Advocacy, Research, and Anesthesia Practice Models: Key Studies of Safety and Cost-Effectiveness

The way towards ethical anesthesia care: no aim - no game - no fame or blame?

PURPOSE OF REVIEW

This review explores the intricacies of ethical anesthesia, exploring the necessity for precision anesthesia and its impact on patient-reported outcomes. The primary objective is to advocate for a defined aim, promoting the implementation of rules and feedback systems. The ultimate goal is to enhance precision anesthesia care, ensuring patient safety through the implementation of a teamwork and the integration of feedback mechanisms.

RECENT FINDINGS

Recent strategies in the field of anesthesia have evolved from intraoperative monitorization to a wider perioperative patient-centered precision care. Nonetheless, implementing this approach encounters significant obstacles. The article explores the evidence supporting the need for a defined aim and applicable rules for precision anesthesia's effectiveness. The implementation of the safety culture is underlined. The review delves into the teamwork description with structured feedback systems.

SUMMARY

Anesthesia is a multifaceted discipline that involves various stakeholders. The primary focus is delivering personalized precision care. This review underscores the importance of establishing clear aims, defined rules, and fostering effective and well tolerated teamwork with accurate feedback for improving patient-reported outcomes. The Safe Brain Initiative approach, emphasizing algorithmic monitoring and systematic follow-up, is crucial in implementing a fundamental and standardized reporting approach within patient-centered anesthesia care practice.

Analysis of Transurethral Resection of Bladder Tumor Efficiency Utilizing Nonprocedural Operating Room Times

OBJECTIVE

To analyze the contribution of nonprocedural operating room (OR) times to transurethral resection of bladder tumor (TURBT) operative efficiency.

METHODS

Over a 24-month period, all nonprocedural OR times from TURBT surgeries performed at a single institution were prospectively collected. Nonprocedural times included: in-room to anesthesia release time, anesthesia release to cut time, and close to wheels out time. Procedural OR time was cut to close time. We also analyzed the impact of time of day on TURBT efficiency (morning vs afternoon). Comparisons between groups were made using the Wilcoxon rank sum test for continuous variables.

RESULTS

We identified 777 consecutive TURBT procedures from 2019 to 2020. The median total OR time was 63 minutes (interquartile range: 50-81 minutes). The nonprocedural time occupied a median of 49.4% of the total operating time (interquartile range: 38.9%-60.4%). Median anesthesia release to cut time was slower when 1 TURBT was performed a day compared to 2 or more (13 minutes vs 12 minutes, P = .04). Median close to wheels out time was faster when there was 1 TURBT in a day (7 minutes vs 8 minutes, P = .02). Median in-room to anesthesia release time was faster in the morning than it was in the afternoon (10 minutes vs 11 minutes, P = .02).

CONCLUSION

Nonprocedural times made up roughly half of the total TURBT operating time and should be considered in OR efficiency analyses. TURBT OR efficiency may be related to the number of TURBTs performed in a day as well as the time of day of TURBT start.

Trends in Degree Conferrals, Degree-Associated Debt, and Employment Outcomes Among Undergraduate Public Health Degree Graduates, 2001‒2020

Objectives. To characterize the trends in degree conferrals, degree-associated debt, and employment outcomes among undergraduate public health degree (UGPHD) graduates. Methods. We reported administrative data on degree conferrals from 2001 to 2020 from the National Center for Education Statistics (NCES). For alumni graduating from 2015 to 2019, we also reported degree-associated debt and earnings 1 year after graduation compiled by NCES. Finally, we utilized a data set on 1-year postgraduation employment outcomes for graduates from 2015 to 2020 from the Association of Schools and Programs of Public Health. Results. As of 2020, more than 18 000 UGPHDs were awarded each year, more than 140 000 in total over the past 20 years. UGPHD graduates are highly diverse, with more than 80% being women and 55% being individuals from communities of color. We find alumni worked mostly in for-profit organizations (34%), health care (28%), nonprofits (11%), academic organizations (10%), government (10%), and other (6%). Degree-associated debt was $24 000, and the median first-year earnings were $34 000. Conclusions. While growth in UGPHD conferrals has slowed, it remains among the fastest-growing degree in the nation. However, the limited pathways into government remains a significant challenge. (Am J Public Health. 2023;113(1):115-123. https://doi.org/10.2105/AJPH.2022.307113).

Defining competencies for nurse anaesthetists: A Delphi study

AIM

To define the competencies of nurse anaesthetists in the hospitals of Catalonia on the basis of their clinical practice through a consensus-building process.

DESIGN

We used the Delphi method to determine consensus among a group of 16 nurse anaesthetists.

METHODS

Between February and June 2020, we administered a questionnaire of 142 questions distributed among seven domains: expert, communicator, collaborator, manager, health advocate, scholar and professional. Two rounds were conducted.

RESULTS

In round 1, 18 competencies were discarded and nine had inconclusive results. Eighteen competencies were proposed by participants. The nine competencies with inconclusive results and the 18 newly proposed competencies were considered in round 2. In round 2, three of these 27 competencies tested were discarded, and consensus was reached on the other 24.

CONCLUSION

Health education and the empowerment of the patient and family are fundamental pillars in the practice of nurse anaesthetists in Spain, especially in pre-anaesthetic assessment and pain care. These areas of practice can help define competencies in other countries where the profession of nurse anaesthetist is less developed.

IMPACT

The lack of regulation of the competencies of nurse anaesthetists leads to great variability in training and practice. The results can help in their standardization in Spain and in other countries lacking regulation. Our approach can also help policymakers and hospital administrators in health systems that are undergoing the process of regulation. The regulation of the competencies of nurse anaesthetists will allow them to contribute their expertise to the health-illness continuum, increasing safety and improving the quality of care.

The experience of working with anaesthesia associates in the United Kingdom and the impact on medical anaesthetic training

Anaesthesia Associates have been established in the UK for over 10 years, but without statutory regulation. Renewed interest surfaced based on a widening gap between patient need and workforce supply in the UK and established advanced practice non-doctor roles within healthcare systems elsewhere. However, there are no robust data on their impact on patient or hospital outcomes, or training opportunities for medical anaesthetists, and perceptions of the profession within the anaesthetic community are mixed. This paper describes an investigation into the demographics and scope of practice of Anaesthesia Associates in the UK in 2017, and the experience of working together as an anaesthetic team. Through qualitative interviews, we explored the role and relationships, the impact on medical anaesthetic training and ideas about future development. The overall experience of working with Anaesthesia Associates was positive. Successful integration requires understanding of the educational needs and competencies of all. Future development relies on strong leadership and robust patient outcome and efficiency measures. Interviewees strongly supported statutory regulation, which was agreed by the government in 2019 but not yet implemented. Anaesthesia Associates were seen as a benefit to anaesthetic departments and as such may provide part of the solution to the prevailing workforce issues in UK Anaesthesia, further critically challenged by the SARS-CoV-2 pandemic.

Role of perioperative nursing in anesthesia: a national overview

Abstract Objectives: To assess the actions performed by the operating room nurse during anesthesia and their behavior for patient safety regarding the reporting on adverse events, and to analyze their knowledge about anesthetic practices. Method: This is a cross-sectional study carried out using an electronic questionnaire consisting of socio-demographic, professional practice, knowledge in anesthesia, patient safety, and professional practice questions, conducted from January to March 2019 with operating room nurses. Results: One hundred nurses participated, 89 (89%) being women, with a mean age of 41.09 years (SD = 9.36), time of undergraduate completion of 14.33 years (SD = 8.34). The average attendance was 4.69 operating rooms (SD = 2.07) per nurse, with an emphasis on action before induction (49; 49%). Professionals reported performance of simultaneous activities (72; 72%) and insufficient number of employees (57; 57%) as difficulties of their daily practice. Among the participants, 77 (77%) correctly cited the periods of general anesthesia and 80.4% always reported the occurrence of an adverse event. Conclusion: Nurses identified their role in anesthesia, with limitations for assistance from multiple activities and lack of professionals.