The Taiwan Society of Anesthesiologists, which was the second medical subspecialty organization in Taiwan, was founded in 1956. In 1988, the Department of Health, Executive Yuan, established the board of scrutinization and certification of qualified anesthesiologists, as well as an official accreditation committee for the recognition of competent medical institutions for training residents to become specialists in anesthesiology. Currently, there are 950 qualified anesthesiologists and 25 medical institutions licensed to train anesthesia residents with a total capacity of 60 trainees per year (although the allowance by the Department of Health in 2011 is just 30).
Acta Anaesthesiologica Taiwanica, the official journal of the Taiwan Society of Anesthesiologists, has become an international periodical, with 55.4% of the submitted manuscripts in 2009 coming from overseas. All this signifies that the research level in anesthesiology, the training of specialists in anesthesia and the production of an acceptable number of qualified anesthesiologists have reached a mature state in Taiwan. Nevertheless, there has been no study on the quality of anesthesia in Taiwan. In this issue of the journal, Liu et al1 report on the mortality related to anesthesia, the number of anesthesias performed by each anesthesiologist, and the ratio of anesthesiologists to nurse anesthetists after a review of the relevant materials collected during the presidencies of five ex-presidents of the Society. They found that the anesthesia-related mortality in Taiwan is 10-fold higher than in America, Britain and Japan, that the number of anesthesias carried out by each anesthesiologist per year is twice that of each American anesthesiologist, that the ratio of anesthesiologists to nurse anesthetists is 1:3−5, and that more than 50% of the anesthetic complications were preventable. These findings indicate that there is much room for improvement in the quality and service of anesthesia in Taiwan.
Liu et al1 also suggest improvements, such as an increase in the reimbursement of anesthesias by the Bureau of Health Insurance, implementation of high-quality training of anesthesia residents, stricter scrutinization of qualified anesthesia specialists, and increased emphasis on continuing education for anesthesiologists.
Other effective means to improve the quality of the anesthesia service would be to improve the training of nurse anesthetists so as to make them competent assistants to anesthesiologists, setting up standard anesthesia monitoring, and enforcing quality assurance and continuous improvement by the anesthesia service.
Liu et al’s report1 is the first commentary to deal with the quality of anesthesia in Taiwan, about which some grave problems have been uncovered. To solve these problems not only constitutes a great challenge to all anesthesiologists in Taiwan but will also require the united efforts of all members of the Society. It is hopeful that this appeal will not fall on deaf ears. We are looking forward to an elevation of the quality of anesthesia in Taiwan in the near future that would be comparable to that in developed countries.
Tak-Yu Lee, MD
Honorary Editor-in-Chief,
Acta Anaesthesiologica Taiwanica
Professor and Consultant Anesthesiologist,
Tri-Service General Hospital,
National Defense Medical Center