ANESTHESIA IN BARBADOS

Purpose: To describe the anaesthesia services in Barbados: to present the major challenges confronting the Anaesthesia Department of the gov ernment-owned Queen Elizabeth Hospital (QEH): and to describe the Depa rtment's approaches to optimise safety and cost-effectiveness of anaes thesia at QEH. Source of Information: Authors (KBS, HSLM, RAH), who co llectively provided more than 50 yr of anaesthesia at QEH; the Dean (E RW) of the University of West indies Medical School (Barbados campus); archives of Barbados; and records of QEH. Principal findings: The gov ernment oi Barbados provides modern health care services to all of its citizens, primarily at QEH, Barbados, however, has tight financial co nstraints, intrastructural limitations, and a bureaucratic administrat ion that predispose QEH's Anaesthesia Department to unexpected depleti ons of drugs and disposable supplies, sporadic shortages of personnel and functioning equipment, and occasional quality assurance problems. To deal with such problems, the Anaesthesia Department has implemented several pro-active measures: establishing an audit system to prevent depletion of imported drugs and supplies: training local personnel to maintain; equipment: purchasing an oxygen concentrator to reduce oxyge n costs: decreasing nitrous oxide use (expensive in Barbados): and ini tiating its own quality and safety standards. Conclusion: Continuous d elivery of high quality cost-effective anaesthesia care requires thoug htful planning by administrators and judicious resource allocations He alth care administrators and clinical departments need to work togethe r closely to establish a framework that enables departments to play a major role in determining how the institution's limited financial reso urces are best allocated to meet the departmental priorities.