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Bradley J Hindman - One of the best experts on this subject based on the ideXlab platform.
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Nurse anesthetists' evaluations of Anesthesiologists' operating room performance are sensitive to Anesthesiologists' years of postgraduate practice
Journal of clinical anesthesia, 2018Co-Authors: Mary K. O'brien, Franklin Dexter, Clarence D. Kreiter, Chad Slater-scott, Bradley J HindmanAbstract:Abstract Study objective The first aim of this study was to test whether a 7 item evaluation scale developed by our department's certified registered nurse anesthetists (CRNAs) was psychometrically reliable. The second aim was to test whether Anesthesiologists' performance changed with their years of postgraduate experience. Design, setting, measurements Sixty-two University of Iowa CRNAs evaluated 81 Anesthesiologists during one weekend. Anesthesiologists' scores were adjusted for CRNA rater leniency. Anesthesiologists' scores were tested for sensitivity to CRNA-Anesthesiologist case-specific variables. Scores also were tested against Anesthesiologists' years of postgraduate experience. The latter association was tested for sensitivity to case-specific variables, Anesthesiologists' clinical supervision scores provided by residents, and Anesthesiologist clinical assignment variables. Main results The 7 items demonstrated a single-factor structure, allowing calculation of mean score over the 7 items. Individual Anesthesiologist scores were reliable when scores were provided by at least 10 different CRNAs. Anesthesiologists' scores (mean 3.34 [SD 0.41]) were not affected by the interval since last CRNA-Anesthesiologist interaction, number of interactions, or case-specific variables. There was a negative association between leniency-adjusted Anesthesiologist scores and years of Anesthesiologist postgraduate practice (coefficient −0.20 per decade, t = −19.39, P Conclusions Anesthesiologists' operating room performance can be evaluated reliably by non-physician anesthesia providers (CRNAs). The evaluation process can be done reliably and validly using an assessment scale consisting of only a few (
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quality of supervision as an independent contributor to an Anesthesiologist s individual clinical value
Anesthesia & Analgesia, 2015Co-Authors: Franklin Dexter, Bradley J HindmanAbstract:BACKGROUND: Although the clinical (operating room) production of individual Anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by Anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an Anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. METHODS: Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each Anesthesiologist with whom they worked the previous day in an operating room setting. We compared Anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, Anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all Anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). RESULTS: Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 Anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by Anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). CONCLUSIONS: When Anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual Anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to Anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual Anesthesiologists can learn about the quality of supervision they provide.
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quality of supervision as an independent contributor to an Anesthesiologist s individual clinical value
Anesthesia & Analgesia, 2015Co-Authors: Franklin Dexter, Bradley J HindmanAbstract:BACKGROUND Although the clinical (operating room) production of individual Anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by Anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an Anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. METHODS Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each Anesthesiologist with whom they worked the previous day in an operating room setting. We compared Anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, Anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all Anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). RESULTS Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 Anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by Anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). CONCLUSIONS When Anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual Anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to Anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual Anesthesiologists can learn about the quality of supervision they provide.
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influence of provider type nurse anesthetist or resident physician staff assignments and other covariates on daily evaluations of Anesthesiologists quality of supervision
Anesthesia & Analgesia, 2014Co-Authors: Franklin Dexter, Johannes Ledolter, Thomas C Smith, David L Griffiths, Bradley J HindmanAbstract:BACKGROUND: At many U.S. healthcare facilities, supervision of anesthesiology residents and/or Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of Anesthesiologists. Our department implemented a daily process by which the supervision provided by each Anesthesiologist working in operating rooms was evaluated by the anesthesiology resident(s) and CRNA(s) with whom they worked the previous day. METHODS: Requests for evaluation were sent daily via e-mail to each resident and CRNA after working in an operating room. Supervision scores were analyzed after 6 months, and aligned with the cases' American Society of Anesthesiologists Relative Value Guide units. RESULTS: (1) Mean monthly evaluation completion rates exceeded 85% (residents P = 0.0001, CRNAs P = 0.0005). (2) Pairwise by Anesthesiologist, residents and CRNAs mean supervision scores were correlated (P < 0.0001), but residents assigned greater scores than did CRNAs (P < 0.0001). The pairwise differences between residents and CRNAs were heterogeneous among Anesthesiologists (P < 0.0001). (3) Anesthesiologist supervision scores provided by residents were: (a) greater when a resident had more units of work that day with the rated Anesthesiologist (P < 0.0001), and (b) less when the Anesthesiologist had more units of work that same day with other providers (P < 0.0001). However, the relationships were unimportantly small, Kendall τb = +0.083 ± 0.014 (SE) and τb = -0.057 ± 0.014, respectively. The correlations were even less among the CRNAs, τb = -0.029 ± 0.013 and τb = -0.004 ± 0.012, respectively. (4) There also was unimportantly small association between a resident's or CRNA's mean score for an Anesthesiologist and the number of days worked together (τb = -0.069 ± 0.023 and τb = +0.038 ± 0.020, respectively). CONCLUSIONS: Although the attributes that residents and CRNA perceive as constituting "supervision" significantly share commonalities, supervision scores should be analyzed separately for residents and CRNAs. Although mean supervision scores differ markedly among Anesthesiologists, supervision scores are influenced negligibly by staff assignments (e.g., how busy the Anesthesiologist is with other operating rooms).
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bernoulli cumulative sum cusum control charts for monitoring of Anesthesiologists performance in supervising anesthesia residents and nurse anesthetists
Anesthesia & Analgesia, 2014Co-Authors: Franklin Dexter, Johannes Ledolter, Bradley J HindmanAbstract:We describe our experiences in using Bernoulli cumulative sum (CUSUM) control charts for monitoring clinician performance. The supervision provided by each Anesthesiologist is evaluated daily by the Certified Registered Nurse Anesthetists (CRNAs) and/or anesthesia residents with whom they work. Each of 9 items is evaluated (1 = never, 2 = rarely, 3 = frequently, 4 = always). The score is the mean of the 9 responses. Choosing thresholds for low scores is straightforward, <2.0 for CRNAs and <3.0 for residents. Bernoulli CUSUM detection of low scores was within 50 ± 14 (median ± quartile deviation) days rather than 182 days without use of CUSUM. The true positive detection of Anesthesiologists with incidences of low scores greater than the chosen "out-of-control" rate was 14 of 14. The false-positive detection rate was 0 of 29. This CUSUM performance exceeded that of Shewhart individual control charts, for which the smallest threshold sufficiently large to detect 14 of 14 true positives had false-positive detection of 16 of 29 Anesthesiologists. The Bernoulli CUSUM assumes that scores are known right away, which is untrue. However, CUSUM performance was insensitive to this assumption. The Bernoulli CUSUM assumes statistical independence of scores, which also is untrue. For example, when an evaluation of an Anesthesiologist 1 day by a CRNA had a low score, there was an increased chance that another CRNA working in a different operating room on the same day would also give that same Anesthesiologist a low score (P < 0.0001). This correlation among scores does affect the Bernoulli CUSUM, such that detection is more likely. This is an advantage for our continual process improvement application since it flags individuals for further evaluation by managers while maintaining confidentiality of raters.
Franklin Dexter - One of the best experts on this subject based on the ideXlab platform.
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sustained management of the variability in work hours among Anesthesiologists providing patient care in operating rooms and not on call to work late if necessary
Journal of Clinical Anesthesia, 2021Co-Authors: Franklin Dexter, Richard H Epstein, Anil A MarianAbstract:Abstract Study objective We evaluated a department's long-term (6.5-year) success of achieving an overall and individual incidence of Anesthesiologists working late of approximately 20% of days when not on call to work late, if necessary, and providing care in operating rooms. Design Historical cohort study, January 2014 through September 2020. Setting Inpatient surgical suite of large teaching hospital. Main results The percentage of days worked past 5:00 PM was mean (standard deviation) 17.7% (5.0%) of days, 99% confidence interval (CI) 15.0% to 20.4%. There was considerable variability among quarters, the coefficient of variation being 28% (99% CI 20% to 45%). This was caused, in part, by Anesthesiologists less often working late during January–March versus July–September (14.0% [4.5%] versus 21.6% [3.2%]; P = 0.0031; N = 7 years each). The N = 67 Anesthesiologists not on call differed in their percentages of workdays finishing after 5:00 PM (P Conclusions An anesthesia department aiming for a 20% incidence of Anesthesiologists having to work late when not on call can achieve this objective, long-term, within a few percent (e.g., 2%). Seasonal variation can contribute to variability among quarters in the overall departmental incidence. Individual Anesthesiologists can have variability among themselves, though, and that is caused by large heterogeneity in their relative risks of working late when receiving relief versus when not handing off a case. For departments choosing to provide information to Anesthesiologists to increase predictability, factors to consider should include season of the year and the individual Anesthesiologist.
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Nurse anesthetists' evaluations of Anesthesiologists' operating room performance are sensitive to Anesthesiologists' years of postgraduate practice
Journal of clinical anesthesia, 2018Co-Authors: Mary K. O'brien, Franklin Dexter, Clarence D. Kreiter, Chad Slater-scott, Bradley J HindmanAbstract:Abstract Study objective The first aim of this study was to test whether a 7 item evaluation scale developed by our department's certified registered nurse anesthetists (CRNAs) was psychometrically reliable. The second aim was to test whether Anesthesiologists' performance changed with their years of postgraduate experience. Design, setting, measurements Sixty-two University of Iowa CRNAs evaluated 81 Anesthesiologists during one weekend. Anesthesiologists' scores were adjusted for CRNA rater leniency. Anesthesiologists' scores were tested for sensitivity to CRNA-Anesthesiologist case-specific variables. Scores also were tested against Anesthesiologists' years of postgraduate experience. The latter association was tested for sensitivity to case-specific variables, Anesthesiologists' clinical supervision scores provided by residents, and Anesthesiologist clinical assignment variables. Main results The 7 items demonstrated a single-factor structure, allowing calculation of mean score over the 7 items. Individual Anesthesiologist scores were reliable when scores were provided by at least 10 different CRNAs. Anesthesiologists' scores (mean 3.34 [SD 0.41]) were not affected by the interval since last CRNA-Anesthesiologist interaction, number of interactions, or case-specific variables. There was a negative association between leniency-adjusted Anesthesiologist scores and years of Anesthesiologist postgraduate practice (coefficient −0.20 per decade, t = −19.39, P Conclusions Anesthesiologists' operating room performance can be evaluated reliably by non-physician anesthesia providers (CRNAs). The evaluation process can be done reliably and validly using an assessment scale consisting of only a few (
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quality of supervision as an independent contributor to an Anesthesiologist s individual clinical value
Anesthesia & Analgesia, 2015Co-Authors: Franklin Dexter, Bradley J HindmanAbstract:BACKGROUND: Although the clinical (operating room) production of individual Anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by Anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an Anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. METHODS: Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each Anesthesiologist with whom they worked the previous day in an operating room setting. We compared Anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, Anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all Anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). RESULTS: Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 Anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by Anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). CONCLUSIONS: When Anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual Anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to Anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual Anesthesiologists can learn about the quality of supervision they provide.
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quality of supervision as an independent contributor to an Anesthesiologist s individual clinical value
Anesthesia & Analgesia, 2015Co-Authors: Franklin Dexter, Bradley J HindmanAbstract:BACKGROUND Although the clinical (operating room) production of individual Anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by Anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an Anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. METHODS Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each Anesthesiologist with whom they worked the previous day in an operating room setting. We compared Anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, Anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all Anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). RESULTS Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 Anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by Anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). CONCLUSIONS When Anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual Anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to Anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual Anesthesiologists can learn about the quality of supervision they provide.
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influence of provider type nurse anesthetist or resident physician staff assignments and other covariates on daily evaluations of Anesthesiologists quality of supervision
Anesthesia & Analgesia, 2014Co-Authors: Franklin Dexter, Johannes Ledolter, Thomas C Smith, David L Griffiths, Bradley J HindmanAbstract:BACKGROUND: At many U.S. healthcare facilities, supervision of anesthesiology residents and/or Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of Anesthesiologists. Our department implemented a daily process by which the supervision provided by each Anesthesiologist working in operating rooms was evaluated by the anesthesiology resident(s) and CRNA(s) with whom they worked the previous day. METHODS: Requests for evaluation were sent daily via e-mail to each resident and CRNA after working in an operating room. Supervision scores were analyzed after 6 months, and aligned with the cases' American Society of Anesthesiologists Relative Value Guide units. RESULTS: (1) Mean monthly evaluation completion rates exceeded 85% (residents P = 0.0001, CRNAs P = 0.0005). (2) Pairwise by Anesthesiologist, residents and CRNAs mean supervision scores were correlated (P < 0.0001), but residents assigned greater scores than did CRNAs (P < 0.0001). The pairwise differences between residents and CRNAs were heterogeneous among Anesthesiologists (P < 0.0001). (3) Anesthesiologist supervision scores provided by residents were: (a) greater when a resident had more units of work that day with the rated Anesthesiologist (P < 0.0001), and (b) less when the Anesthesiologist had more units of work that same day with other providers (P < 0.0001). However, the relationships were unimportantly small, Kendall τb = +0.083 ± 0.014 (SE) and τb = -0.057 ± 0.014, respectively. The correlations were even less among the CRNAs, τb = -0.029 ± 0.013 and τb = -0.004 ± 0.012, respectively. (4) There also was unimportantly small association between a resident's or CRNA's mean score for an Anesthesiologist and the number of days worked together (τb = -0.069 ± 0.023 and τb = +0.038 ± 0.020, respectively). CONCLUSIONS: Although the attributes that residents and CRNA perceive as constituting "supervision" significantly share commonalities, supervision scores should be analyzed separately for residents and CRNAs. Although mean supervision scores differ markedly among Anesthesiologists, supervision scores are influenced negligibly by staff assignments (e.g., how busy the Anesthesiologist is with other operating rooms).
Mandeep S Sawhney - One of the best experts on this subject based on the ideXlab platform.
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a prospective assessment of sedation related adverse events and patient and endoscopist satisfaction in ercp with Anesthesiologist administered sedation
Gastrointestinal Endoscopy, 2011Co-Authors: Tyler M Berzin, Sirish Sanaka, Sheila R Barnett, Eswar Sundar, Paul S Sepe, Moshe Jakubowski, Douglas K Pleskow, Ram Chuttani, Mandeep S SawhneyAbstract:Background Despite the increasing use of Anesthesiologist-administered sedation for monitored anesthesia care (MAC) or general anesthesia in patients undergoing ERCP, limited prospective data exist on the effectiveness, safety, and cost of this approach. Objective To prospectively assess sedation-related adverse events (SRAEs), patient- and procedure-related risk factors associated with SRAEs, and endoscopist and patient satisfaction with Anesthesiologist-administered sedation. Design Single-center, prospective cohort study. Setting Tertiary-care referral center. Patients A total of 528 consecutive patients undergoing ERCP. Interventions Anesthesiologist-administered MAC or general anesthesia. Main Outcome Measurements SRAEs, endoscopist and patient satisfaction. Results There were 120 intraprocedure SRAEs during 109 of the 528 ERCPs (21% of cases). Intraprocedure SRAEs included hypotension (38 events), arrhythmia (20 events), O 2 desaturation to less than 85% (66 events), unplanned intubation (16 events), and procedure termination (1 event). Thirty postprocedure SRAEs occurred in a total of 22 patients (4% of cases), including hypotension (5 events), endotracheal intubation (2 events), and arrhythmia (12 events). Patient-related variables associated with adverse intraprocedure events were American Society of Anesthesiologists class ( P = .004) and body mass index (kg/m 2 ) ( P = .02). On a 10-point scale, mean endoscopist satisfaction with sedation was 9.2 (standard deviation 1.8) and patient satisfaction with sedation was 9.9 (standard deviation 0.7). Limitations The approach to sedation was not randomized. Conclusions Higher American Society of Anesthesiologists class and body mass index are associated with an increased rate of cardiac and respiratory events during ERCP. Cardiac and respiratory events are generally minor, and MAC can be considered a safe option for most ERCP patients. Despite the frequency of minor sedation-related events, procedure interruption or premature termination was rare in the setting of Anesthesiologist-administered sedation.
Ashish C Sinha - One of the best experts on this subject based on the ideXlab platform.
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anesthesia for ercp impact of Anesthesiologist s experience on outcome and cost
Anesthesiology Research and Practice, 2013Co-Authors: Basavana Goudra, Preet Mohinder Singh, Ashish C SinhaAbstract:The present study evaluates the effect of Anesthesiologist's experience in providing deep sedation for endoscopic retrograde cholangiopancreatography (ERCP) on cost and safety. Methodology. Perioperative records of 1167 patients who underwent ERCP were divided on the basis of Anesthesiologist assisting these procedures either on regular basis (Group R) or on ad hoc basis (Group N). Comparisons were made for anesthesia times, complication rates, and airway interventions. Results. Across all American Society of Anesthesiologists (ASA) Classes, regular Anesthesiologists were more efficient (overall mean anesthesia time in Group R was 24.82 ± 12.96 versus 48.63 ± 21.53 minutes in Group N). Within Group R, anesthesia times across all ASA classes were comparable. In Group N, anesthesia times for higher ASA status patients were significantly longer (ASA IV, 64.62 ± 35.78 versus ASA I, 45.88 ± 11.19 minutes). Intubation rates (0.76% versus 12.8%) and median minimal oxygen saturation (100% versus 97.01%) were significantly higher in Group R. Had Group R Anesthesiologists performed all procedures, the hospital could have saved US $ 758536 (based upon operating room time costs). Conclusion. Experience in providing deep sedation improved patient safety and decreased the operating room turnaround time, thereby lowering operating room costs associated with these procedures.
Penelope M. Sanderson - One of the best experts on this subject based on the ideXlab platform.
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An exploratory clinical evaluation of a head-worn display based multiple-patient monitoring application: impact on supervising Anesthesiologists’ situation awareness
Journal of Clinical Monitoring and Computing, 2019Co-Authors: Paul D. Schlosser, Tobias Grundgeiger, Penelope M. Sanderson, Oliver HappelAbstract:PurposeSupervising Anesthesiologists overseeing several operating rooms must be aware of the status of multiple patients, so they can consult with the anesthetist in single operating rooms or respond quickly to critical events. However, maintaining good situation awareness can be challenging when away from patient bedsides or a central monitoring station. In this proof-of-concept study, we evaluated the potential of a head-worn display that showed multiple patients’ vital signs and alarms to improve supervising Anesthesiologists’ situation awareness.MethodsEight supervising Anesthesiologists each monitored the vital signs of patients in six operating rooms for 3 h with the head-worn display, and for another 3 h without the head-worn display. In interviews with each Anesthesiologist, we assessed in which situations the head-worn display was used and whether the continuous availability of the vital signs improved situation awareness. We also measured situation awareness quantitatively from six of the eight Anesthesiologists, by instructing them to press a button whenever they noticed a patient alarm.ResultsThe median number of patient alarms occurring was similar when the Anesthesiologists monitored with the head-worn display (42.0) and without the head-worn display (40.5). However, the Anesthesiologists noticed significantly more patient alarms with the head-worn display (66.7%) than without (7.1%), P = 0.028, and they reported improved situation awareness with the head-worn display. The head-worn display helped the Anesthesiologists to perceive and comprehend patients’ current status and to anticipate future developments. A negative effect of the head-worn display was its tendency to distract during demanding procedures.ConclusionsHead-worn displays can improve supervising Anesthesiologists’ situation awareness in multiple-patient monitoring situations. The Anesthesiologists who participated in the study expressed enthusiasm about monitoring patients with a head-worn display and wished to use and evaluate it further.
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monitoring with head mounted displays in general anesthesia a clinical evaluation in the operating room
Anesthesia & Analgesia, 2010Co-Authors: David Liu, Penelope M. Sanderson, Simon Jenkins, Perry Fabian, John W RussellAbstract:BACKGROUND: Patient monitors in the operating room are often positioned where it is difficult for the Anesthesiologist to see them when performing procedures. Head-mounted displays (HMDs) can help Anesthesiologists by superimposing a display of the patient's vital signs over the Anesthesiologist's field of view. Simulator studies indicate that by using an HMD, Anesthesiologists can spend more time looking at the patient and less at the monitors. We performed a clinical evaluation testing whether this finding would apply in practice.