The Mandate to Measure Patient Experience: How Can Patients "Value" Anesthesia Care?

Impact of anesthesiologists on parental perioperative satisfaction scores

BACKGROUND

While the focus on patient experience as an important outcome has significantly increased over the past decade, there is paucity of data on predictive factors associated with parental recommendation of a surgical facility to friends and family.

METHODS

Data for this report were obtained from a Hospital Information System and Picker Health validated surveys completed by 538 parents whose children underwent outpatient surgery from July 2014 to March 2016. Bivariate, chi-squared, and multivariate logistic regression analysis were carried out using the Picker Health item "Would you recommend this outpatient surgical facility to your friends and family?" as the primary outcome. Demographic data and 53 Picker Health items were used as potential predictors.

RESULTS

Multivariate logistic regression analysis found the following variables as independent predictors for parental recommendation: quality of perioperative communication by anesthesiologists (odds ratio [95% confidence interval]=0.23 [0.09, 0.58]); provision of information on whom to call for help after discharge (0.22 [0.07, 0.64]); child's perceived baseline health (0.37 [0.15, 0.90]); and ill-informed staff about child's procedure (0.30 [0.21, 0.79]). Variables such as child's pain and child's nausea and vomiting were not predictive for referral pattern.

CONCLUSION

Parental recommendation of a surgical facility to friends and family depends on a number of variables with the quality of perioperative communication with the anesthesiologist being the most predictive item.

Fresh-Frozen Plasma: Ordering Patterns and Utilization in the Operating Rooms of a Tertiary Referral Hospital

BACKGROUND

Blood product transfusion is the most commonly performed hospital procedure. Intraoperative blood product utilization varies between institutions and anesthesiologists. In the United States in 2011, nearly 4 million plasma units were transfused.

METHODS

A retrospective analysis of intraoperative plasma ordering patterns and utilization (thawing and transfusing) was performed at a tertiary, academic hospital between January 2015 and March 2016.

RESULTS

Over 15 months, 46,002 operative procedures were performed. In 1540 of them, plasma was thawed or transfused: 8297 plasma units were thawed and 3306 of those units were transfused. These 3306 plasma units were transfused in 749 cases with a median of 2 plasma units (interquartile range, 2-4) transfused. The percentage of average monthly procedures with plasma thawed and none transfused was 51.3% (confidence interval, 49.0%-53.6%). The cardiac surgery service requested the greatest number of plasma units to be thawed (2143) but only transfused 712 (33.2%) of them. Of all plasma units not transfused, 45% were generated by procedures with 1 to 4 units of plasma thawed; 95.7% of these units were thawed as even integers (ie, 2, 4).

CONCLUSIONS

For operative procedures, far more plasma was thawed than was transfused and this practice occurred across surgical specialties and anesthesiologists. Considering the plasma that was not transfused, 45% occurred in procedures with 4 or fewer units of plasma requested suggesting these low-volume requests were a primary source of potential waste. Further studies are needed to examine associations between plasma utilization and clinical outcomes.