The chief aims of the Association are the advancement of knowledge and skill in perioperative anesthesia care for the veteran undergoing surgery. The vision of the AVAA is aligned with the VA mission to promote excellence in anesthetic care of veteran population by building a culture of education and research. In roughly past 10 years, our specialty evolved from the frame of the operating room theater to complex tasks of a perioperative physician anywhere in the hospital. As perioperative physicians, we provide care for both medical and surgical patients in critical care units, oversee chronic pain and pre-operative medical evaluation clinics and are involved in daily management of the OR. In many VA hospitals, Anesthesiology managers are the sole managers of the operating rooms or jointly working with Chiefs of Surgery and/or the OR Nurse Managers.
Since the AVAA shares similar objectives with the National Anesthesiology Services (NAS), it may sound that these organizations are duplicates. In order to decrease the overlap, AVAA mainly functions as an organization to educate its members about the pearls of “Practice of Anesthesiology” in VA settings rather than being involved in administrative aspect of this specialty. We will closely collaborate with Anesthesia Services of armed forces and welcome our colleagues from uniformed forces to have joint membership. The AVAA has revised the website to allow its new members to apply and pay their dues online.
Most anesthesiologists practicing in the United States probablybelieve that the practice of Anesthesia is reasonablysimilar in private sector and VA. Through my tenure at the VA, I have learned howsignificant these variations are. Anesthesiologists have assumed several roles in perioperative medicine and ply active role to help the organization to meet or exceed on external peer review program (EPRP) measures related to surgical infection prevention (SCIP). Clinical pathways, evidence-based practices and guidelines adopted from various professional societies are routine used by VA anesthesiologists. AVAA is equipped to educate its members with concepts and “how to’s” in Anesthesia practice and related VHA directives.
The AVAA website has been reformed and includes forums and share points for scientific discussions. Please note that patient identifiable information should not be shared in these forums. Any educational material that is suitable for CME credits will be reviewed by the scientific editorial board and be placed on the website to be accessed by the members. State University of New York at Buffalo has accepted to sponsor the CME materials following a thorough review by the editorial board. Now, AVAA members will be able to earn CME credits by completing a post-test prepared for these educational courses.
The future goal is to expand the educational website to host a VA Anesthesia Journal, and I hope that with the help of the AVAA members this will be a success. Future indexing by Medline and Pubmed search engines will be sought. During Annual meetings, various workshops in the field of airway management and use of Ultrasound for nerve blocks will be offered. I would like to thank Dr. Ann Walia, the current Secretary of the Association for her outstanding efforts to make these educational sessions a reality.
Nader D. Nader
Transformation. It’s a big word that means big things. As VA anesthesiologists, I believe we are at the forefront of the next transformative change in the practice of anesthesiology. What do I mean?
I’ve recently been reflecting on the many technological advances in our medical specialty since I entered the field. When I was an anesthesiology resident , it was not uncommon to use a vernitrol for anesthetic gas delivery ,while end tidal C02 monitors and pulse oximeters were the new kids on the block. In fact, intraoperative use of one of these scarce monitors was a decision made by the board runner, usually based on a resident’s persuasive skills. How times have changed! Through the years, as monitoring systems have become more sophisticated, the information made available to us has guided our practice standards and led to safer and more precise delivery of anesthetics. From a business cost standpoint, the dramatic decline in anesthesiology malpractice premiums is a direct correlation to the improved margins of safety in anesthetic delivery.
So what is the next quantum leap for our specialty and what role do we, VA anesthesiologists, play in this advancement? For the past several years, the Department of Veterans Affairs has been in the business of using automated healthcare information systems through its Veterans Integrated System and Technology Architecture (VISTA). We are industry leading in this area, far outpacing the private sector. Though many VA medical centers already have automated anesthesia record keeping systems (ARKS) in place, currently these are stand alone systems that produce records that must later be scanned into VISTA.
The revolutionary news is that through the recent development of data bridges designed to allow external software to communicate to and from VISTA, the automated anesthesia record systems will soon be included as a seamless component in the documentation of patient care throughout the entire perioperative period. The implications are immense.
Access to the huge amounts of anonymous patient data in VISTA will allow correlation between patient outcomes with anesthetic technique. As a result, I expect we will soon see further refinement in anesthetic practices and tighter intraoperative hemodynamic control. Tighter control meaning fewer instances of post-op confusion or renal insufficiency in our elderly population, fewer ICU days, fewer hospital days, fewer infections……better outcomes, better care. In effect, this is an opportunity for VA anesthesiologists to set the practice standard for our specialty while asserting ourselves as the experts in patient care through the continuum of the perioperative experience. That is an important concept. We are physicians who practice anesthesiology.
At the recent National Anesthesia Service Chief’s meeting in September, it was very clear that we are on the cusp of this important transformation. The missing piece, data bridges, is now on the launching pad. Many thanks are owed to Gerald Ozanne MD, VA Medical Center San Francisco and William Schmeling MD PhD , VA Medical Center Milwaukee for their tireless work in advancing this cause. They have built the platform. It is up to the rest of us to seize the opportunity.
Susan V. Calhoun MD,MBA
Chief, Anesthesiology Service
National President, Association of VA Anesthesiologists 2008-2010
Leadership VA 2009
Dear Friends and Colleagues,
It is my pleasure to update you once again on this year’s AVAA proceedings. First, I would like to note that our thoughts go out to all those affected by the recent hurricane tragedies. The AVAA is proud to have donated $1500 to the Red Cross and $1500 to the VA Employee Relief Fund to help victims recuperate from Hurricanes Katrina and Rita.
Due to the damage New Orleans suffered from Hurricane Katrina, ASA was unable to hold its annual conference in New Orleans and moved the meeting to Atlanta. This last-minute change forced many of the ASA’s component societies to cancel their annual meetings. AVAA was no exception and voted to cancel the formal meeting through an email poll. However, there was enough interest from AVAA members attending the ASA meeting for an informal meeting.
We had our informal dinner/meeting on Sunday October 23 at HSU’s restaurant in downtown Atlanta. The Director of National Anesthesia Service, Dr Bishop updated us on some issues for the National Anesthesia Service. I updated everyone on the latest news on the physician pay bill. I do not recall there were any critical issues discussed. With only nineteen attendees, the informal setting allowed members to get to know each other better and candidly share best practices from their local institutions. The food and wine were delicious and everyone had a very enjoyable evening.
I look forward to leading the next meeting in Chicago during the ASA Annual meeting. AVAA annual meetings provide a rare opportunity for all VA anesthesiologists to hear the message from Dr Bishop and to get updated on the latest news on any VA anesthesia issues. And of course, it is always nice to catch up with old friends and meet new ones. Please make every effort to attend.
The 2003 AVAA Annual Meeting was held on October 12 at the venerable Empress of China Restaurant in the heart of San Francisco’s historic Chinatown. I think it is safe to say that the meeting was historic in its own right since the number of attendees was approximately twice as large as any previous AVAA meeting…..nearly 75 guests, approximately 60-65 of them AVAA members with assorted spouses, guests and perhaps even a few gate crashers (heck, we were having so much fun we lost count…)! What excited me the most was how many young faces there were and how excited they were to be working in the VA! The food and libations were as expected for this landmark restaurant, superb and no one left hungry…The AVAA profusely thanks a “friendly and spontaneous consortium” of information technology companies (EKO, Drager, GE) for gracious unrestricted educational donations that helped support this event which is truly the cornerstone of the AVAA’s mission.
As the plates were cleared the business began and an impressive meeting it was. In the comfortable surroundings (seems like the first year in quite a long time we had ample space to move around!), the vitally important interchange of ideas from the multitude of VAMC’s represented really “started to flow” following my intro presentation (mostly light hearted jabs at our new governor elect “the Terminator” but laced with pleas for our members to get involved, stay involved, urge any of their new colleages to join, and for heaven sakes, please take full advantage of our rapidly growing and easier to use web site)! The presentation is posted in the Annual Meeting Minutes section for registered members to see. Coupled with the appropriate catalyst from our own National Anesthesia Service director, Mike Bishop and his trusty and talented side kick Doug Rotter …the meeting heated up as we covered a range of topics important to any and all VA Anesthesiologists starting with the pending physician pay bill and its ramifications, information about physician hours and documentation and other topics (also in the Annual Meeting Minutes page for registered members to view).
Adding presentations from our immediate past president , the unflappable Al Perrino from West Haven on the important and controversial state/military-VA component society issue and the timeless Bill Schmeling from Milwaukee (hey , if you don’t believe me just look at that baby face in the “Report from the Field Advisory Committee” section) on the billing issue and important computer interface software issues which are of particular importance to us and the corporate community involved in anesthesia record keepers and integrated perioperative information systems. We have all the details of these discussion on our meeting minutes page shortly as soon as our trusty secretary/treasurer Grace Chien from Portland finishes typing that long document!
AVAA is growing rapidly and we’re making lots of changes behind the scenes to keep up (members will hearing about this soon)….we’ve found a new mission as our former emphasis on supporting the establishment of a strong NAS which has came to fruition (keep up the great work Mike!). We are defining ourselves as a true advocacy and educational organization for the talented and hardworking Anesthesiologists of the VA. I’m very optimistic about our future and foresee strong advances on multiple fronts including research! With the upcoming publication of our perioperative beta blockade survey in the February 2004 issue of the Journal of Cardiothoracic and Vascular Anesthesia (performed in collaboration with the Association of VA Surgeons) we are entering that realm and others in the organization are already active through the AVAA!
Finally, just as I ended my update earlier this year just as the Iraq war had begun, many brave servicemen and women are still at great risk and many have perished in the line of duty. Needless to say words can’t express the loss and sacrifice on the part of these brave individuals and their families. Although we are not directly involved in delivering health care to our active armed forces members, all of us in AVAA strive to bring the best health care possible to veterans after their term of service. We will continue to advocat e for the highest standards of health care and the ability to attract and retain well trained anesthesiologists and support staff. That’s what it’s all about!
Stayed tuned to your email box and to this page for further updates and I’m already looking forward to seeing all of you and lots new faces in Las Vegas at the 2004 ASA meeting!
Martin J. London, M.D.
Attending Physician, San Francisco VA Medical Center
Professor of Clinical Anesthesia
University of California, San Francisco