our Committee on Quality Management and Departmental Administration (QMDA) remains one of the busiest and most active committees in the Society. The committee is charged per the ASA Bylaws with “reviewing all matters pertaining to peer-review, quality management, departmental administration and medical staff issues relevant to the membership’s practice of the medical specialty of anesthesiology.” The elements of our committee charge translate into a variety of specific activities for committee members:

• Representation of the Society’s interests to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and the Accreditation Association for Ambulatory Health Care (AAAHC);

• Responsibility for the ASA Anesthesia Consultation Program;

• Biannual publication of the “Manual for Anesthesia Department Organization and Management” (now online!);

• Maintenance of reference materials on the ASA Web site; and

• Provision of an expert panel for Society members’ questions regarding quality of care.

Let us take a brief look at these objectives and review the committee’s recent efforts in each area:

Liaison activities to JCAHO are primarily conducted through membership on Professional and Technical Advisory Committees (Hospital PTAC and Ambulatory PTAC). Jerry A. Cohen, M.D., and Robert S. Lagasse, M.D., serve as representative and alternate to the Hospital PTAC, while Walter G. Maurer, M.D., and J. Lance Lichtor, M.D., are our representative and alternate to the Ambulatory PTAC. Dr. Cohen, as Vice-Chair of the PTAC, also serves on the Survey and Standards Procedure Committee. They attend regular meetings of these committees and often find themselves deeply involved in controversy relating to preservation of the principles of safety in anesthesia and sedation care throughout the hospital. Similarly our representatives to AAAASF (Jeffrey L. Apfelbaum, M.D.) and AAAHC (Sorin J. Brull, M.D., and former QMDA member Thomas A. Joas, M.D.) enjoy respected positions on the boards of these two organizations representing ASA’s interests.

The ASA Consultation Program was created in 1982 to respond to the needs of hospitals and anesthesiology departments that seek expert review on a variety of quality concerns. Issues often presenting themselves to consultants include departmental leadership and organization, practitioner competence, relationships between anesthesiologists, surgeons and administrators and a number of less frequently occurring but no less vexing concerns. The program provides for two experienced consultants to visit the requesting hospital for two or three days (depending on hospital size and the nature of the concerns) and perform a comprehensive review of the department’s function and interactions. Following their visit, a detailed set of findings and recommendations are submitted to the requesting parties within four to six weeks of the site visit. Responses to the program elicited six months after each consultation reveal essentially unanimous satisfaction with the consultants and their recommendations.

The costs of the consultation program are borne by the requesting institutions and, in some cases, departments of anesthesiology. The program is operated on a cost-neutral basis as a service to our members and their hospitals.

QMDA’s “Manual for Anesthesia Department Organization and Management” (MADOM) is a work product of the committee, which, although not a formally approved publication of the House of Delegates, brings together in one document the diverse information required to establish and manage a department of anesthesiology. It contains all pertinent ASA standards, policies and statements germane to departmental organization as well as background information on quality management, peer-review mechanisms, outpatient services and a myriad of other details useful in the establishment and operation of a modern department of anesthesiology.

Biannually the MADOM is completely reviewed and revised with updated policies of the Society as well as information from JCAHO and other standard-setting organizations. The MADOM is now available only as an online document for ASA members and only through the ASA Web site.

QMDA also provides several additional helpful tools for department leaders and quality managers, which can be found in the “Members Only” area of the ASA Web site:

• QA/PDX^sm Quality Assurance Software for Anesthesia is a complete quality management software system sponsored by QMDA and developed and managed by Dr. Cohen.

• The Quality Management Template is another tool produced jointly by the Committee on Performance and Outcomes Measurement and QMDA. The excellent explanation of the goals of a quality program was originally drafted by former committee member Ronald A. Gabel, M.D., and is currently managed by Dr. Lagasse.

• Example of a policy on unintended intraoperative awareness was developed by QMDA as an aid for departments seeking a template for their own policy on the subject. As are all of the above, these documents are work products of the committee and, although they represent a consensus of the Society’s experts in quality management, are not standards or guidelines that have been officially adopted by the House of Delegates.

• The QMDA Toolkit offers a variety of helpful information and links to sites useful in establishing and managing an anesthesiology department. It is available on the Web at <www.ASAhq.org/clinical/toolkit/faq.htm>.

Member Inquiry Response Services
Via our senior staff liaison, Associate Director of Professional Affairs Karin Bierstein, J.D., M.P.H., and other sources, the committee frequently receives inquiries regarding anesthesia quality issues. These are fielded to the membership via our listserve, and committee members actively share their opinions and experiences with the members.

QMDA members also make regular contributions to the ASA NEWSLETTER and sponsor at least one panel discussion at the ASA Annual Meeting.

Other issues recently demanding the committee’s attention include Sentinel Event Alerts from JCAHO, the “locked cart” conundrum vexing many departments undergoing JCAHO inspections and the difficult issue of nonanesthesiologists administering increasingly deep levels of sedation. It is not unusual for an issue to seemingly be resolved, only to have it reappear from another part of the country or with a slightly different presentation.

QMDA enjoys excellent staff support by Ms. Bierstein and the administrative assistance of Assistant Executive Director Denise M. Jones, Director of Information Services Janice L. Plack, Administrative Assistant Sandra Cincotti, ASA Web Administrator Anita Abbatacola and Executive Director Ronald A. Bruns at the Executive Office in Park Ridge, Illinois.

James S. Hicks, M.D., is Associate Professor of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, Portland, Oregon.