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Franklin Dexter - One of the best experts on this subject based on the ideXlab platform.
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throughout the united states pediatric patients undergoing ambulatory surgery enter the operating room and are discharged earlier in the day than are adults
Perioperative Care and Operating Room Management, 2019Co-Authors: Franklin Dexter, Richard H Epstein, Luis I RodriguezAbstract:Abstract Background Previously it was shown that greater minutes that pediatric surgical cases start later than scheduled were associated with more parents’ complaints regarding anesthesiologists’ care. Cases starting later in the day have less reliable start times. Thus, starting pediatric cases earlier in the surgical day would result in less tardiness of starts and fewer complaints. The objective of the current study was to evaluate start times and the corresponding durations of workdays nationally for outpatient surgery. Methods The current cohort study used the United States’ National Hospital Ambulatory Medical Care Survey (NHAMCS), which includes outpatient surgery performed at hospitals and unaffiliated freestanding surgery centers. The data were limited to surgical cases with an anesthetic administered by an anesthesiologist and/or Nurse Anesthetist. Patients were considered pediatric if age ≤14 years. Results Pediatric cases started on average at 09:34, 57 (SE 11) minutes earlier than for adults (P Conclusions These national data can be as representative of policies in place regarding the sequencing of pediatric patients’ OR start times when adult and pediatric patients are scheduled in the same ORs.
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Anesthesiologists' perceptions of minimum acceptable work habits of Nurse Anesthetists.
Journal of Clinical Anesthesia, 2017Co-Authors: Ilana I. Logvinov, Franklin Dexter, Bradley J Hindman, Sorin J. BrullAbstract:Abstract Study objective Work habits are non-technical skills that are an important part of job performance. Although non-technical skills are usually evaluated on a relative basis (i.e., "grading on a curve"), validity of evaluation on an absolute basis (i.e., "minimum passing score") needs to be determined. Design Survey and observational study. Patients None. Interventions None. Measurements The theme of "work habits" was assessed using a modification of Dannefer et al.'s 6-item scale, with scores ranging from 1 (lowest performance) to 5 (highest performance). E-mail invitations were sent to all consultant and fellow anesthesiologists at Mayo Clinic in Florida, Arizona, and Minnesota. Because work habits expectations can be generational, the survey was designed for adjustment based on all invited (responding or non-responding) anesthesiologists' year of graduation from residency. Main results The overall mean±standard deviation of the score for anesthesiologists' minimum expectations of Nurse Anesthetists' work habits was 3.64±0.66 (N=48). Minimum acceptable scores were correlated with the year of graduation from anesthesia residency (linear regression P=0.004). Adjusting for survey non-response using all N=207 anesthesiologists, the mean of the minimum acceptable work habits adjusted for year of graduation was 3.69 (standard error 0.02). The minimum expectations for Nurse Anesthetists' work habits were compared with observational data obtained from the University of Iowa. Among 8940 individual Nurse Anesthetist work habits scores, only 2.6% were Conclusions Our results suggest that routinely evaluated work habits of Nurse Anesthetists within departments should not be compared with an appropriate minimum score (i.e., of 3.69). Instead, work habits scores should be analyzed based on relative reporting among Anesthetists.
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growth in an anesthesiologist and Nurse Anesthetist supervised sedation Nurse program using propofol and dexmedetomidine
A & A case reports, 2016Co-Authors: Joss J Thomas, Ruth E Wachtel, Franklin Dexter, Michael M ToddAbstract:In 2007, the Department of Anesthesia at the University of Iowa established an anesthesiologist-supervised Nurse-managed sedation program. In 2008, the use of propofol and dexmedetomidine by Nurses was approved in Iowa. We reviewed 11,038 elective sedation cases done between January 1, 2007, and June 30, 2014. Caseload increased from 170 to 470 cases/quarter. Propofol use increased from 0% to approximately equal to 70% of cases and dexmedetomidine from 0% to approximately equal to 25% of cases. There were no safety issues. The number of Nurses working each day (on average) increased from 2.2 to 4.7, but supervising providers remained at 1/day. There were no changes in general anesthesia or monitored anesthesia care cases performed for comparable procedures. Trained, supervised Nurses can safely administer propofol or dexmedetomidine to selected patients for a wide variety of procedures.
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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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national incidence of use of monitored anesthesia care
Anesthesia & Analgesia, 2011Co-Authors: Emine O Bayman, John J Laur, Franklin Dexter, Ruth E WachtelAbstract:BACKGROUND: Sedation or monitored anesthesia care (MAC), alone or after peripheral regional nerve block, is currently administered by anesthesiologists and/or certified registered Nurse Anesthetists. Some of this care may be at risk for substitution by other providers or by reductions in reimbursement. METHODS: Data from the 2006 United States of America National Survey of Ambulatory Surgery were analyzed to determine national rates for the percentage of total ambulatory anesthesia operating room (OR) time that was either (1) sedation and/or MAC, or (2) peripheral regional nerve block with/without sedation or MAC. RESULTS: MAC cases alone comprised 29% ± 2% of OR time with an anesthesiologist and/or certified registered Nurse Anesthetist. MAC and/or peripheral block comprised 34% ± 2% of OR time. Percentages by cases were larger than by OR time (P < 0.0001). Among cases with anesthesia, 42% ± 3% were MAC and 47% ± 2% were MAC with/without peripheral block. Percentages of American Society of Anesthesiologists' Relative Value Guide units for MAC would be intermediate between the 29% and 42%, and for MAC and/or peripheral block between the 34% and 47%. CONCLUSIONS: MAC alone or after peripheral nerve block accounts for a relatively high percentage of ambulatory anesthetics nationwide.
Weifang Xu - One of the best experts on this subject based on the ideXlab platform.
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effect assessment of follow up training for Nurse Anesthetist by aidet communication model with scenario simulation
Chinese Journal of Modern Nursing, 2015Co-Authors: Xinlin Li, Weifang XuAbstract:Objective To evaluate the effects of the AIDET(Ackonwledge, Introduce, Duration, Explicate, Thank you) communication model and scenario simulation training in anesthesiology Nurses were followed up after the operation. Methods We built up the standard language, and utilize scenario simulation an standard follow-up language to train nursing staffs. Before and after the training, the satisfaction and compliance of follow-up service were investigated by self-designed patient′s satisfaction for follow-up service scale. Results After training, Nurse Anesthetists were increased the ability of communication language, flexible language application, communication skills, and online cooperation and communication having statistical significance compared with those of before training (P<0.05). After training, the patient′s compliance increased to (8.25±1.17) score through Nurse′s follow-up compared with that of before training (t=7.313, P<0.05), and the satisfaction of patients to Nurse Anesthetist′s follow-up increased as well(P<0.05). Conclusions Nurse Anesthetists use the AIDET communication and scenario simulation training to acquire a good communication effects in postoperative follow-up, and these methods also can promote the quality of follow-up. Key words: Nurse Anesthetist; Postoperative follow-up; AIDET communication model; Scenario simulation; Training
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Effect assessment of follow-up training for Nurse Anesthetist by AIDET communication model with scenario simulation
Chinese Journal of Modern Nursing, 2015Co-Authors: Xinlin Li, Weifang XuAbstract:Objective To evaluate the effects of the AIDET(Ackonwledge, Introduce, Duration, Explicate, Thank you) communication model and scenario simulation training in anesthesiology Nurses were followed up after the operation. Methods We built up the standard language, and utilize scenario simulation an standard follow-up language to train nursing staffs. Before and after the training, the satisfaction and compliance of follow-up service were investigated by self-designed patient′s satisfaction for follow-up service scale. Results After training, Nurse Anesthetists were increased the ability of communication language, flexible language application, communication skills, and online cooperation and communication having statistical significance compared with those of before training (P
Mary C Karlet - One of the best experts on this subject based on the ideXlab platform.
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interprofessional education sessions involving doctor of pharmacy bachelor of science in nursing and Nurse Anesthetist students
Currents in Pharmacy Teaching and Learning, 2013Co-Authors: Catherine D Henderson, Amy E Broeseker, Cindy G Berry, D Fort, Angela R Thomason, Terri M Cahoon, Mary C KarletAbstract:Abstract Objectives To implement and assess the initial didactic interprofessional education (IPE) sessions in the health professions at our institution. Methods Volunteer pharmacy students met with senior bachelor of science in nursing students or graduate Nurse Anesthetist students for case discussion during three different sessions. Each session had a different pedagogical approach. A survey was administered at the completion of each session to ascertain students’ attitudes about these experiences. Results Overall, the results showed that the session involving pharmacy students and bachelor of science in nursing students was more favorable than those involving pharmacy students and Nurse Anesthetist students. At least 80% of all participants responded that it is important to have IPE sessions like this and they would participate in them again if the opportunity was available. Moreover, 100% of the pharmacy students in each session agreed that the discussions were relevant to them and they enjoyed these learning experiences. Conclusions This educational research showed that pharmacy and nursing students believed that the IPE sessions were beneficial for them. In the future, focused sessions may be the best pedagogical approach in order for these opportunities to be the most productive for everyone involved.
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short communication interprofessional education sessions involving doctor of pharmacy bachelor of science in nursing and Nurse Anesthetist students
2013Co-Authors: Catherine D Henderson, Amy E Broeseker, Cindy G Berry, D Fort, Angela R Thomason, Terri M Cahoon, Mary C KarletAbstract:Objectives: To implement and assess the initial didactic interprofessional education (IPE) sessions in the health professions at our institution. Methods: Volunteer pharmacy students met with senior bachelor of science in nursing students or graduate Nurse Anesthetist students for case discussion during three different sessions. Each session had a different pedagogical approach. A survey was administered at the completion of each session to ascertain students’ attitudes about these experiences. Results: Overall, the results showed that the session involving pharmacy students and bachelor of science in nursing students was more favorable than those involving pharmacy students and Nurse Anesthetist students. At least 80% of all participants responded that it is important to have IPE sessions like this and they would participate in them again if the opportunity was available. Moreover, 100% of the pharmacy students in each session agreed that the discussions were relevant to them and they enjoyed these learning experiences. Conclusions: This educational research showed that pharmacy and nursing students believed that the IPE sessions were beneficial for them. In the future, focused sessions may be the best pedagogical approach in order for these opportunities to be the most productive for everyone involved. r 2013 Elsevier Inc. All rights reserved.
Bo Pang - One of the best experts on this subject based on the ideXlab platform.
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scope of practice laws and anesthesia complications no measurable impact of certified registered Nurse Anesthetist expanded scope of practice on anesthesia related complications
Medical Care, 2016Co-Authors: Brighita Negrusa, Paul F Hogan, John T Warner, Caryl H Schroeder, Bo PangAbstract:BACKGROUND: Scope of practice (SOP) laws governing Certified Registered Nurse Anesthetists (CRNAs) vary by state and drive CRNA practice and reimbursement. OBJECTIVE: To test whether the odds of an anesthesia complication vary by SOP and delivery model (CRNA only, anesthesiologist only, or mixed anesthesiologist and CRNAs team). METHODS: Anesthesia claims and related complications were identified in a large commercial payor database, including inpatient and ambulatory settings. Logit regression models were estimated by setting to determine the impact of SOP and delivery model on the odds of an anesthesia-related complication, while controlling for patient characteristics, patient comorbidities, procedure and procedure complexity, and local area economic factors. RESULTS: Overall, 8 in every 10,000 anesthesia-related procedures had a complication. However, complications were 4 times more likely in the inpatient setting (20 per 10,000) than the outpatient setting (4 per 10,000). In both settings, the odds of a complication were found to differ significantly with patient characteristics, patient comorbidities, and the procedures being administered. The odds of an anesthesia-elated complication are particularly high for procedures related to childbirth. However, complication odds were not found to differ by SOP or delivery model. CONCLUSIONS: Our research results suggest that there is strong evidence of differences in the likelihood of anesthesia complications by patient characteristics, patient comorbidities, and the procedures being administered, but virtually no evidence that the odds of a complication differ by SOP or delivery model.
Ruth E Wachtel - One of the best experts on this subject based on the ideXlab platform.
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growth in an anesthesiologist and Nurse Anesthetist supervised sedation Nurse program using propofol and dexmedetomidine
A & A case reports, 2016Co-Authors: Joss J Thomas, Ruth E Wachtel, Franklin Dexter, Michael M ToddAbstract:In 2007, the Department of Anesthesia at the University of Iowa established an anesthesiologist-supervised Nurse-managed sedation program. In 2008, the use of propofol and dexmedetomidine by Nurses was approved in Iowa. We reviewed 11,038 elective sedation cases done between January 1, 2007, and June 30, 2014. Caseload increased from 170 to 470 cases/quarter. Propofol use increased from 0% to approximately equal to 70% of cases and dexmedetomidine from 0% to approximately equal to 25% of cases. There were no safety issues. The number of Nurses working each day (on average) increased from 2.2 to 4.7, but supervising providers remained at 1/day. There were no changes in general anesthesia or monitored anesthesia care cases performed for comparable procedures. Trained, supervised Nurses can safely administer propofol or dexmedetomidine to selected patients for a wide variety of procedures.
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national incidence of use of monitored anesthesia care
Anesthesia & Analgesia, 2011Co-Authors: Emine O Bayman, John J Laur, Franklin Dexter, Ruth E WachtelAbstract:BACKGROUND: Sedation or monitored anesthesia care (MAC), alone or after peripheral regional nerve block, is currently administered by anesthesiologists and/or certified registered Nurse Anesthetists. Some of this care may be at risk for substitution by other providers or by reductions in reimbursement. METHODS: Data from the 2006 United States of America National Survey of Ambulatory Surgery were analyzed to determine national rates for the percentage of total ambulatory anesthesia operating room (OR) time that was either (1) sedation and/or MAC, or (2) peripheral regional nerve block with/without sedation or MAC. RESULTS: MAC cases alone comprised 29% ± 2% of OR time with an anesthesiologist and/or certified registered Nurse Anesthetist. MAC and/or peripheral block comprised 34% ± 2% of OR time. Percentages by cases were larger than by OR time (P < 0.0001). Among cases with anesthesia, 42% ± 3% were MAC and 47% ± 2% were MAC with/without peripheral block. Percentages of American Society of Anesthesiologists' Relative Value Guide units for MAC would be intermediate between the 29% and 42%, and for MAC and/or peripheral block between the 34% and 47%. CONCLUSIONS: MAC alone or after peripheral nerve block accounts for a relatively high percentage of ambulatory anesthetics nationwide.
