ACT Anaesthesia Pty Ltd is based in Canberra and was established in 2003, the first private practice group in that city. Originally comprising four anaesthetists, the practice now has thirteen anaesthetists who work across all specialties. The business operates as a service company charging fees to the doctors on a per patient basis.
The main practice aims at establishment were:
- The provision of high-quality clinical care through good information collection and use. We were particularly mindful of the changing nature of our specialty and the increased emphasis on patient throughput. We were keen to mitigate where possible any adverse effects that this could have on patient care (and anaesthetist stress levels!)
- To create a service that would handle billing and other administrative functions such as leave cover and list management. We wanted a systematic approach to pre-operative informed financial consent whenever possible.
- To create a refuge away from the hospital environment. We hoped to create a physical place that would serve several purposes: to see our patients in a calm rooms environment; to facilitate and consolidate our educational endeavours and to have a forum to regularly discuss any relevant professional issues.
We specifically did not want to make our lives more complicated or to increase our non-clinical and out of hours workload. At inception we agreed to employ both nursing and administrative staff and to run two separate but interlinked practice domains. The nursing staff collect preoperative clinical information from multiple sources including the patients (via telephone and email), the surgeon’s rooms – who provide our patients with our practice information – and GPs and hospitals. One of our major challenges was to establish positive relationships and networks with all these groups unaccustomed to our more proactive approach.
Protocols have been developed to aid our staff in determining what information is collected and how it is presented and used. In general, the information includes: a completed perioperative questionnaire, relevant specialist and past medical or anaesthetic information. The consolidated clinical information includes a summary of financial information, which has been provided to the patients by our administrative staff and is always available to the anaesthetist via a secure web-based calendar system.
Patients identified by any means, including direct referral, as requiring additional preoperative input are seen in rooms consultation or managed by other means, as necessary. The patients seen in the rooms vary according to doctor practice and preference. At least one consultant also sees selected patients as house calls. These patients are generally frail and elderly or have mobility problems. While establishing the office we had to deal with issues such as practice indemnity, IT security and medical records management. Our communication flow was based on readily available Internet technologies to collect, manage, and distribute information amongst staff and doctors. We also use this to employ staff working remotely using VOIP and Server based technologies. Some of the less technologically inclined doctors now appreciate the greater utility and real time provision of information this system allows.
At the office, the practice members attend one regular combined session per month for continuing education and addressing practice administrative issues. Attendance and active participation at this meeting is seen as a vital part of maintaining the integrity of the group. Clinical and administrative staff report to the meeting and provide relevant feedback or suggestions. We have run several clinical practice audits and generally include a journal discussion as part of the meeting. At the meeting we also receive our collated monthly post-operative reports. We view the completed information we receive for each clinical episode very positively both in terms of individual feedback and also for its value in risk management.
Twenty years on we feel we have progressed significantly towards our aims. We strive to ensure our practice is responsive to ever-changing demands. As a group we also pay tribute to our staff who strive to translate our mission into reality.