Getting an Anaesthetist in Code Blue Situations

The above matter was discussed with all the anaesthetists, and we decided on the following recommendations. These recommendations were presented to the MAB on 10 November 1999 and were accepted with minor modifications.

a) Modification of the Weekly Anaesthetic Roster

Basically, the list of anaesthetists covering the emergencies for the day will be listed in one column right next to the date with the relevant times printed next to each name, e.g.

1800-0800 1st Radha
	     2nd BSingh

A footnote will be added to the weekly roster stating the following,

b) Guidelines on How to Contact an Anaesthetist for Non-Operative Emergencies

We recommend the following steps,

1. One person shall be designated as the Contact. This will be,
1. During office hours (0730-1900 on Mon. to Fri. and 0730-1300 on Sat.), the Coordinator of the North Tower Operation Theatres, and
2. Outside of office hours, the Deputy Nursing Administrator (DNA) for OT.
2. All non-operative emergency cases shall be referred directly to the Contact who will be fully responsible to get an anaesthetist to attend the emergency. The order of preference will be,
1. Emergency or 1st on call anaesthetist
2. 2nd on call anaesthetist
3. Any available anaesthetist still in the hospital
4. Other anaesthetists outside the hospital
3. The Contact must be informed of the reason for the referral to judge the urgency of the case and to inform the anaesthetist. It is not sufficient to say that Dr. X wants an anaesthetist.
4. All anaesthetists have agreed to extend their full cooperation and to try their best to come when called. If they are not in the hospital, they should inform the Contact how long it will take them to reach the hospital so that she may arrange for another anaesthetist if necessary.

Please note that if the responding anaesthetist is not covering emergencies, he or she may hand the case back to the person covering emergencies.

c) Distribution of Weekly Anaesthetic Roster

The weekly anaesthetic roster will henceforth be distributed to all the wards, including ICU, CCU, HDU, Daycare, ER and Labour Ward.

d) Changes to Anaesthetic Roster

1. If any anaesthetist makes any changes to the roster after it has been distributed to the wards, he will be responsible to inform the Contact of these changes.
2. During office hours, the Coordinator will inform Medical Staff Services (Ms. Doreen Loh) at Ext. 6680 who will be responsible for informing all other critical areas including ICU, CCU, HDU, ER and Labour Ward. After office hours, the DNA will be personally responsible to inform all critical areas.

e) Care of ICU/CCU Patients Who Are Already Under the Care of an Anaesthetist

 

We have decided on the following,

1. The anaesthetist concerned is responsible to ensure continuity of care to the patient.
1. If he knows that he will not be available, e.g. when going on leave, he should arrange for another anaesthetist to cover him during his absence.
2. If he is unexpectedly called, and is unable to attend to the patient, it is the responsibility of the anaesthetist to arrange for a colleague, generally the anaesthetist covering emergencies at the time, to attend to the patient.
2. The anaesthetist is personally responsible to find a replacement anaesthetist and should not pass off this responsibility to the primary physician.
3. While he may ask the Contact to find out who is available, he must, nonetheless, personally speak to the other anaesthetist to ensure that the other anaesthetist is fully aware of the clinical status of the patient.

Please note that the above guidelines only apply to the ventilatory care of the patients, as is the practice in SJMC. In general, the primary physician is still responsible for the overall care of the patient including the resuscitative management of the patient. However, this may vary depending on the arrangement between the primary physician and the anaesthetist for that particular patient.

If approved by the MAB, the above procedures in a), b), c) and d) will be passed on to the appropriate nursing and administrative staff to ensure that they know the proper procedures to follow.

Additional News on the Above

Ms. Irene Quah had proposed that SOP No. MEDS 1.011 – Anaesthetic Emergency Roster which had been implemented on 24 November 1999 be changed so that if there were any changes to the Anaesthetic Weekly Roster initiated by the anaesthetists, the anaesthetists were to inform the Manager of Medical Services during office hours instead of the OT Coordinator. However, the MAB at its Jan 2000 meeting was of the opinion that it would be easier for the anaesthetists to inform the OT Coordinator as is currently done. Furthermore, the current procedure had been shown to be a workable one and, hence, the SOP would not be changed. However, Ms. Doreen Loh was asked to help the OT clerks to work out a system to disseminate the changes by internal e-mail.