An In-Depth Analysis of Providers and Services of Cancellation in Anesthesia Reveals a Complex Picture after Systemic Analysis

The variances in operating room (OR) cancellation rates between different service lines and operators within these service lines were assessed by reviewing the electronic medical record (EMR) covering 34,561 cases performed by 199 OR operators in 2018. We assumed that cancellations would differ between different service lines, but the between-operators variance was minimal within the service line. We hypothesized that most variability would be secondary to patient-specific (weekdays, time of year, and national holidays), seasonal and administrative issues. Of 4165 case cancellations, the majority (73.1%) occurred before the patient arrived at the hospital. A total of 60% of all cancellations were within gastroenterology, interventional cardiology, and orthopedics. Cancellation rate variability between surgeons operating within the same service line greatly varied between services from very homogenous to very diverse across providers. The top reasons for cancellation were: date change, canceled by a patient, or "no show". The highest cancellation rates occurred on Mondays and Tuesdays, in January and September, and during weeks associated with national holidays. In summary, cancellation variability must be analyzed at the level of individual specialties, operators, and time variability.

A cross-sectional survey exploring the attitude, knowledge, and use of anesthesia teams toward evidence-based practice in Riyadh Saudi Arabia

Background

Evidence-based practice (EBP) plays a crucial role in improving the quality of healthcare services by ensuring the delivery of the highest and safest level of patient care since EBP helps in justifying treatment choices to patients. Studies that examine the levels of EBP knowledge, attitudes toward EBP, and use of the use of EBP within anesthetic teams' practice are lacking, hence it is necessary to explore this.

Aim

To evaluate anesthesia teams' levels of knowledge, attitude toward and use of the evidence-based practice in a local hospital in Saudi Arabia.

Method

In one hospital, a cross-sectional survey was conducted using a convenience sampling technique using a validated questionnaire instrument called the Evidence-Based Practice EBP Questionnaire. The questionnaire was distributed through an online method to 173 participants. Descriptive and inferential statistics Tests were utilized to analyse the retrieved data using the SPSS program.

Results

One hundred and forty questionnaires were completed and returned, yielding a response rate of 80.9%. Overall, anesthesia teams showed a high positive attitude toward EBP but low levels of knowledge and use of EBP. Participants with higher levels of education and/or work experience exhibited significantly higher levels of knowledge and use of EBP than those who had lower education levels and/or work experience. Also, higher levels of education and/or work experience exhibited a significant positive association toward a higher level of knowledge and use of EBP. However, attitude levels toward EBP did not exhibit either significant or associated. Physicians showed significantly higher knowledge and use of EBP than non-physicians. Lack of knowledge and lack of time due to workload were the leading barriers encountered by anesthesia teams ATs.

Conclusion

Education level, work experience and job position affect the knowledge, attitude, and use of EBP. Continuous education and minimizing barriers are recommended to enhance the knowledge, attitude, and use of EBP among anesthesia teams in Saudi Arabia.

Importance of non-technical skills in anaesthesia education

Rising concern about patient safety has resulted in growing interest in non-technical skills (NTS) among anaesthesiologists. Growing evidence suggesting the use of good NTS training in patient safety in simulated as well as real-world environment made them important in medical education. Both technical skills (TS) and NTS are interdependent. Successful task performance depends on effective integration of both TS and NTS for any given situation. Development of tools for assessing the NTS of an anaesthesiologist in improving health care outcomes is challenging. Teaching, understanding and evaluating NTS among anaesthesiologists in improving health care outcomes is a domain which is supposed to be a rich seam for future studies.

Mapping multicenter randomized controlled trials in anesthesiology: a scoping review

BACKGROUND

Evidence suggests that there are substantial inconsistencies in the practice of anesthesia. There has not yet been a comprehensive summary of the anesthesia literature that can guide future knowledge translation interventions to move evidence into practice. As the first step toward identifying the most promising interventions for systematic implementation in anesthesia practice, this scoping review of multicentre RCTs aimed to explore and map the existing literature investigating perioperative anesthesia-related interventions and clinical patient outcomes.

METHODS

Multicenter randomized controlled trials were eligible for inclusion if they involved a tested anesthesia-related intervention administered to adult surgical patients (≥ 16 years old), with a control group receiving either another anesthesia intervention or no intervention at all. The electronic databases Embase (via OVID), MEDLINE, and MEDLINE in Process (via OVID), and Cochrane Central Register of Control Trials (CENTRAL) were searched from inception to February 26, 2021. Studies were screened and data were extracted by pairs of independent reviewers in duplicate with disagreements resolved through consensus or a third reviewer. Data were summarized narratively.

RESULTS

We included 638 multicentre randomized controlled trials (n patients = 615,907) that met the eligibility criteria. The most commonly identified anesthesia-related intervention theme across all studies was pharmacotherapy (n studies = 361 [56.6%]; n patients = 244,610 [39.7%]), followed by anesthetic technique (n studies = 80 [12.5%], n patients = 48,455 [7.9%]). Interventions were most often implemented intraoperatively (n studies = 233 [36.5%]; n patients = 175,974 [28.6%]). Studies typically involved multiple types of surgeries (n studies = 187 [29.2%]; n patients = 206 667 [33.5%]), followed by general surgery only (n studies = 115 [18.1%]; n patients = 201,028 [32.6%]) and orthopedic surgery only (n studies = 94 [14.7%]; n patients = 34,575 [5.6%]). Functional status was the most commonly investigated outcome (n studies = 272), followed by patient experience (n studies = 168), and mortality (n studies = 153).

CONCLUSIONS

This scoping review provides a map of multicenter RCTs in anesthesia which can be used to optimize future research endeavors in the field. Specifically, we have identified key knowledge gaps in anesthesia that require further systematic assessment, as well as areas where additional research would likely not add value. These findings provide the foundation for streamlining knowledge translation in anesthesia in order to reduce practice variation and enhance patient outcomes.

How to do no harm: empowering local leaders to make care safer in low-resource settings

In a companion paper, we showed how local hospital leaders could assess systems and identify key safety concerns and targets for system improvement. In the present paper, we consider how these leaders might implement practical, low-cost interventions to improve safety. Our focus is on making immediate safety improvements both to directly improve patient care and as a foundation for advancing care in the longer-term. We describe a 'portfolio' approach to safety improvement in four broad categories: prioritising critical processes, such as checking drug doses; strengthening the overall system of care, for example, by introducing multiprofessional handovers; control of known risks, such as only using continuous positive airway pressure when appropriate conditions are met; and enhancing detection and response to hazardous situations, such as introducing brief team meetings to identify and respond to immediate threats and challenges. Local clinical leaders and managers face numerous challenges in delivering safe care but, if given sufficient support, they are nevertheless in a position to bring about major improvements. Skills in improving safety and quality should be recognised as equivalent to any other form of (sub)specialty training and as an essential element of any senior clinical or management role. National professional organisations need to promote appropriate education and provide coaching, mentorship and support to local leaders.

Variability in risk tolerance and adherence to guidelines in "go or no-go" decisions among anesthetists in Saudi Arabia

Background:

Anesthetists deal with many situations where they decide whether proceeding with anesthesia is safe or not. These are termed “go or no-go” decisions. Although guidelines have been developed to ensure safe anesthesia, many factors affect anesthetists' decision in practice. Therefore, we aimed to assess the variability in risk tolerance when making “go or no-go” decisions among anesthetists in Saudi Arabia.

Materials and Method:

A questionnaire-based study that included anesthetists practicing in Saudi Arabia from 1--14^th October 2017 was conducted. The questionnaire presented 11 clinical scenarios that involved deviation from guidelines, followed by four questions where the participants were asked to decide whether they would proceed with administering anesthesia, write a comment explaining their decision, to predict whether a colleague would make the same decision, and if they had a previous similar experience.

Results:

A total of 124 anesthetists responded, of which 56.5% were consultants. There was no absolute consensus over the decision to proceed in any scenario. Most of the respondents who would proceed (67.35%) expected a colleague to make the same decision. Anesthetists who encountered a previous similar experience were more likely to proceed (P = 0.000). There was no significant difference among the respondents' decisions according to years of experience (P = 0.121). Analysis of the comments showed that procedure urgency and presence of alternatives to deficient resources were the most frequent factors that dictated anesthetists' decision.

Conclusion:

There is a wide variation in risk tolerance among anesthetists. Further simulation-based studies are needed to identify and address factors that affect anesthetists' decisions.

A Clinical Audit of An Office-Based Anaesthesia Service for Dental Procedures in Victoria

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.