Anesthesiologists' Role in Interdisciplinary Teams

Core Leadership Functions

The American Society of Anesthesiologists emphasizes that anesthesiologists should use the surgical experience as the first touchpoint to reengage patients in their own healthcare, coordinating with multiple stakeholders to improve outcomes while reducing costs 1, 2
Anesthesiologists occupy a unique position to drive value-based perioperative care because they interact with patients across the entire surgical continuum and possess expertise in acute physiology, risk assessment, and crisis management 1, 2

Lead multidisciplinary preoperative assessment clinics that provide comprehensive evaluation beyond traditional cardiopulmonary assessment, including frailty measurement, cognitive status, nutrition, chronic pain management, substance use screening, and mental health evaluation 3
Direct risk stratification and optimization programs that identify high-risk patients requiring a "surgical pause" to mitigate modifiable risk factors before nonurgent procedures 3
Coordinate with surgeons, primary care providers, and specialists in shared decision-making approaches, resetting patient and family expectations about postoperative outcomes based on realistic assessments of surgical risk 3
Implement multimodal intervention strategies to prevent postoperative delirium, particularly in elderly patients who are at highest risk 4, 5

Pre-assign specific tasks to each team member during surgical pauses or team briefings, ensuring every member understands their designated responsibilities during routine and emergency situations 6

Advocate for evidence-based postoperative protocols including early mobilization, multimodal opioid-sparing analgesia, and timely removal of urinary catheters 5

Partner with surgeons in reducing mortality and complications by presenting a united front when counseling patients about realistic postoperative expectations, particularly for high-risk patients whom surgeons may feel pressured to operate on despite poor candidacy 3
Support expanded roles for senior geriatricians in coordinating perioperative care for elderly patients, with input from senior anesthesiologists to ensure integrated care pathways that are individualized to each patient 4
Implement age-appropriate protocols that address the higher risk of postoperative delirium, underappreciated pain, and the need to maintain continuity of community care during hospitalization 4, 5
Engage multidisciplinary teams comprised of primary care providers and physician specialists working in concert with patients through shared decision-making, particularly in preoperative optimization clinics 3
Ensure reciprocal information flow between patients, relatives/caregivers, and primary and secondary care services to maintain care continuity 5

Implementing data-driven, evidence-based best practices that provide structure allowing patients to return to optimal functional, cognitive, and psychological health 1, 2, 7
Segmenting patients based on complexity and risk to personalize and standardize care delivery appropriately 1, 2, 7
Focusing on cost avoidance through reduced complications and improved discharge disposition, which increases profit margins despite potentially reducing revenue in fee-for-service systems 3

Do not ration surgical or critical care based on age alone, but actively participate in discussions about the utility of surgery and resuscitation for individual patients 4
Avoid confining practice solely to the operating room when anesthesiologists' expertise in acute physiology and risk management can add value throughout the perioperative continuum 1, 2, 8
Do not assume elderly patients lack mental capacity to make treatment decisions; presume capacity exists unless clearly demonstrated otherwise, and ensure good communication to facilitate informed decision-making 4, 5
Prevent task fragmentation during critical periods by implementing automated electronic record systems and appropriate workload ratios, as fragmentation doubles medication errors 6
Recognize that supervising more than two operating rooms simultaneously creates an 87% probability of being unable to intervene in short cases and 40% in long cases, compromising patient safety 6