CHAPTER

2

Scope of Practice

Medical practice, including its infrastructure and functional details, is changing and evolving rapidly in the United States (Eichhorn JH, Grider JS. Scope of practice. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Ortega R, Stock MC, eds. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013: 28–60). Traditionally, anesthesia professionals were minimally involved in the management of the many components of their practice beyond the strictly medical elements.

I. ADMINISTRATIVE COMPONENTS OF ALL ANESTHESIOLOGY PRACTICES

A. Operational and Information Resources

1. The American Society of Anesthesiologists (ASA) provides extensive resource materials to its members regarding practice management (www.asahq.org) (Table 2-1).

2. These documents are updated regularly by the ASA through its committees and House of Delegates.

3. The Web site for the Anesthesia Patient Safety Foundation (www.apsf.org) is useful in promoting safe clinical practice.

B. The Credentialing Process and Clinical Privileges

1. The system of credentialing a health care professional and granting clinical privileges is motivated by the assumption that appropriate education, training, and experience, along with an absence of an excessive number of adverse patient outcomes, increase the likelihood that the health care professional will deliver high-quality care.

2. Models for credentialing anesthesiologists are offered by the ASA.

3. An important issue in granting clinical privileges, especially in procedure-oriented specialties such as anesthesiology, is whether it is reasonable to grant “blanket” privileges (i.e., the right to do everything traditionally associated with the specialty).

C. Maintenance of Certification in Anesthesiology

1. Anesthesiologists certified as diplomats by the American Board of Anesthesiology after January 1, 2000, are issued a “time-limited” board certification valid for 10 years. A formal process culminating in the recertification of an anesthesiologist for an additional and then subsequent 10-year intervals is designated Maintenance of Certification in Anesthesiology (MOCA).

2. The MOCA program introduced in 2000 is subdivided into four components or modules that include professional standing, lifelong learning and self-assessment, cognitive examination, and practice performance assessment and improvement.

D. Professional Staff Participation and Relationships

1. Medical staff activities are increasingly important in achieving a favorable accreditation status from The Joint Commission (JC).

2. Anesthesiologists should be active participants in medical staff activities (Table 2-2).

E. Establishing Standards of Practice and Understanding the Standard of Care

1. American anesthesiology is one of the leaders in establishing practice standards that are intended to maximize the quality of patient care and help guide anesthesiologists make difficult decisions, including those about the risk–benefit and cost–benefit aspects of specific practices (Table 2-3).

2. The standard of care is the conduct and skill of a prudent practitioner that can be expected at all times by a reasonable patient.

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