A survey of Canadian specialist anesthesiologists and family practice anesthetists: rural operating room use, a mixed model of care, and mentoring.

PURPOSE: The aim of this project was to collect data on the delivery of anesthesia in Canada. Specifically, our goal was to increase knowledge by identifying provider demographics and different models of anesthesia delivery, and to explore relationships among specialist anesthesiologists (SAs) and family practice anesthetists (FPAs) with a focus on mentoring. METHODS: An online questionnaire was circulated to SAs and FPAs holding membership with the Canadian Anesthesiologists' Society or the Society of Rural Physicians of Canada. A total of 274/2,578 individuals completed the survey (170 SAs and 104 FPAs), providing a response rate of 10.6%. The survey included questions about demographics, anesthesia training, anesthesia resources, models of care, and mentoring relationships. RESULTS: Three major themes emerged from the data: 1) FPAs and rural operating rooms are underused resources as 65% (64/98) of FPAs reported having capacity to increase their individual volume of anesthesia services and 41% (40/98) thought capacity existed within their hospital to increase the volume of surgery; 2) 20 hospitals employed a mixed model of anesthesia care whereby SAs and FPAs worked collectively within the same site; providers working within this model reported high levels of satisfaction and independence; 3) most SAs and FPAs perceived a benefit to mentoring and were interested in participating in a mentoring program. CONCLUSION: This survey shows perceived capacity to expand surgical services in rural areas, a precedent for a mixed SA-FPA model of anesthesia delivery at the same site, and desire for anesthesia providers to engage in mentoring. Such options should be considered to strengthen the physician-led anesthesiology profession in Canada.

RéSUMé: OBJECTIF: L'objectif de ce projet était de recueillir des données sur la prestation de l'anesthésie au Canada. Plus précisément, notre objectif était d'accroître les connaissances en identifiant les caractéristiques démographiques des prestataires et les différents modèles de prestation d'anesthésie, et d'explorer les relations entre les anesthésiologistes spécialisé·es (AS) et les anesthésiologistes en médecine familiale (AMF) en mettant l'accent sur le mentorat. MéTHODE: Un questionnaire en ligne a été distribué aux AS et aux AMF membres avec la Société canadienne des anesthésiologistes ou la Société de la médecine rurale du Canada. Au total, 274 personnes sur 2578 ont répondu à l'enquête (170 AS et 104 AMF), soit un taux de réponse de 10,6 %. L'enquête comprenait des questions sur les données démographiques, la formation en anesthésie, les ressources en anesthésie, les modèles de soins et les relations de mentorat. RéSULTATS: Trois grands thèmes se sont dégagés des données : 1) Les AMF et les salles d'opération en milieu rural sont des ressources sous-utilisées, puisque 65 % (64/98) des AMF ont déclaré avoir la capacité d'augmenter le volume individuel de leurs services d'anesthésie et 41 % (40/98) pensaient qu'il existait une capacité au sein de leur hôpital pour augmenter le volume chirurgical; 2) 20 hôpitaux utilisent un modèle mixte de soins d'anesthésie dans lequel les AS et les AMF travaillent collectivement sur le même site; les prestataires qui travaillent dans le cadre de ce modèle ont fait état de niveaux élevés de satisfaction et d'indépendance; 3) la plupart des AS et des AMF perçoivent un avantage au mentorat et sont intéressé·es à participer à un programme de mentorat. CONCLUSION: Cette enquête montre la capacité perçue d'étendre les services chirurgicaux dans les zones rurales, un précédent pour un modèle mixte AS-AMF de prestation d'anesthésie sur le même site, et le désir des prestataires d'anesthésie de s'engager dans le mentorat. De telles options devraient être envisagées pour renforcer la profession médicale de l'anesthésiologie au Canada.

Rare causes of abdominal pain: a primer for the admitting general surgeon.

The broad uptake of the acute surgical unit (ASU) model of surgical care in Australia has resulted in general surgeons becoming increasingly involved in the management of patients with acute abdominal pain (AAP), some of whom will be labelled as having non-specific abdominal pain (NSAP) (Kinnear N, Jolly S, Herath M, et al. The acute surgical unit: An updated systematic review and meta-analysis. review. Int. J. Surg. 2021;94:106109; Lehane CW, Jootun RN, Bennett M, Wong S, Truskett P. Does an acute care surgical model improve the management and outcome of acute cholecystitis? ANZ J. Surg. 2010;80:438-42). NSAP patients lack a clear diagnosis of surgical pathology based on standard clinical, laboratory and imaging work-up, although they may require ASU admission for pain control and assessment. This article provides a review of uncommon conditions, presenting as AAP, that could possibly be mis-labelled as NSAP, with a focus on aspects of the presentation that may aid diagnosis and management including specific demographic features, clinical findings, key investigations and initial treatment priorities for ASU clinicians. Ultimately, most of the conditions discussed will not require surgical intervention, however, they require a diagnosis to be made and initial treatment planning before on-referral to the appropriate specialty. For the on-call general surgeon, some knowledge of these conditions and an index of suspicion are invaluable for the prompt diagnosis and efficient management of these patients.

Hospital in the home-based management of acute diverticulitis: a safe and effective alternative to inpatient care.

BACKGROUND: The traditional approach to management of acute uncomplicated diverticulitis involves admission to hospital, antibiotic therapy, gut rest and monitoring for the development of complications. Despite evidence to suggest this can safely be performed in an outpatient setting, inpatient care remains standard practice in Australia potentially due to a variety of factors (van Dijk et al. 2018; Cirocchi et al. 2019). Hospital in the home (HIH) allows patients requiring complex care including intravenous antibiotics, intravenous fluids and complex pain relief to be managed at home. This study examined the safety and efficacy of HIH-based care for acute diverticulitis over a 16-year period. METHODOLOGY: A retrospective review of cases of acute diverticulitis managed under our HIH service from the period of 1st of January 2004 to 20th of October 2020 was completed. Baseline descriptive data relating to age, co-morbidities and severity of diverticulitis was collected. Details of medical treatment provided and subsequent complications were also collected. RESULTS: During the study period, 23 patients with acute diverticulitis were treated under the HIH unit. Among the study population, the median age was 60 (interquartile range 15) with a slight female predominance (n = 13, 56.5%). This represented the first presentation in 60.9% of patients. Average length of stay was 3.6 days (SD = 1.0) with no acute complications recorded in the study period. Two patients (8.7%) had further episodes of acute diverticulitis within 60 days. CONCLUSION: In this study, the lack of complications demonstrated indicates that HIH-based management of acute diverticulitis may be a viable and safe alternative to inpatient care.