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Escalante GO, Sun J, Schnell S, Guderian E, Mack CA, Argenziano M, Kurlansky P. Hospital characteristics associated with failure to rescue in cardiac surgery. JTCVS OPEN 2023; 16:509-521. [PMID: 38204725 PMCID: PMC10775121 DOI: 10.1016/j.xjon.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 01/12/2024]
Abstract
Objective The study objective was to examine the association between hospital processes of care and failure to rescue in a diverse, multi-institutional cardiac surgery network. Methods Failure to rescue was defined as an operative mortality after 1 or more of 4 complications: prolonged ventilation, stroke, renal failure, and unplanned reoperation. Society of Thoracic Surgeons data from 20,950 consecutive patients in the Columbia HeartSource network who underwent 1 of 7 cardiac operations-coronary artery bypass grafting, aortic valve replacement ± coronary artery bypass grafting, mitral valve repair or replacement ± coronary artery bypass grafting-were analyzed to calculate failure to rescue rates. Hospital-specific characteristics were ascertained by survey method. Multivariable mixed-effects logistic models assessed the association of these hospital characteristics with failure to rescue while adjusting for patient-related factors known to be associated with mortality. Results Failure to rescue rates at affiliate hospitals ranged from 5.45% to 21.74% (median, 12.5%; interquartile range, 6.9%). When controlling for Society of Thoracic Surgeons-predicted risk of mortality with hospital as a random effect, 4 hospital characteristics were found to be associated with lower failure to rescue rates; the presence of cardiac-trained anesthesiologists (odds ratio, 0.41; CI, 0.31-0.55, P < .001), availability of extracorporeal membrane oxygenation mechanical circulatory support (odds ratio, 0.41; CI, 0.31-0.54, P < .001), ratio of intensive care unit beds to intensivists (odds ratio, 0.87; CI, 0.76-0.99, P = .039), and total number of intensive care unit beds (odds ratio, 0.97; CI, 0.96-0.99, P = .002). Conclusions In a diverse multi-institutional cardiac surgical network, we were able to identify specific hospital processes of care associated with failure to rescue, even when adjusting for patient-related predictors of operative mortality.
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Affiliation(s)
| | - Jocelyn Sun
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University New York, New York, NY
| | - Susan Schnell
- Division of Cardiac, Thoracic and Vascular Surgery, Columbia University, New York, NY
| | - Emily Guderian
- Division of Cardiac, Thoracic and Vascular Surgery, Columbia University, New York, NY
| | - Charles A. Mack
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Michael Argenziano
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University New York, New York, NY
- Division of Cardiac, Thoracic and Vascular Surgery, Columbia University, New York, NY
| | - Paul Kurlansky
- Center for Innovation and Outcomes Research, Department of Surgery, Columbia University New York, New York, NY
- Division of Cardiac, Thoracic and Vascular Surgery, Columbia University, New York, NY
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Beier J, Ahrens E, Rufino M, Patel J, Azimaraghi O, Kumar V, Houle TT, Schaefer MS, Eikermann M, Wongtangman K. The impact of residency training level on early postoperative desaturation: A retrospective multicenter cohort study. J Clin Anesth 2023; 90:111238. [PMID: 37639750 DOI: 10.1016/j.jclinane.2023.111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE We studied the primary hypothesis that the training level of anesthesiology residents (first clinical anesthesia year, CA1 vs CA2/3 residents) is associated with early postoperative desaturation (oxygen saturation < 90%). We also analyzed the change in the rate (trajectory) of desaturation during the resident's development from CA1 to CA2/3 resident, and its effects on postoperative respiratory complications. DESIGN Retrospective hospital registry study. SETTING Two university-affiliated hospitals networks (MA and NY, USA). PATIENTS 140,818 adults undergoing non-cardiac surgery under general anesthesia and extubation in the operating room by residents (n = 378) between 2005 and 2021. MEASUREMENTS Multivariate logistic and quantile regression were used in the analyses. The secondary outcome was major respiratory complication within 7 days after surgery. MAIN RESULTS In 6.5% and 1.6% of cases, early postoperative desaturation to < 90% and 80% occurred. Compared to CA2/3 residents, CA1 residents had higher odds of experiencing early postoperative desaturation to < 90% and 80% (adjusted odds ratio [ORadj], 1.07; 95%CI 1.03-1.12; p = 0.002, and ORadj 1.10; 95%CI 1.01-1.20; p = 0.037, respectively). The change in postoperative desaturation rate during the transition from CA1 to CA2/3 status varied substantially from ORadj 0.80 (decreased risk) to 1.33 (increased risk). Major respiratory complication did not differ between experience levels (p = 0.52). However, a strong decline in improvement regarding the rate of postoperative desaturation during the transition from CA1 to CA2/3, was paralleled by an increased odds of major respiratory complication for CA2/3 residents (ORadj 1.20; 95%CI 1.02-1.42; p = 0.026, p-for-interaction = 0.056). CONCLUSION Patients treated by CA1 residents have an increased risk of postoperative desaturation. Some residents show an improvement and others a decline in postoperative desaturation rate. Our secondary analysis suggests that there should be more focus on those residents who had a declining performance in postoperative desaturation despite becoming more experienced.
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Affiliation(s)
- Juliane Beier
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Elena Ahrens
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael Rufino
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jashvin Patel
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Vivek Kumar
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Anesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany.
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
| | - Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Yee MS, Tarshis J. Anesthesia quality indicators to measure and improve your practice: a modified delphi study. BMC Anesthesiol 2023; 23:256. [PMID: 37525089 PMCID: PMC10388503 DOI: 10.1186/s12871-023-02195-w] [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: 08/01/2022] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Implementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice. METHODS An initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel. RESULTS The initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome. CONCLUSION This ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.
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Affiliation(s)
- May-Sann Yee
- Southlake Regional Health Centre, Newmarket, ON, L3Y 2P9, Canada.
| | - Jordan Tarshis
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Schnelle C, Jones MA. Characteristics of exceptionally good Doctors-A survey of public adults. Heliyon 2023; 9:e13115. [PMID: 36718151 PMCID: PMC9883187 DOI: 10.1016/j.heliyon.2023.e13115] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Background Systematic reviews have found that doctors can have a substantial effect on patients' physical health, beyond what can be explained by known factors. In a previous qualitative study, 13 medical doctors were interviewed on their experiences of exceptionally good doctors, and all had met at least one such doctor. Objective To determine how common it is for exceptionally good doctors to be encountered by patients and what are the characteristics of exceptionally good doctors. Design Mixed methods cross-sectional survey of 580 Amazon Mechanical Turk participants. Questions included doctor and participant demographics, and 34 Likert questions on characteristics of exceptionally good and average doctors. Free-text questions allowed participants to describe exceptional doctors, record their experience, and provide survey feedback. Stratified sampling ensured gender parity and 33% of participants aged ≥55 years. Analysis included descriptive statistics, statistical modelling of associations between Likert scale scores and patient demographics, and factor analysis. Results Of 580 responses, 505 (86%) were included in the analysis. Factor analysis confirmed internal validity. Most respondents (86%) had met at least two exceptionally good doctors, of whom 55% were specialists. 58% of respondents regarded doctors as exceptional based on an overall impression with multiple reasons. Doctors were most commonly considered exceptional based on one or more of their personality, diagnostic, or intervention ability. Respondents who reported the doctors "willingly listened to them to the end" scored their doctors higher on 33 of 34 Likert questions, except for popularity. They also rated average doctors lower throughout. Conclusions Exceptionally good doctors appear to be commonly encountered by the adult public. Listening to patients willingly to the end is a highly rated and influential characteristic, suggesting that listening could be targeted for quality improvement.
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Schnelle C, Clark J, Mascord R, Jones MA. Is There a Doctors' Effect on Patients' Physical Health, Beyond the Intervention and All Known Factors? A Systematic Review. Ther Clin Risk Manag 2022; 18:721-737. [PMID: 35903086 PMCID: PMC9314759 DOI: 10.2147/tcrm.s372464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/11/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Despite billions of doctor visits worldwide each year, little is known on whether doctors themselves affect patients’ physical health after accounting for intervention and confounders such as patients’ and doctors’ data, hospital effects, nor how strong that doctors’ effect is. Knowledge of surgeons’ and psychotherapists’ effects exists, but not for 102 other medical specialties notwithstanding the importance of such knowledge. Methods Eligibility Criteria: Randomized controlled trials (RCTs), case-control, and cohort studies including medical doctors except surgeons for any intervention, reporting the proportion of variance in patients’ outcomes owing to the doctors (random effects), or the fixed effects of grading doctors by outcomes, after multivariate adjustment. Exclusions: studies of <15 doctors or solely reporting doctors’ effects for known variables. Sources Medline, Embase, PsycINFO, inception to June 2020. Manual search for papers referring/referred to by resulting studies. Risk of Bias Using Newcastle–Ottawa scale. Results Despite all medical interventions bar surgery being eligible, only thirty cohort papers were found, covering 36,239 doctors, with 10 specialties, 21 interventions, 60 outcomes (17 unique). Studies reported doctors’ effects by grading doctors from best to worst, or by diversely calculating the doctor-attributed percentage of patients’ outcome variation, ie the intra-class correlation coefficient (ICC). Sixteen studies presented fixed effects, 18 random effects, and 3 another approach. No RCTs found. Thirteen studies reported exceptionally good and/or poor performers with confidence intervals wholly outside the average performance. ICC range 0 to 33%, mean 3.9%. Highly diverse reporting, meta-analysis therefore not applicable. Conclusion Doctors, on their own, can affect patients’ physical health for many interventions and outcomes. Effects range from negligible to substantial, even after accounting for all known variables. Many published cohorts may reveal valuable information by reanalyzing their data for doctors’ effects. Positive and negative doctor outliers appear regularly. Therefore, it can matter which doctor is chosen. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/uXjR7VOXTwQ
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Justin Clark
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachel Mascord
- General Dentist, BMA House, Sydney, New South Wales, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
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Schnelle C, Jones MA. The Doctors' Effect on Patients' Physical Health Outcomes Beyond the Intervention: A Methodological Review. Clin Epidemiol 2022; 14:851-870. [PMID: 35879943 PMCID: PMC9307914 DOI: 10.2147/clep.s357927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/22/2022] [Indexed: 01/02/2023] Open
Abstract
Background Previous research suggests that when a treatment is delivered, patients’ outcomes may vary systematically by medical practitioner. Objective To conduct a methodological review of studies reporting on the effect of doctors on patients’ physical health outcomes and to provide recommendations on how this effect could be measured and reported in a consistent and appropriate way. Methods The data source was 79 included studies and randomized controlled trials from a systematic review of doctors’ effects on patients’ physical health. We qualitatively assessed the studies and summarized how the doctors’ effect was measured and reported. Results The doctors’ effects on patients’ physical health outcomes were reported as fixed effects, identifying high and low outliers, or random effects, which estimate the variation in patient health outcomes due to the doctor after accounting for all available variables via the intra-class correlation coefficient. Multivariable multilevel regression is commonly used to adjust for patient risk, doctor experience and other demographics, and also to account for the clustering effect of hospitals in estimating both fixed and random effects. Conclusion This methodological review identified inconsistencies in how the doctor’s effect on patients’ physical health outcomes is measured and reported. For grading doctors from worst to best performances and estimating random effects, specific recommendations are given along with the specific data points to report. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/rvHjVIEPVhI
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Affiliation(s)
- Christoph Schnelle
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
| | - Mark A Jones
- Institute of Evidence-Based Healthcare, Bond University, Robina, QLD, 4226, Australia
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Riedel B, Dubowitz J, Yeung J, Jhanji S, Kheterpal S, Avidan MS. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia. Br J Anaesth 2022; 129:284-289. [PMID: 35835606 DOI: 10.1016/j.bja.2022.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022] Open
Abstract
There are two established techniques of delivering general anaesthesia: propofol-based total intravenous anaesthesia (TIVA) and volatile agent-based inhaled anaesthesia. Both techniques are offered as standard of care and have an established safety track record lasting more than 30 years. However, it is not currently known whether the choice of anaesthetic technique results in a fundamentally different patient experience or affects early, intermediate-term, and longer-term postoperative outcomes. This editorial comments on a recently published study that suggests that inhaled volatile anaesthesia might be associated with fewer postoperative surgical complications than propofol-based TIVA for patients undergoing colorectal cancer surgery. We consider the strengths and limitations of the study, place these findings in the context of the broader evidence, and discuss how the current controversies regarding anaesthetic technique can be resolved, thereby helping to bring precision medicine into the modern practice of perioperative care.
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Affiliation(s)
- Bernhard Riedel
- Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Julia Dubowitz
- Department of Anaesthesia, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia
| | - Joyce Yeung
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Warwick Medical School, University of Warwick, Coventry, UK
| | - Shaman Jhanji
- Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK; Division of Cancer Biology, Institute of Cancer Research, London, UK
| | - Sachin Kheterpal
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA
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Schnelle C, Clark J, Mascord R, Jones MA. Is There a Surgeons’ Effect on Patients’ Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review. Ther Clin Risk Manag 2022; 18:467-490. [PMID: 35502434 PMCID: PMC9056050 DOI: 10.2147/tcrm.s357934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To find and review published papers researching surgeons’ effects on patients’ physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are “hospital” and “psychotherapist” effects, there may be “surgeons” effects that persist after controlling for known variables like patient health and operation riskiness. Methods Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients’ physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons’ effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle–Ottawa Scale. Results Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients’ variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion Interpretation: There is a surgeons' effect on patients’ physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons’ effects especially after methodological reporting guidelines are published. Conclusion In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/pL-eGyAGhSk
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Affiliation(s)
- Christoph Schnelle
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
- Correspondence: Christoph Schnelle, Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia, Email
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachel Mascord
- General Dentist, BMA House, Sydney, New South Wales, Australia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
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Setting up a quality program: defining the value proposition for anesthesiology. Int Anesthesiol Clin 2021; 59:1-11. [PMID: 34320569 DOI: 10.1097/aia.0000000000000332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hensley NB, Grant MC, Cho BC, Suffredini G, Abernathy JA. How Do We Use Dashboards to Enhance Quality in Cardiac Anesthesia? J Cardiothorac Vasc Anesth 2021; 35:2969-2976. [PMID: 34059439 DOI: 10.1053/j.jvca.2021.04.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/30/2021] [Accepted: 04/20/2021] [Indexed: 02/04/2023]
Abstract
The use of clinical dashboards has expanded significantly in healthcare in recent years in a variety of settings. The ability to analyze data related to quality metrics in one screen is highly desirable for cardiac anesthesiologists, as they have considerable influence on important clinical outcomes. Building a robust quality program within cardiac anesthesia relies on consistent access and review of quality outcome measures, process measures, and operational measures through a clinical dashboard. Signals and trends in these measures may be compared to other cardiac surgical programs to analyze gaps and areas for quality improvement efforts. In this article, the authors describe how they designed a clinical cardiac anesthesia dashboard for quality efforts at their institution.
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Affiliation(s)
- Nadia B Hensley
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian C Cho
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Giancarlo Suffredini
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - James A Abernathy
- Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD
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Massoth C, Meersch M. [Safer anesthesia and duty hour limits: are handovers of personnel allowed?]. Anaesthesist 2021; 70:439-448. [PMID: 33825936 DOI: 10.1007/s00101-021-00949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Restrictions of duty hours in medicine are an ambivalent matter with respect to patient safety. Continuity of treatment carries the risk of medical errors from declining performance capability and must be balanced against the risk of communication failure and information loss due to personnel changes. Complete intraoperative changes of anesthetists are frequently carried out in the clinical routine but possibly have the potential to negatively influence the postoperative morbidity and mortality. The relevance of anesthesiological care for the perioperative outcome also seems to vary depending on the specialist discipline involved. While standardized handover protocols seem to be only of limited effectiveness for the improvement of transfer of information, they are nevertheless a reasonable approach for optimization of interprofessional communication and reduction of treatment errors.
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Affiliation(s)
- Christina Massoth
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland
| | - Melanie Meersch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland.
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Is a Mean Arterial Pressure Less Than 65 mm Hg an Appropriate Indicator of the Quality of Anesthesia Care? Anesth Analg 2021; 132:942-945. [PMID: 33723192 DOI: 10.1213/ane.0000000000005281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Variability in Anesthesia Models of Care in Cardiac Surgery. SURGERIES 2021. [DOI: 10.3390/surgeries2010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The operating room in a cardiothoracic surgical case is a complex environment, with multiple handoffs often required by staffing changes, and can be variable from program to program. This study was done to characterize what types of practitioners provide anesthesia during cardiac operations to determine the variability in this aspect of care. A survey was sent out via a list serve of members of the cardiac surgical team. Responses from 40 programs from a variety of countries showed variability across every dimension requested of the cardiac anesthesia team. Given that anesthesia is proven to have an influence on the outcome of cardiac procedures, this study indicates the opportunity to further study how this variability influences outcomes and to identify best practices.
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Quality improvement: identifying and disseminating perioperative cardiac outcomes to providers. Int Anesthesiol Clin 2020; 59:66-71. [PMID: 33231941 DOI: 10.1097/aia.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Del Rio JM, Abernathy JJ, Taylor MA, Habib RH, Fernandez FG, Bollen BA, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Adult Cardiac Anesthesiology Section of STS Adult Cardiac Surgery Database: 2020 Update on Quality and Outcomes. Anesth Analg 2020; 131:1383-1396. [PMID: 33079860 DOI: 10.1213/ane.0000000000005093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- J Mauricio Del Rio
- From the Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Omaha, Nebraska
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Del Rio JM, Jake Abernathy J, Taylor MA, Habib RH, Fernandez FG, Bollen BA, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Adult Cardiac Anesthesiology Section of STS Adult Cardiac Surgery Database: 2020 Update on Quality and Outcomes. J Cardiothorac Vasc Anesth 2020; 35:22-34. [PMID: 33008722 DOI: 10.1053/j.jvca.2020.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The Society of Cardiovascular Anesthesiologists, in partnership with The Society of Thoracic Surgeons, has developed the Adult Cardiac Anesthesiology Section of the Adult Cardiac Surgery Database. The goal of this landmark collaboration is to advance clinical care, quality, and knowledge, and to demonstrate the value of cardiac anesthesiology in the perioperative care of cardiac surgical patients. Participation in the Adult Cardiac Anesthesiology Section has been optional since its inception in 2014 but has progressively increased. Opportunities for further growth and improvement remain. In this first update report on quality and outcomes of the Adult Cardiac Anesthesiology Section, we present an overview of the clinically significant anesthesia and surgical variables submitted between 2015 and 2018. Our review provides a summary of quality measures and outcomes related to the current practice of cardiothoracic anesthesiology. We also emphasize the potential for addressing high-impact research questions as data accumulate, with the overall goal of elucidating the influence of cardiac anesthesiology contributions to patient outcomes within the framework of the cardiac surgical team.
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Affiliation(s)
- J Mauricio Del Rio
- Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Omaha, Nebraska
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Del Rio JM, Abernathy JJ, Taylor MA, Habib RH, Fernandez FG, Bollen BA, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Adult Cardiac Anesthesiology Section of STS Adult Cardiac Surgery Database: 2020 Update on Quality and Outcomes. Ann Thorac Surg 2020; 110:1447-1460. [PMID: 33008569 DOI: 10.1016/j.athoracsur.2020.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
The Society of Cardiovascular Anesthesiologists, in partnership with The Society of Thoracic Surgeons, has developed the Adult Cardiac Anesthesiology Section of the Adult Cardiac Surgery Database. The goal of this landmark collaboration is to advance clinical care, quality, and knowledge, and to demonstrate the value of cardiac anesthesiology in the perioperative care of cardiac surgical patients. Participation in the Adult Cardiac Anesthesiology Section has been optional since its inception in 2014 but has progressively increased. Opportunities for further growth and improvement remain. In this first update report on quality and outcomes of the Adult Cardiac Anesthesiology Section, we present an overview of the clinically significant anesthesia and surgical variables submitted between 2015 and 2018. Our review provides a summary of quality measures and outcomes related to the current practice of cardiothoracic anesthesiology. We also emphasize the potential for addressing high-impact research questions as data accumulate, with the overall goal of elucidating the influence of cardiac anesthesiology contributions to patient outcomes within the framework of the cardiac surgical team.
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Affiliation(s)
- J Mauricio Del Rio
- Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | - Felix G Fernandez
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Omaha, Nebraska
| | - G Burkhard Mackensen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Intraoperative Management by a Craniofacial Team Anesthesiologist is Associated With Improved Outcomes for Children Undergoing Major Craniofacial Reconstructive Surgery. J Craniofac Surg 2019; 30:418-423. [PMID: 30614991 DOI: 10.1097/scs.0000000000005086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The benefits of using a dedicated team for complex surgeries are well established for certain specialties, but largely unknown for others. The aim of this study was to determine whether management by a dedicated craniofacial team anesthesiologist would impact perioperative outcomes for children undergoing major surgery for craniosynostosis. Sixty-two children undergoing complex cranial vault reconstruction were identified. Fifty-four patients were managed by the craniofacial anesthesia team, while 8 patients were not. Primary outcome measures were calculated blood loss, red blood cell transfusion volume, blood donor exposures, extubation rate, and postoperative complication rate. Secondary outcome measures included intraoperative opioid administration, crystalloid and colloid administration, intraoperative complication rate, and intensive care unit (ICU) and hospital length of stay. Children cared for by the craniofacial team had significantly lower calculated blood loss, reduced red blood cell transfusion volume, fewer blood donor exposures, less crystalloid administration, higher rate of postoperative extubation, fewer postoperative complications, and decreased ICU and hospital length of stay than patients who were managed by noncraniofacial team anesthesiologists. There were no significant differences in demographics, opioid administration, colloid volume administration, or intraoperative complication rates between the 2 groups. Management by a craniofacial team anesthesiologist was associated with improved outcomes in children undergoing major craniofacial reconstructive surgery. While some variability can be attributed to provider-volume relationship, these findings suggest that children may benefit from a subspecialty anesthesia team-based approach for the management of craniofacial surgery, and potentially other similar high-risk cases.
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Coulson TG, Karalapillai D. Providence, patient or provider? Looking for truth in retrospective database studies. Anaesthesia 2019; 74:424-426. [DOI: 10.1111/anae.14573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- T. G. Coulson
- The Austin Hospital; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
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Abstract
A robust quality management system (QMS) will provide value to patients, providers, and hospitals or systems by focusing on system performance. The QMS must remain independent of provider-specific measures used for privileging. Some outcome measures may be used to assess system performance; they must not be used to assess individual provider performance. All anesthesia providers, especially leaders, must be guardians of an organization's safety culture.
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Affiliation(s)
- John Allyn
- Department of Anesthesiology and Peri-operative Medicine, Spectrum Healthcare Partners, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
| | - Craig Curry
- Department of Anesthesiology and Peri-operative Medicine, Spectrum Healthcare Partners, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA
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Dexter F, Ledolter J, Hindman BJ. Validity of using a work habits scale for the daily evaluation of nurse anesthetists' clinical performance while controlling for the leniencies of the rating anesthesiologists. J Clin Anesth 2017; 42:63-68. [DOI: 10.1016/j.jclinane.2017.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/27/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
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Dexter F, Shafer SL. Narrative Review of Statistical Reporting Checklists, Mandatory Statistical Editing, and Rectifying Common Problems in the Reporting of Scientific Articles. Anesth Analg 2017; 124:943-947. [PMID: 27676281 DOI: 10.1213/ane.0000000000001593] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Considerable attention has been drawn to poor reproducibility in the biomedical literature. One explanation is inadequate reporting of statistical methods by authors and inadequate assessment of statistical reporting and methods during peer review. In this narrative review, we examine scientific studies of several well-publicized efforts to improve statistical reporting. We also review several retrospective assessments of the impact of these efforts. These studies show that instructions to authors and statistical checklists are not sufficient; no findings suggested that either improves the quality of statistical methods and reporting. Second, even basic statistics, such as power analyses, are frequently missing or incorrectly performed. Third, statistical review is needed for all papers that involve data analysis. A consistent finding in the studies was that nonstatistical reviewers (eg, "scientific reviewers") and journal editors generally poorly assess statistical quality. We finish by discussing our experience with statistical review at Anesthesia & Analgesia from 2006 to 2016.
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Affiliation(s)
- Franklin Dexter
- From the *Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa; and †Department of Perioperative and Pain Medicine, Stanford University, Stanford, California
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Coulson TG, Bailey M, Reid CM, Tran L, Mullany DV, Smith JA, Pilcher D. The association between peri-operative acute risk change (ARC) and long-term survival after cardiac surgery. Anaesthesia 2017; 72:1467-1475. [DOI: 10.1111/anae.13967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 01/23/2023]
Affiliation(s)
- T. G. Coulson
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - M. Bailey
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - C. M. Reid
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- School of Public Health; Curtin University; Perth Western Australia Australia
| | - L. Tran
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - D. V. Mullany
- Critical Care Research Group; University of Queensland; Brisbane Queensland Australia
| | - J. A. Smith
- Department of Surgery; Monash University; Melbourne Victoria Australia
| | - D. Pilcher
- Department of Epidemiology and Preventive Medicine; School of Public Health and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Intensive Care; The Alfred Hospital; Melbourne Victoria Australia
- ANZICS Centre for Outcome and Resource Evaluation; Carlton, Melbourne Victoria Australia
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Willingham M, Avidan M. Triple low, double low: it’s time to deal Achilles heel a single deadly blow. Br J Anaesth 2017; 119:1-4. [DOI: 10.1093/bja/aex132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ebadi A, Tighe PJ, Zhang L, Rashidi P. DisTeam: A decision support tool for surgical team selection. Artif Intell Med 2017; 76:16-26. [PMID: 28363285 PMCID: PMC5892206 DOI: 10.1016/j.artmed.2017.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/18/2017] [Accepted: 02/05/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Surgical service providers play a crucial role in the healthcare system. Amongst all the influencing factors, surgical team selection might affect the patients' outcome significantly. The performance of a surgical team not only can depend on the individual members, but it can also depend on the synergy among team members, and could possibly influence patient outcome such as surgical complications. In this paper, we propose a tool for facilitating decision making in surgical team selection based on considering history of the surgical team, as well as the specific characteristics of each patient. METHODS DisTeam (a decision support tool for surgical team selection) is a metaheuristic framework for objective evaluation of surgical teams and finding the optimal team for a given patient, in terms of number of complications. It identifies a ranked list of surgical teams personalized for each patient, based on prior performance of the surgical teams. DisTeam takes into account the surgical complications associated with teams and their members, their teamwork history, as well as patient's specific characteristics such as age, body mass index (BMI) and Charlson comorbidity index score. RESULTS We tested DisTeam using intra-operative data from 6065 unique orthopedic surgery cases. Our results suggest high effectiveness of the proposed system in a health-care setting. The proposed framework converges quickly to the optimal solution and provides two sets of answers: a) The best surgical team over all the generations, and b) The best population which consists of different teams that can be used as an alternative solution. This increases the flexibility of the system as a complementary decision support tool. CONCLUSION DisTeam is a decision support tool for assisting in surgical team selection. It can facilitate the job of scheduling personnel in the hospital which involves an overwhelming number of factors pertaining to patients, individual team members, and team dynamics and can be used to compose patient-personalized surgical teams with minimum (potential) surgical complications.
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Affiliation(s)
- Ashkan Ebadi
- Department of Biomedical Engineering, University of Florida, 1064 Center Dr., Gainesville, FL 32611, USA.
| | - Patrick J Tighe
- Department of Anesthesiology, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32603, USA
| | - Lei Zhang
- Department of Anesthesiology, University of Florida, 1600 SW Archer Rd., Gainesville, FL 32603, USA
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, 1064 Center Dr., Gainesville, FL 32611, USA
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Do Not Use Hierarchical Logistic Regression Models with Low-incidence Outcome Data to Compare Anesthesiologists in Your Department. Anesthesiology 2016; 125:1083-1084. [DOI: 10.1097/aln.0000000000001363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gebauer S, Petersen T, Steele E. Is it time for a HIPAA for physicians? HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:298-301. [PMID: 27497520 DOI: 10.1016/j.hjdsi.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 06/17/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022]
Abstract
Practices, hospitals, and healthcare systems are increasingly able to collect data about individual physician clinical performance. There is a strong temptation to use the data to make decisions about physicians' quality of care without first taking the time to establish a system that ensures valid conclusions. In addition, physicians are not informed that their data are being used, and thus do not have an opportunity to correct any inaccuracies. A HIPAA-equivalent law or regulation for physicians would help patients and physicians more accurately address these and other issues related to complex healthcare data. FERPA provides a useful framework for these concerns.
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Affiliation(s)
- Sarah Gebauer
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, USA; Department of Internal Medicine, Division of Palliative Care, University of New Mexico, Albuquerque, USA.
| | - Timothy Petersen
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, USA.
| | - Elizabeth Steele
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, USA.
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