(1) Grading and classification of anesthesia

1. Refer to the American Society of Anesthesiologists (ASA) disease grading standards: Levels I to VI

ASA grading standards:

Level I: Physically healthy, normal organ functions, no mental illness, etc.

Level II: In addition to surgical diseases, there are mild systemic diseases (such as mild asthma) and functional compensation is sound.

Level III: There are obvious or serious systemic diseases (such as congestive heart failure), physical activity is limited, but the patient can still cope with daily activities.

Grade IV: Severe systemic disease, loss of ability to perform daily activities, often life-threatening.

Level V: A dying patient who cannot sustain life for 24 hours regardless of surgery or not

Level VI: Confirmed brain death and his or her organs are intended for organ transplantation

Emergency surgery is indicated by an “E”

2. Anesthesia classification standards

Anesthesia classification is divided into categories one to four. For details, please refer to the "Hunan Province Medical Record Writing Standards and Management Regulations and Case (Case) Medical Quality Assessment Standards".

3. Anesthesia for special surgeries

Anesthesia for heart and large blood vessel surgery, anesthesia for intracranial aneurysm surgery, anesthesia for giant meningioma surgery, anesthesia for brainstem surgery, anesthesia for adrenal gland surgery, anesthesia for multiple severe trauma surgery, anesthesia for shock patients, Anesthesia for high cervical spinal cord surgery, anesthesia for organ transplant surgery, anesthesia for elderly patients, neonatal anesthesia, controlled blood pressure reduction, hypothermic anesthesia, cardiopulmonary and cerebral resuscitation, etc.

4. Newly launched projects, anesthesia for scientific research surgeries.

(2) Level of anesthesiologists

The level of anesthesiologists shall be standardized based on their health technical qualifications, technical positions employed and years of working in corresponding technical positions. All anesthesiologists should obtain medical practitioner qualifications in accordance with the law.

The level of anesthesiologists is standardized based on their health technical qualifications, employed technical positions and years of working in corresponding technical positions. All anesthesiologists should obtain medical practitioner qualifications in accordance with the law.

1. Resident Physicians

(1) Junior resident physicians: those who have worked as a resident physician for less than 3 years, or who have obtained a master's degree and have worked as a resident physician for less than 2 years.

(2) Senior resident physicians: those who have worked as a resident physician for more than 3 years, or who have obtained a master's degree, obtained the qualification of a practicing physician, and have worked as a resident physician for more than 2 years.

2． Attending Physician

(1) Junior Attending Physician: Those who have worked as an attending physician for less than 3 years, or who have obtained a clinical doctorate and have worked as an attending physician for less than 2 years.

(2) Senior attending physician: those who have worked as an attending physician for more than 3 years, or who have obtained a clinical doctorate and have worked as an attending physician for more than 2 years.

3. Deputy Chief Physician:

(1) Junior Deputy Chief Physician: Has worked in the position of Deputy Chief Physician for less than 3 years.

(2) Senior deputy chief physician: those who have worked as deputy chief physician for more than 3 years.

4. Chief Physician: A person employed in the position of Chief Physician.

(3) Permissions of anesthesiologists at all levels

1. Under the guidance of superior physicians, junior residents can perform anesthesia for ASA Class I to III patients and perform anesthesia for first- and second-level surgeries. Some junior residents with outstanding abilities can provide anesthesia for patients with ASA classifications I to III. Under the guidance, anesthesia for ASA grade IV or grade III surgeries can be performed.

2． Senior resident physicians

Under the guidance of superior physicians, they can perform anesthesia for ASA grade I-VI patients, level one to level four surgical anesthesia, and be initially familiar with anesthesia for heart and large vessel surgery, and anesthesia for intracranial aneurysm surgery. , anesthesia for giant meningioma surgery, anesthesia for brainstem surgery, anesthesia for adrenal gland surgery, anesthesia for multiple severe trauma surgery, anesthesia for shock patients, anesthesia for high cervical spinal cord surgery, anesthesia for organ transplant surgery, anesthesia for elderly patients, anesthesia for neonates, endobronchial anesthesia, control Antihypertensive, hypothermic anesthesia, cardiopulmonary and cerebral resuscitation, etc.

3. Junior attending physicians

Can independently carry out anesthesia for ASA grade I-IV surgical patients, first- to fourth-level surgical anesthesia, have preliminary knowledge and can independently carry out anesthesia for cardiac and large blood vessel surgeries, and intracranial aneurysm surgeries. Anesthesia, anesthesia for massive meningioma surgery, anesthesia for brainstem surgery, anesthesia for adrenal gland surgery, anesthesia for multiple severe trauma surgery, anesthesia for shock patients, anesthesia for high cervical spinal cord surgery, anesthesia for kidney transplant surgery, anesthesia for elderly patients, anesthesia for neonates, endobronchial anesthesia, Controlled blood pressure reduction, hypothermic anesthesia, cardiopulmonary and cerebral resuscitation, etc., and can also carry out pain clinics and anesthesia clinics.

4. Senior attending physicians

can independently carry out anesthesia for ASA grade I-VI surgical patients, level one to level four surgical anesthesia, and are proficient in anesthesia for cardiac and large vessel surgery, intracranial aneurysm surgery, and giant meningeal surgery. Anesthesia for tumor surgery, anesthesia for brainstem surgery, anesthesia for adrenal gland surgery, anesthesia for multiple severe trauma surgery, anesthesia for shock patients, anesthesia for high cervical spinal cord surgery, anesthesia for liver and kidney transplantation, anesthesia for elderly patients, anesthesia for neonates, endobronchial anesthesia, controlled Antihypertensive, controlled cooling anesthesia, cardiopulmonary and cerebral resuscitation, etc., and carry out pain clinic and anesthesia clinic.

5. The junior deputy chief physician

can independently provide anesthesia for ASA grade I to VI patients, anesthesia for level four surgeries, and rotate pain clinics.

6． The senior deputy chief physician

guides junior doctors to perform anesthesia on difficult patients and deal with anesthesia accidents caused by junior doctors, as well as the diagnosis and treatment of difficult patients in the pain clinic.

7. Chief physician

Guide doctors at all levels to perform anesthesia for difficult patients and deal with anesthesia operation accidents of doctors at all levels, diagnosis and treatment of difficult patients in pain clinics, and launch new projects, extremely high-risk surgical anesthesia, etc.

(4) Anesthesia shift arrangement

1. The daily dispatch of elective surgeries is completed by the department director. The list of anesthesiologists for each operation is determined according to the doctor's level. If a general consultation is required, it must be submitted to the department director at least 2 days in advance to organize a general consultation and approve it.

2． Emergency surgeries, night shift surgeries and surgeries on holidays are arranged and coordinated by the department director.

3. When patients choose an anesthesiologist, they should implement the anesthesiologist grading system as a premise.

(5) Approval authority for special anesthesia

1. Diagnosis and treatment of anesthesia and pain with qualifications

Anesthesia and analgesia with qualifications refer to anesthesia and analgesia that are specially qualified or authorized by the health administrative department at or above the municipal level in accordance with regulations. Special anesthesia and analgesia qualification certificates or authorization certificates shall be issued to hospitals and physicians by the health administrative department at or above the municipal level or its recognized professional organization. Only anesthesiologists who have obtained certain types of anesthesia and analgesia qualifications have the authority to preside over corresponding anesthesia and analgesia.

2． High-risk anesthesia

High-risk anesthesia must be discussed within the department, signed and approved by the department director, and then reported to the medical department. The medical department will decide on its own for approval or submit it to the vice president of business for approval. After approval, the designated chief physician will Or a senior deputy chief physician is responsible for implementation.

3. Anesthesia for emergency surgery

Anesthesia can be administered when the anesthesia level for the expected surgery is within the anesthesia authority level of the on-call physician. If the risk is high or the expected anesthesia exceeds your own anesthesia authority level, you should urgently report to the second-line duty and report to the department director if necessary. However, in situations where emergency life-saving is required, and when the superior physician is temporarily unable to attend the operation and administer anesthesia, the physician on duty has the right and must, without violating medical principles, to preside over the rescue that he deems reasonable according to the specific situation, and the rescue shall not be delayed. opportunity.

4. New technologies and new projects

1) General new technologies and new projects must be discussed within the department and approved and filed in accordance with relevant procedures.

2) High-risk new technologies and projects must be reported to the provincial health authorities for approval by the hospital within the department. If necessary, the provincial health authorities will entrust a designated academic group to conduct demonstrations, and only after review and approval by the expert committee can it be implemented in the hospital.

(6) Anesthesiologist qualification classification authorization procedure

The department establishes an anesthesia authorization management group to be responsible for the management of the anesthesia authority of the department physicians. The management group is composed of the department director and/or 2-3 It is composed of personnel with professional titles of deputy chief physician or above. The department director serves as the team leader and is the first person responsible for the management of anesthesia authority in the department. The authorization management team regularly evaluates the anesthesia authority of the anesthesiologists in the department and clarifies the specific anesthesia authority of each anesthesiologist based on his actual work level and ability.

1. When an anesthesiologist can independently undertake anesthesia, or when an anesthesiologist needs to be promoted to undertake a higher level of anesthesia in accordance with the above-mentioned relevant provisions, he should fill in the "Anesthesiologist Qualification Application Form" based on his or her qualifications, actual technical level, and operational ability. , hand it over to the director of the undergraduate department;

2. Anyone who applies for the senior management or low-experience management level will be approved by the department director based on the department's promotion assessment index and announced within the department.

3. For those who apply for the junior attending level or above and meet the department's promotion assessment indicators, the department director will organize a group of experts within the department to discuss and evaluate their technical capabilities, and then submit them to the medical department for approval, which will be recorded and announced in the hospital.

(7) Supervision and management

1. The Medical Department performs management, supervision and inspection responsibilities;

2. Carry out access and dynamic management of anesthesiologist qualification classification authorization in accordance with this system and procedure;

3. The implementation status will be inspected from time to time, and the inspection results will be included in the medical quality assessment project;

4. Once it is verified that those who violate this specification and exceed their authority for anesthesia will be held accountable, the department head will be held accountable and handled in accordance with the relevant regulations of the hospital. For medical disputes arising therefrom, the violator will be personally liable for corresponding legal and financial compensation.