilitation. Those are both aspects of perioperative medicine that anesthesiologists have staked a claim to, Dr. Fleisher said.

The Perioperative Brain Health Initiative, which is formally being launched during ANESTHESIOLOGY 2017, is another example of an area where anesthesiologists can act as leaders by trying to reduce cognitive dysfunction and delirium. But in all of these actions, they should not focus solely on the science and lose sight of the patients, who are speaking with a louder voice in an age of value-based care.

“Your patients want to be heard, but are you listening?” Dr. Fleisher asked. “What are the factors patients care about that we traditionally have not focused on? What are the areas in which we can show leadership? We can stay relevant by listening and responding better to what our patients want from us.”

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