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Abraham J, Duffy C, Kandasamy M, France D, Greilich P. An evidence synthesis on perioperative Handoffs: A call for balanced sociotechnical solutions. Int J Med Inform 2023; 174:105038. [PMID: 36948060 DOI: 10.1016/j.ijmedinf.2023.105038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
SIGNIFICANCE Perioperative handoffs interconnect the preoperative, intraoperative, and postoperative phases underlying surgical care to maintain care continuity -yet are prone to coordination and communication failures. OBJECTIVE To synthesize evidence on factors affecting the safety and quality of perioperative handoff conduct and process. MATERIALS AND METHODS A search of PubMed, EMBASE, and CINAHL was conducted to include observational, descriptive studies of preoperative, intraoperative, and postoperative handoffs published in English language, peer-reviewed journals. Data analysis was informed by the Systems Engineering Initiative for Patient Safety (SEIPS) framework describing the relationship between the work-system, work processes, and outcomes. Study quality was assessed using the Quality Scoring System. RESULTS Twenty-three studies were included. Eighteen studies focused on postoperative handoffs, with one on preoperative, three on intraoperative and only one that looked at preoperative/postoperative handoffs combined. The SEIPS framework elucidated the complex inter-related factors (enablers and barriers) related to perioperative handoff safety. While some studies found that the use of standardized handoff tools and protocols and interdisciplinary teamwork were frequently-reported enablers, other studies identified the lack of structured handoff tools and protocols, poor teamwork and communication, and improper use of documentation tools were top-cited barriers affecting handoff quality. Suggestions to ensure handoff safety and quality included implementing structured handoff checklists and protocols and building interprofessional teamwork competencies for effective communication. DISCUSSION AND CONCLUSION Our review highlights an urgency to develop more holistic sociotechnical solutions that can create and sustain a balance between technical innovations in tools and technologies and the non-technical interventions/training needed to improve interpersonal relations and teamwork competencies - taken together, can improve the quality and safety of perioperative handoff practice.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA; Institute for Informatics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Caoimhe Duffy
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Madhumitha Kandasamy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Dan France
- Department of Anesthesiology, Nursing, Medicine, & Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Philip Greilich
- Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zemedkun A, Destaw B, Hailu S, Milkias M, Getachew H, Angasa D. Assessment of postoperative patient handover practice and safety at post anesthesia care unit of Dilla University Referral Hospital, Ethiopia: A cross-sectional study. Ann Med Surg (Lond) 2022; 79:103915. [PMID: 35860080 PMCID: PMC9289298 DOI: 10.1016/j.amsu.2022.103915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Good handover creates a common understanding of responsibility and patients’ status. To proceed with effective handover process, effective communication between healthcare providers plays a vital role. But, it is commonly observed that there is ineffective communication between health care providers and it increases the risk of medical errors and negatively affects the quality of care, patient outcome and satisfaction. In addition, the transfer of care after surgery to the postanesthesia care unit (PACU) presents special challenges to providers on both the delivering and receiving teams. Methodology A descriptive cross-sectional study was conducted at post anesthesia care unit of Dilla University Referral Hospital from October 1 to November 30, 2020. To conduct the study, consecutively selected 208 handovers of patients from operation theatre (OT) to PACU were assessed. A checklist was developed based on a combination of criteria adopted from the Australian Medical Association 2006 and British Doctors Committee 2004. It was pilot tested and changes were made before the actual data collection. Result Our study found that the postoperative patient handover practice among professionals was poor (below 50%) in the areas of patients’ full name, age, medical registration number (MRN), ASA class, allergic history, medical history, baseline vital signs, preoperative diagnosis and surgical procedure performed. Our study also found poor postoperative hand overing regarding the intraoperative blood loss 9.6%, intraoperative clinical incidents 5.3%, recovery condition 7.2%, postoperative analgesia plan 18.8%, and post operative antibiotic plan 8.2%. Whereas, type of anesthesia 81.3%, intraoperative vital signs 80.8%, and intraoperative analgesia used 79.8%, intraoperative fluid management 80.8% were among the indicators with >50% completion rate. Conclusion and recommendation Our study found a poor practice of patient handover regarding sociodemographic and preoperative profile, anesthesia, surgery and other necessary information. We believe standardizing this process and providing training will improve the quality of postoperative handovers and the safety of patients during this critical period. Good handover creates a common understanding of responsibility and patients' status. Postoperative patients are in an at-risk state and require constant vigilance. Our study found a poor practice of post operative handover. Providing training regarding postoperative handover may improve the practice.
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Jaulin F, Lopes T, Martin F. Standardised handover process with checklist improves quality and safety of care in the postanaesthesia care unit: the Postanaesthesia Team Handover trial. Br J Anaesth 2021; 127:962-970. [PMID: 34364652 DOI: 10.1016/j.bja.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/19/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Miscommunication is a leading cause of preventable incidents in healthcare. A number of checklists have been created in an attempt to improve patient outcomes with only a small impact. However, the 2009 WHO Surgical Safety Checklist demonstrated benefits in terms of reduced morbidity and mortality. Our aim was to determine whether use of a Postanaesthesia Team Handover (PATH) checklist would reduce hypoxaemic events in the postanaesthesia care unit (PACU). METHODS This single-centre, prospective, pre-/post-implementation study was conducted between February 2019 and July 2020 in the PACU of Versailles Private Hospital, Paris, France. Pre-PATH implementation data were collected for 294 consecutive adult patients (≥18 yr old) admitted to the PACU and post-PATH implementation data were collected for 293 consecutive patients. The primary outcome was the rate of hypoxaemic events post-surgery during PACU stay. RESULTS The rates of hypoxaemic events were 4.1% (11/267 [95% confidence interval {CI}: 2.3-7.2%]) before the PATH checklist was introduced and 0.8% (2/266 [95% CI: 0.2-2.7%]) after. Patients in the PATH group were 5.6 times (odds ratio [OR] [95% CI: 1.3-33.6], P=0.041) less likely to have a hypoxaemic event than those in the control group. The handover process in the PATH checklist group also had significantly less interruptions (38.6% control vs 20.7% PATH; OR=2.5 [95% CI: 1.7-3.7]; P<0.0001). CONCLUSIONS Implementation of the PATH checklist in adult patients post-surgery was associated with a reduction in the rate of hypoxaemic events in the PACU. These findings support standardisation of the handover process with checklists following anaesthesia and surgery. CLINICAL TRIAL REGISTRATION NCT03972423.
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Affiliation(s)
- François Jaulin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France
| | - Thomas Lopes
- Versailles Private Hospital, Ramsay Santé, Paris, France
| | - Frederic Martin
- Patient Safety Database, SafeTeam Academy, Facteurs Humains en Santé Association, Paris, France; Versailles Private Hospital, Ramsay Santé, Paris, France.
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Dusse F, Pütz J, Böhmer A, Schieren M, Joppich R, Wappler F. Completeness of the operating room to intensive care unit handover: a matter of time? BMC Anesthesiol 2021; 21:38. [PMID: 33546588 PMCID: PMC7863365 DOI: 10.1186/s12871-021-01247-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Handovers of post-anesthesia patients to the intensive care unit (ICU) are often unstructured and performed under time pressure. Hence, they bear a high risk of poor communication, loss of information and potential patient harm. The aim of this study was to investigate the completeness of information transfer and the quantity of information loss during post anesthesia handovers of critical care patients. METHODS Using a self-developed checklist, including 55 peri-operative items, patient handovers from the operation room or post anesthesia care unit to the ICU staff were observed and documented in real time. Observations were analyzed for the amount of correct and completely transferred patient data in relation to the written documentation within the anesthesia record and the patient's chart. RESULTS During a ten-week study period, 97 handovers were included. The mean duration of a handover was 146 seconds, interruptions occurred in 34% of all cases. While some items were transferred frequently (basic patient characteristics [72%], surgical procedure [83%], intraoperative complications [93.8%]) others were commonly missed (underlying diseases [23%], long-term medication [6%]). The completeness of information transfer is associated with the handover's duration [B coefficient (95% CI): 0.118 (0.084-0.152), p<0.001] and increases significantly in handovers exceeding a duration of 2 minutes (24% ± 11.7 vs. 40% ± 18.04, p<0.001). CONCLUSIONS Handover completeness is affected by time pressure, interruptions, and inappropriate surroundings, which increase the risk of information loss. To improve completeness and ensure patient safety, an adequate time span for handover, and the implementation of communication tools are required.
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Affiliation(s)
- Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Johanna Pütz
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Andreas Böhmer
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Mark Schieren
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Robin Joppich
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Center Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Piekarski F, Zhong G, Neef V, Kloka J, Wunderer F, Meybohm P, Zacharowski K, Raimann FJ. Audit of international intraoperative hemotherapy and blood loss documentation on anesthetic records. Minerva Anestesiol 2020; 87:312-318. [PMID: 33319948 DOI: 10.23736/s0375-9393.20.14828-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Anesthetic records facilitate information transmission to the next healthcare professional and should contain all relevant information of perioperative care. While most anesthesia societies provide guidelines for record content, important topics like hemotherapy and hemostatic therapy are not well represented. We considered the quality of anesthetic records with regard to the documentation options for hemotherapy and hemostatic therapy. A secondary objective was to examine guidelines for appropriate recommendations. METHODS Anesthetic records of international anesthesiology departments were evaluated for the presence of 20 defined fields associated with hemotherapy, hemostatic and fluid therapy as well as intraoperative diagnostics and monitoring. International guidelines were reviewed for appropriate recommendations. RESULTS A total of 98 anesthetic records from eight countries and guidelines of six anesthesia societies were analyzed. Data fields for red blood cell transfusion have been found in 29.3% (95% CI 0.20 to 0.38), ABO-testing in 6.1% (95% CI 0.01 to 0.11) and indication for transfusion in 2.0% (CI 0.00 to 0.05) of records. Most records contain fields for blood loss (94.4%; 95% CI 0.91 to 0.99) and diuresis (87.9%; 95% CI 0.81 to 0.94). International guidelines that were analyzed do not cover the topic of transfusion, but most give recommendations on basic monitoring, blood loss and fluid management documentation. CONCLUSIONS Most of the evaluated anesthetic records did not contain fields for relevant aspects of perioperative hemotherapy, hemostatic therapy and diagnostics. Guidelines and protocols for anesthetic documentation should include these topics to ensure information transfer and patient safety.
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Affiliation(s)
- Florian Piekarski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany -
| | - George Zhong
- Department of Anesthesia, Concord Repatriation General Hospital, Sydney, Australia
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Jan Kloka
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Florian Wunderer
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Patrick Meybohm
- Department of Anesthesia and Critical Care, University Hospital Würzburg, Würzburg, Germany
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Florian J Raimann
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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Xu W, Huang Y, Bai J, Varughese AM. A quality improvement project to reduce postoperative adverse respiratory events and increase safety in the postanesthesia care unit of a pediatric institution. Paediatr Anaesth 2019; 29:200-210. [PMID: 30365205 DOI: 10.1111/pan.13534] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/08/2018] [Accepted: 10/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Quality improvement methods can identify solutions and make dramatic improvements in patient safety during daily clinical care. The science of quality improvement in healthcare is still a very new concept in developing countries like China. AIMS We initiated a quality improvement project to minimize adverse respiratory events in our postanesthesia care unit with the guidance of an experienced quality improvement expert from Cincinnati Children's Hospital Medical Center. METHODS We set up a quality improvement team that included anesthesia safety team members at Shanghai Children's Medical Center, and a quality improvement expert in pediatric anesthesia from Cincinnati Children's Hospital Medical Center. Data from the previous year were reviewed. After using Failure Mode and Effect Analysis to access risks associated with the current process, a Key Driver Diagram and a Smart Aim were developed. Key drivers included establishing a safety culture, resource allocation to meet needs, education and training, standardization of care, improved communication and handoff, and enhanced detection, recognition, and response to adverse events. Using Plan-Do-Study-Act cycles of the improvement model, interventions were conducted to improve the process. The primary outcome was the percentage of postoperative respiratory adverse events in the postanesthesia care unit, and we calculated the average recovery time as a balancing measure. Data were collected and analyzed using a run chart and control chart. RESULTS The median percentage of respiratory adverse events in postanesthesia care unit decreased from 2.8% to 1.4%. Respiratory adverse events were reduced by over 30% compared to the previous period with no significant change in mean recovery time. CONCLUSION Using quality improvement methods, we successfully reduced the percentage of respiratory adverse events in the postanesthesia care unit. This helped to establish a safety culture among the anesthesia staff. Quality and safety improvement can be successfully implemented in developing countries like China with collaboration with quality improvement experts from more experienced institutions.
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Affiliation(s)
- Wenyan Xu
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College Medicine, Cincinnati, Ohio
| | - Yue Huang
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Bai
- Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anna M Varughese
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College Medicine, Cincinnati, Ohio
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Halladay ML, Thompson JA, Vacchiano CA. Enhancing the Quality of the Anesthesia to Postanesthesia Care Unit Patient Transfer Through Use of an Electronic Medical Record-Based Handoff Tool. J Perianesth Nurs 2018; 34:622-632. [PMID: 30528308 DOI: 10.1016/j.jopan.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/30/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Anesthesia to postanesthesia care unit (PACU) handoffs are often incomplete, imprecise, and highly variable with respect to information transfer, and therefore can jeopardize patient safety. A standardized anesthesia to PACU electronic medical record (EMR)-based patient handoff checklist was implemented and evaluated for its effect on the information transfer. DESIGN An observational preimplementation and postimplementation design was used. METHODS Assessment of the completeness and accuracy of information transfer during the PACU handoff was performed for a convenience samples of 100 patients preimplementation, 3 weeks postimplementation, and 3 months postimplementation. FINDINGS The mean percentage of total handoff checklist items addressed significantly increased 3 weeks and 3 months postimplementation compared with baseline. CONCLUSIONS The use of a standardized anesthesia to PACU EMR-based handoff checklist significantly increased the percent of accurate information transferred without considerably affecting the duration of the PACU handoff process.
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Abstract
The handover of the care of patients is acknowledged as a vulnerable period in the perioperative patient journey, and handovers given within the perioperative environment present the risk of potentially harmful errors occurring. These errors can result from poor communication and inaccurate information transfer, and may be avoided through the implementation of standardised protocols. This article presents an in depth literature review and discussion allowing for the examination of best practice in the delivery of a handover within the perioperative environment, drawing clear conclusions and presenting recommendations for best practice.
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Affiliation(s)
- Ashley McFarlane
- Operating Department Practice (Awarded with Distinction), Operating Department Practitioner, Golden Jubilee National Hospital, Telephone Number: 07736 743 290
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Lautz AJ, Martin KC, Nishisaki A, Bonafide CP, Hales RL, Hunt EA, Nadkarni VM, Sutton RM, Boyer DL. Focused Training for the Handover of Critical Patient Information During Simulated Pediatric Emergencies. Hosp Pediatr 2018. [PMID: 29514852 DOI: 10.1542/hpeds.2017-0173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Miscommunication has been implicated as a leading cause of medical errors, and standardized handover programs have been associated with improved patient outcomes. However, the role of structured handovers in pediatric emergencies remains unclear. We sought to determine if training with an airway, breathing, circulation, situation, background, assessment, recommendation handover tool could improve the transmission of essential patient information during multidisciplinary simulations of critically ill children. METHODS We conducted a prospective, randomized, intervention study with first-year pediatric residents at a quaternary academic children's hospital. Baseline and second handovers were recorded for residents in the intervention group (n = 12) and residents in the control group (n = 8) during multidisciplinary simulations throughout the academic year. The intervention group received handover education after baseline handover observation and a cognitive aid before second handover observation. Audio-recorded handovers were scored by using a Delphi-developed assessment tool by a blinded rater. RESULTS There was no difference in baseline handover scores between groups (P = .69), but second handover scores were significantly higher in the intervention group (median 12.5 [interquartile range 12-13] versus median 7.5 [interquartile range 6-8] in the control group; P < .01). Trained residents were more likely to include a reason for the call (P < .01), focused history (P = .02), and summative assessment (P = .03). Neither timing of the second observation in the academic year nor duration between first and second observation were associated with the second handover scores (both P > .5). CONCLUSIONS Structured handover training and provision of a cognitive aid may improve the inclusion of essential patient information in the handover of simulated critically ill children.
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Affiliation(s)
- Andrew J Lautz
- Department of Pediatrics, College of Medicine, University of Cincinnati and Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
| | - Kelly C Martin
- Divisions of Critical Care Medicine and.,Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Divisions of Critical Care Medicine and.,Departments of Anesthesiology and Critical Care Medicine and
| | - Christopher P Bonafide
- General Pediatrics and.,Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Roberta L Hales
- Center for Simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth A Hunt
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vinay M Nadkarni
- Divisions of Critical Care Medicine and.,Departments of Anesthesiology and Critical Care Medicine and
| | - Robert M Sutton
- Divisions of Critical Care Medicine and.,Departments of Anesthesiology and Critical Care Medicine and
| | - Donald L Boyer
- Divisions of Critical Care Medicine and.,Departments of Anesthesiology and Critical Care Medicine and
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