Signing Out Patients

Anesthesia is one of only a handful of specialties that allows the full responsibility for care of a patient to pass through multiple providers. At the end of the day, those on call will "relieve" the non-call anesthesiologists. We sign over the entirety of care to those taking over, something only seen in places like the emergency department. While on other services like medicine, surgery, or pediatrics, a night person often "covers" patients while the primary providers aren't in house, the main provider stays the same. So becoming comfortable with this new concept took me some time.

On some level, it makes a lot of sense. A surgery may be incredibly long, and fatigue is the anathema of the anesthesiologist (our motto is "vigilance"). We give each other breaks, and an extension of this is to sign over all the care of the patient. This means we have to encapsulate all our thoughts, our plans, and our anticipations for a case in a brief summary to another provider; it also means that if we're taking over, we have to quickly assimilate to a new situation to care for a patient safely. We have to deal with differences in anesthetic approach, quirks, or complex situations, but for the most part, this is fine; there are only so many ways of providing anesthesia, and all anesthesiologists need to be facile with managing any of them.

The trade-off is that we lose continuity of patient care, but we build a trust and relationship with our colleagues that is quite remarkable. This system also allows a shared responsibility for the burden of long cases and call; as a result, anesthesiology is known for its quality of life.