Ontario’s health-care system is struggling. In addition to staffing shortages and lengthy waits to see specialists, the province is facing a backlog of over 200,000 surgeries (as of January 2023). While there’s no quick fix for the current situation, there are proven solutions that could have a real impact on how quickly Ontarians receive care.
One of those solutions is the Anesthesia Care Team (ACT) model. For nearly two decades, this program has quietly and steadily allowed Ontario’s operating rooms to tackle more surgeries. Ontario’s Anesthesiologists (OA), the organization that represents anesthesiologists in our province, believes investment into the expansion of this model will achieve even greater results.
“We’re calling on the Ontario government to expand the ACT model,” says OA Chair, Dr. Rohit Kumar, “The model has proven to be an efficient and effective tool that allows surgical teams to do more. Additional funding will allow the model to be implemented for more surgeries, helping our hospitals deliver more high-quality care to patients faster.”
What’s the Anesthesia Care Team (ACT) Model?
Under the ACT model, a certified clinical anesthesia assistant (CCAA) aids the anesthesiologist prior to, during and immediately after surgery. At all times, the CCAA directed and supervised by the anesthesiologist, who develops and leads the implementation of the patient’s anesthesia plan.
The CCAA acts as a second set of hands, helping with a variety of tasks that can include preparing anesthesia machines and drugs prior to the start of surgery and helping monitor a patient during their procedure. They can also help transfer and observe a patient post-surgery.
Having a CCAA present is extremely valuable during emergencies or critical moments when they can help in stabilizing a patient. When these situations occur in a non-ACT model surgery, a second anesthesiologist may be called in to assist, which can result in delays in other surgeries.
Dr. Monica Olsen, the lead of our Anesthesia Health Human Resources Working Group and OA Past Chair, explains that the ACT is a more efficient way of delivering physician-led anesthesia care, “It allows for concurrent or parallel work for patients by two clinicians instead of the conventional model of one anesthesiologist doing sequential work.”
“It’s a really specialized team and that’s why it’s effective as it is,” says Rob Bryan, a Toronto-based CCAA with nearly 20 years of experience and a CCAA representative on our Anesthesia Health Human Resources Working Group.
In Ontario, the ACT model has been used for over 15 years, mostly in urban and suburban hospitals. The model has developed a solid track record of being safe and increasing efficiency; data from research into the ACT model shows that it increases patient safety. The model can aid in nearly every facet of anesthesia care delivery, including elective and emergency surgical and diagnostic procedures, pediatric and obstetrical procedures and much more.
While the exact number of surgeries performed under the ACT model in Ontario hasn’t been tracked, we are confident that it’s more than 100,000 procedures based on reporting that was maintained during the model’s earlier years. Dr. Eric Goldszmidt, former Deputy Anesthesiologist-in-Chief of The Mount Sinai Hospital and OA Executive member notes, "Our team of amazing CCAAs from Sinai Health System and University Health Network provides supervised sedation for over 13,000 eye surgeries per year at the Kensington Eye Institute in Toronto."
To maximize the efficiency of the ACT model, we are also calling on the provincial government to invest in and develop stronger metrics around health care human resources. This would allow Ontario’s health-care system to make evidence-based decisions about staffing and ensure we have the right people in the right places.
Meet the Certified Clinical Anesthesia Assistants
The ACT model requires two medical professionals: The anesthesiologist and the certified clinical anesthesia assistant. The latter group consists of either registered nurses or respiratory therapists who have completed additional specialized training. This training takes roughly 18 months to complete, includes 600 clinical hours and is capped off by an entrance-to-practice exam. In Ontario, all CCAAs are certified and credentialed by the Canadian Society of Respiratory Therapists.
“We have specialized training that helps anesthesiologists provide their care and extend the capabilities of the anesthesia department to help it meet growing demands,” explains Bryan.
Check out the image to learn what tasks CCAAs can perform and click here to see the full version of this infographic, which was created by the Canadian Society of Respiratory Therapists.
"CCAAs are multi-talented, able to provide care to patients and support to anesthesiologists as we provide care at all stages of life, at critical moments of life, and for a huge range of surgical and diagnostic procedures," explains Dr. Olsen.
The only downside to CCAAs? There aren’t enough of them! “There are more jobs now than people that can fill them,” says Bryan. He explains that since you must be a practicing nurse or respiratory therapist to get into the CCAA program, being able to step away from your full-time job to return to school and still maintain your other financial commitments can be a significant challenge.
“The first round of CCAAs were all funded by the Ministry of Health,” says Bryan, who adds that this funding made a big difference in the growth of his field. Unfortunately, “A sustainable financial plan was never established to maintain the workforce.”
While some hospital systems now pay for training, and/or incorporate the required clinical time into an employee’s existing work schedule, there are variations in how these aspects of CCAA training is administered, which Bryan notes is proving to be a barrier to getting more people into the field.
How The ACT Helps Reduce Ontario’s Surgical Backlog
“The ACT model is a great option to address the surgical backlog because it already exists, is already proven, and the structure and familiarity are already present in the province’s hospitals,” explains Dr. Kumar. “It’s a rapid and cost-effective path to addressing the need to do more surgical cases as soon as possible.”
Dr. Olsen explains that being teamed up with a CCAA essentially allows her to be more efficient, “For example, I can leave a CCAA with a stable patient, instructions and a plan for various clinical probabilities, and zip over to labour and delivery to place an epidural for a labouring mother, reducing her wait time; or, run to the emergency department or ICU to perform an emergency intubation (a critical breathing intervention).”
When the ACT model isn’t in use, the anesthesiologist is generally tied to one patient at a time, which can result in longer wait times for patients to receive the care they need. Additionally, emergencies and critical moments may pull the anesthesiologist away from a scheduled case, resulting in further delays.
Bryan says that by using the ACT model, a significant amount of anesthesia time, and therefore surgical time, can be freed up. Depending on the specifics of the procedure, Bryan explains that having a CCAA assist with preparing a patient and turning over the operating room for hip or knee replacement surgery, “Could save half-an-hour to 45 minutes for each case.” He explains, “You can only complete three to four joint replacements a day with the conventional anesthesia care model, but under the ACT model, that can be increased to five or six joint replacements a day.”
To put it simply, both Dr. Kumar and Bryan agree that, “The model increases efficiencies that empower anesthesia departments to cover more areas, decreasing waitlists.” And it does this while providing safe, physician-led care that also allows hospitals and governments to maximize their tight budgets.
What’s Next?
We are encouraging the province of Ontario to invest in training more CCAAs and expanding the ACT model so it can be implemented across all surgical centres and hospitals. The fact is the ACT model is proven and ready to expand; it just needs a proper funding increase!
Our Executive and Anesthesia Health Human Resources Working Group are actively connecting with health-care system stakeholders, including provincial politicians, to educate them about the benefits of the ACT model. But we could use your help with this task!
“Talk or write to your political representatives, health care administrators and leaders,” says Dr. Olsen, “And tell them that you support the ACT model and the increased investment that it needs.” You can find your MPP’s contact details here . Also notes, Dr. Olsen, “If you have surgery, tell your providers that you support an ACT model of care.”
You’re also encouraged to share and engage with our social media posts about the ACT model and other solutions to the challenges facing Ontario’s health-care system. The more public support the model receives, the more likely it is that it will get the funding and attention that it needs. And that means better and faster care for Ontario patients.
We thank you for your support!
