What is an anesthesia resident

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On the occasion of the opening of the ÖGARI annual conference AIC 2019 in Graz, experts gave lectures on the challenges of perioperative intensive care medicine and the future of anesthesiology.

Austria currently has around 44,000 acute inpatient beds in public hospitals, of which 2,450 are intensive care beds. With these figures, Austria and Germany are among the leaders in Europe. In recent years, the costs incurred in the acute inpatient area have averaged around 12 billion euros. 13 percent of the total costs per year, that is around 1.5 billion euros, are spent on intensive care medicine. "Conversely, this means that hospitals with many intensive care units generate a respectable part of their total budget from intensive care points," said Univ.-Prof. GDR. Philipp Metnitz, Head of the Clinical Department for General Anesthesiology, Emergency and Intensive Care Medicine, Medical University of Graz, in the plenary session at AIC 2019 on the future of anesthesiology.

The population development of the last few decades does not stop at the composition of the patient population in intensive care units. While 750,000 people over 70 years of age lived in Austria in 1989 and the median age in intensive care units was 55 years, today 1.25 million Austrians are over 70 years old and the median age in intensive care units is 70 years. This development will continue over the coming decades. “However, I would like to state that age in the intensive care unit should not be equated with a poor prognosis,” emphasized Prof. Metnitz. The hospital mortality of over 80-year-olds is around 30 percent, which, conversely, means that 70 percent of the 80+ patients leave the hospital alive. The demographic development outlined leads to an increase in the need for medical resources. Depending on the supply region, there are currently between one and five intensive care beds per 10,000 inhabitants with a very high density.

A primary measure to influence the need for medical and intensive care services is prevention; long-term through lifestyle measures to prevent cardiovascular diseases or respiratory diseases. Prof. Metnitz expects medium-term effects from preventive measures in hospital operations in order to be able to deal with situations that make an intensive stay necessary.

In addition to preventive measures, improvements in the effectiveness and efficiency of the therapy are also parameters that influence the need. “Intensive care medicine is an important resource. It is effective and is getting better every year in Austria, ”reported Prof. Metnitz. The chance of survival for patients in Austrian intensive care units has increased by around 30 percent in the last 20 years. In terms of efficiency, however, there is definitely variability between the Austrian intensive care units.

If the need for intensive care medicine increases as forecast in the coming years, but the resource does not increase to the same extent, the use of existing facilities must be optimized. On the one hand, it is important to identify patients who will benefit from an intensive stay, but on the other hand also those who cannot benefit from it. Most recently, Prof. Metnitz pointed out that increasing the number of patients also necessitated more doctors.

Shaping the future in anesthesiology

In his presentation, Univ.-Prof. Dr. Rolf Rossaint, President of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) on strategies of the DGAI how anesthesiology should be developed in the future. In the context of strategy meetings, ten key statements were drawn up, which contain a target orientation for the further development of the subject with its sub-areas of anesthesiology and intensive care medicine as well as emergency, pain and palliative medicine. They form the basis for future concrete measures and recommendations of the DGAI. "We want to clearly define ourselves as a subject that takes care of perioperative medicine and represents an important guarantee for a high level of patient safety," said Prof. Rossaint.

The first key statement concerns the unit of the subject anesthesiology, in which all sub-areas and all professional groups working in them find their home and should not be broken down into different subjects. Another key statement concerns safe, empathic and process-oriented patient care. In Germany, for example, quality criteria for anesthesia are currently being developed, which are to be implemented in a certification process. SOPs (Standard Operating Procedures), systems for drug testing and checklists are already in use today, all of which contribute to increasing safety. In addition, the CIRS-AINS program enables sources of error to be identified, solutions to be worked out and errors to be avoided in the future. "I am sure that we need more checklists, more automatic controls, more certification of the clinics, support for diagnosis through artificial intelligence and much more," said Prof. Rossaint.

A major concern of the DGAI is the promotion of research, education, training and further education as well as the development of scientifically based recommendations for action and guidelines. In this context, Prof. Rossaint pointed out that the organization of congresses and training events as well as the development and updating of the guidelines also require large financial resources.

In addition, the DGAI stands for trusting, interdisciplinary and interprofessional cooperation on the basis of mutual respect and appreciation.

"We have to improve the framework conditions for competitive, high-quality basic science, clinical and translational research," demanded Prof. Rossaint, addressing a central topic of his DGAI presidency. If this research is not carried out, Prof. Rossaint fears, anesthesiology as an academic and scientific subject will be called into question. In order to avoid this, the DGAI set up a study center, which is supposed to serve the expansion of scientific activity as well as the national and international visibility of science.

Other activities of the DGAI include measures to strengthen innovation and research, the promotion of excellence in training and teaching as well as the next generation in anesthesiology. Last but not least, increased media presence should increase the visibility of the subject in public. (red / HL)