Department of Anesthesiology, Tri-service General Hospital
In the early days, anesthesia was performed by the surgeons. However, with medical advancements, anesthesiology was separated and became an independent field. In this background and with efforts from previous directors, the origin of anesthesiology in Taiwan is found at the TriService General Hospital (TSGH). In our department, there are 16 attending doctors and 10 residents, including 2 professors, 4 associate professors, 3 assistant professors and 5 lecturers.
Director Xue-Shi Wang, "Father of anesthesia in Taiwan”, established the first Department of Anesthesiology in Taiwan. Director Fu-Nan Wang established first Division of Anesthesiology at Medical College in Taiwan. He also established the Department of Anesthesiology and Intensive Care Unit (ICU) at the Armed Forces First General Hospital, which were the first in Taiwan. Director Xue-Shi Wang set up the Post Anesthesia Room and established the Department of Anesthesiology at the Taipei Veterans General Hospital. After retiring from the army, Director Wei-Bo Ho established the Department of Anesthesiology at Far Eastern Memorial Hospital. Director Chuang-Lin Zhang introduced the new technique, "low-flow closed circuit system anesthesia,” and established the Department of Anesthesiology at National Cheng Kung University Hospital after he retiring from the army.
We have complete training program for our students, interns, PGY doctors, residents and anesthesia nurses and regularly conduct journal club, textbook presentation or other academic lectures. Regarding our research, we acquired many programs including Ministry of Science and Technology. In recent years, many original articles with high quality have been published.
Director Shung-Tai Ho first conducted "anesthesia quality assurance“ to ensure the quality of anesthesia in Taiwan. Director Chih-Shung Wong established the Pain Management Division to provide postoperative patient-controlled analgesia (PCA). Since then, our Department formally formed the Clinical Anesthesia, ICU, and Pain Management Divisions. In 2000, the first Chinese "Clinical Information Integration System“ in the world was used by our Surgical ICU. In 2006, introduction of target-controlled infusion (TCI) total intravenous anesthesia (TIVA) was also a pioneering achievement in Taiwan. Director Liaw initiated the “Anesthesia Consultation Clinic” and established the “Integrated Pain Management Center (IPMC).” Director Zhi-Fu Wu established the Anesthetic Quality Management Team and conducted the Simulation (iStan) to gather self-criticism for the sake of quality improvement. The promotion of the Anesthetic Consultation Clinic resulted in adequate communications before anesthesia, which met fulfilled the “patients‘ right to know“ and decreased surgical cancellation rates. Cultivation of talents, advanced studies, and achievement of the PhD degree were also encouraged.
In 2007, Doctor Zhi-Fu Wu won the “Symbol of National Quality (SNQ)“ award with the “TCI/ TIVA system.” He was the first anesthetic specialist to win the prize in Taiwan. Since 2010, Director Chen-Hwan Cherng has applied for a series of unique patents in Taiwan, including the infusion leakage warning device, temperature maintenance system, and improved supportive structures for the airway to improve the quality of anesthesia. Chief Chen-Hwan Cherng and Doctor Go-Shine Huang won the National Innovation Award with “New Type Nasopharyngeal Airway”. Our anesthetic team won the SNQ with “High Quality Airway Care in Anesthesia”.
In 2008, Wen-Jinn Liaw, the Chief of Surgical ICU also won the SNQ with the “introduction of the clinical information system at the Surgical ICU,“ which marked the first ICU team to win the prize in Taiwan. At the end of 2014, Surgical ICU team won the SNQ silver award with “Life guardian-The end of life-nursing care bundle”.
In pain management, the “IPMC“ was approved by the SNQ and many kinds of therapies including distinctive Enrac have been performed. Our surgical ICU teams use the clinical information system and introduced the newest concepts in hospice palliative care. In 2013, Chief Chung-Chang Yeh won the SNQ with “IPMC”, which was the first PMC to win the prize.
Under the efforts of previous leaders, teaching, research and clinical services are all valued and recognized with many prizes and patents. Therefore, many fellows came from other hospitals each year to TGSH for short-term research. In teaching, many national teaching workshops have been held. In research, we continue to increase the quality and quantity of articles for publication in SCI/ non-SCI peer review Journals worldwide.
In clinical services, our department is famous for low-flow anesthesia and TIVA. The number of anesthesia cases has reached over 27,000 cases annually (Figure 1), over 3000 cases PCA annually (Figure 2), with most patients rating the anesthesia service received as highly satisfactory. The number of Anesthesia Consultation Clinic cases has also been increasing, and the number of cases has reached more than 13,000 every year (Figure 3). Since October, 2017, our department started to apply the intelligent anesthesia record system to assist our clinical work. The system was expected to preserve medical record regarding peri-operative events more completely and conveniently. Meanwhile, its ease to practice could shorten the stay time of patients in the OPD. In addition, the new-built pre-anesthesia OPD was opening since 1st January, 2018. We could provide intact pre-anesthesia assessment and make patients know the operation room and department of anesthesiology before receiving surgeries.
In the future, we will create intact pre-anesthesia assessment and record,improve peri-operative quality of care, keep well contact with surgeons and promote strategies of enhanced recovery after surgery (ERAS), which could improve the patients' safety and prognosis. In addition, we will establish complete education program and make our medical training better. Meanwhile, we will work hard on the research about relationship between anesthesia and cancer and electrical medical record. We will continue to work towards our vision of becoming the preferred hospital of choice for the public of Taiwan.