1
|
Berger-Estilita J, Marcolino I, Radtke FM. Patient-centered precision care in anaesthesia - the PC-square (PC) 2 approach. Curr Opin Anaesthesiol 2024; 37:163-170. [PMID: 38284262 PMCID: PMC10911256 DOI: 10.1097/aco.0000000000001343] [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] [Indexed: 01/30/2024]
Abstract
PURPOSE OF REVIEW This review navigates the landscape of precision anaesthesia, emphasising tailored and individualized approaches to anaesthetic administration. The aim is to elucidate precision medicine principles, applications, and potential advancements in anaesthesia. The review focuses on the current state, challenges, and transformative opportunities in precision anaesthesia. RECENT FINDINGS The review explores evidence supporting precision anaesthesia, drawing insights from neuroscientific fields. It probes the correlation between high-dose intraoperative opioids and increased postoperative consumption, highlighting how precision anaesthesia, especially through initiatives like Safe Brain Initiative (SBI), could address these issues. The SBI represents multidisciplinary collaboration in perioperative care. SBI fosters effective communication among surgical teams, anaesthesiologists, and other medical professionals. SUMMARY Precision anaesthesia tailors care to individual patients, incorporating genomic insights, personalised drug regimens, and advanced monitoring techniques. From EEG to cerebral/somatic oximetry, these methods enhance precision. Standardised reporting, patient-reported outcomes, and continuous quality improvement, alongside initiatives like SBI, contribute to improved patient outcomes. Precision anaesthesia, underpinned by collaborative programs, emerges as a promising avenue for enhancing perioperative care.
Collapse
Affiliation(s)
- Joana Berger-Estilita
- Institute of Anaesthesiology and Intensive Care, Salemspital, Hirslanden Medical Group
- Institute for Medical Education, University of Bern, Bern, Switzerland
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, Porto, Portugal
| | - Isabel Marcolino
- Institute of Anaesthesiology and Intensive Care, Spital Limmattal, Schlieren, Switzerland
| | - Finn M. Radtke
- Department of Anaesthesia and Intensive Care, Hospital of Nykøbing Falster, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Yin C, Li J, Meng W, Hou S, Liu D, Liu M, Yu L, Guo R, Han X, Liu M. Trends in care quality in China from 2011 to 2017: An analysis based on the National Specific (Single) Disease Monitoring System. J Glob Health 2023; 13:04045. [PMID: 37114729 PMCID: PMC10141559 DOI: 10.7189/jogh.13.04045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Background The Ministry of Health of China conducted a study targeting in single-disease quality control in 2009, aimed to strengthen quality management and improve health care services. This study retrospectively investigated the trends of quality indicators for six monitored diseases 2011-2017 to evaluate the improvement of care quality for the first batch of single-disease. Methods We extracted data from the National Specific (Single) Disease Monitoring System for 2011-2017. We focused on six conditions: acute myocardial infarction, heart failure, community-acquired pneumonia, coronary artery bypass graft, hip / knee replacement, and acute ischemic stroke. A total of 56 quality indicators (QIs) were adopted to monitor the quality change and determine the trends in care quality. We also calculated the hospital process composite performance (HPCP) using a denominator-based weighting method for each hospital per year. The estimated annual percentage changes (EAPC) 2011-2017 were calculated at national and regional levels. Results The results showed that use of four QIs had significant downward trends, whereas 25 QIs (including reversed indicators) showed significant upward trends from 2011 to 2017. The greatest improvement was observed in CAP-4 (antibiotic treatment within four hours after admission to the hospital for critical pneumonia) in the central region (EAPC = 48.36, 95% CI = 15.92-89.87); while the largest decrease appeared in AIS-1 (thrombolytic therapy within 4.5 hours of symptom onset) in the western region (EAPC = -13.44, 95% CI = -24.98,-0.11). An increased HPCP was observed in four diseases nationwide, but not for acute myocardial infarction and heart failure. However, there were significant differences across regions in the process of care and outcomes, with the performance of Eastern and Western regions showing remarkable advantages compared with the Central region. Conclusions We provide evidence for major advancement in care quality in China nationwide. However, the improvement of care in China was unbalanced geographically and should be carefully considered. Future challenges include expanding the coverage of quality monitoring, greater delivery efficiency, and region-balanced health care.
Collapse
|
3
|
Azilagbetor DM, Jawara M. Improving patient safety: Did we learn from the story of Jean-Pierre Adams? JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2023. [DOI: 10.1177/25160435231157235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The safety of surgery and anesthesia has seen many advances over the last several decades; however, the frequency of complications experienced by patients undergoing surgical operations remains high. Most of these complications are avoidable, with a considerable portion of surgical patient injuries originating from human factors. Telling stories and assessing what went wrong and why for lessons to be learned are proven methods used to improve patient safety in anesthesia. In this narrative, we revisited a case of an anesthesia mishap that occurred in 1982, leaving the victim in a coma for nearly four decades until his death in September 2021. The patient reported for his operation, but a number of the hospital's staff were on strike. His operation, however, went ahead and the reduction in anesthesia care team members and its consequential increase in workload resulted in a series of avoidable errors. Decades after this event, many of the issues identified still remain a challenge in anesthesia care; there are still lessons to learn. We identified and discussed three major issues of concern: the non-cancellation of his procedure amid a strike action, giving a delicate anesthetic duty to a trainee without active supervision, and poor coordination and teamwork among team members in the operating room.
Collapse
Affiliation(s)
| | - Maimuna Jawara
- Higher Institute of Health Sciences, Hassan 1st University, Settat, Morocco
| |
Collapse
|
4
|
A Brief Assessment of Patient Safety Culture in Anesthesia and Intensive Care Departments. Healthcare (Basel) 2023; 11:healthcare11030429. [PMID: 36767004 PMCID: PMC9914654 DOI: 10.3390/healthcare11030429] [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: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Due to the nature of their activity, anesthesia and critical care have generally well-developed patient safety cultures, which are linked to a greater level of incident awareness and reporting during clinical activity. In order to determine the status quo and identify and adopt, where appropriate, techniques and instruments for further improving patient safety, it is necessary to evaluate the culture and barriers in these departments. The main objective of our study was to assess patient safety culture in Romanian anesthesia and intensive care departments (AICDs), to pinpoint the areas that may need improvement, and to examine the correlation between the prevalence of adverse event reporting, as well as the level of self-reported patient safety culture. To determine how anesthesia and intensive care department staff perceived patient safety, the Hospital Survey on Patient Safety Culture (HSOPSC) was used in a translated Romanian version. In total, 1200 employees from 36 anesthesiology and intensive care departments across 32 hospitals in Romania received the questionnaire, representing 42.66% of all anesthesia and intensive care departments in the country. In 7 of the 12 examined dimensions, significant differences between tertiary and secondary hospitals were observed. Among all dimensions, the highest positive score was for "organizational learning and continuous development". In general, our study revealed a positive view on patient safety in anesthesia and intensive care departments. Further studies are required to determine a threshold of the level of culture development.
Collapse
|
5
|
Mertes PM, Tacquard C. Maîtriser le risque allergique en anesthésie réanimation. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
6
|
Jammer I, Brandsborg B. How to improve perioperative pathways for the patient and society. Acta Anaesthesiol Scand 2023; 67:126-127. [PMID: 36583646 DOI: 10.1111/aas.14192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Ib Jammer
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | |
Collapse
|
7
|
Kristoffersen EW, Opsal A, Tveit TO, Fossum M. Knowledge, safety, and teamwork: a qualitative study on the experiences of anaesthesiologists and nurse anaesthetists working in the preanaesthesia assessment clinic. BMC Anesthesiol 2022; 22:309. [PMID: 36192680 PMCID: PMC9527137 DOI: 10.1186/s12871-022-01852-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022] Open
Abstract
Background The preanaesthesia assessment clinic (PAC) has been shown to contribute to safe anaesthesia assessment in hospitals. In the PAC, patients are assessed with an interview and can also ask relevant questions about anaesthesia. The intention is to ensure that patients are comprehensively prepared for the surgery and hospital stay. Although earlier studies have assessed the effects of PAC, attitudes and satisfaction of the healthcare personnel working in PAC remain unknown. Thus, this study aimed to examine the experiences of anaesthesiologists and nurse anaesthetists working in PACs as well as to explore barriers and facilitators in this context. Methods A descriptive qualitative approach was used to explore the experiences of anaesthesiologists and nurse anaesthetists working in PACs. Thirteen semi-structured interviews were conducted using face-to-face, telephone, or digital platforms in five hospitals in west, south, and north Norway between 2020 and 2021. The interviews were transcribed and thematically analysed according to Braun and Clarke’s six-steps semantic reflexive analysis. Results Four themes and nine subthemes were identified through an active analysis process, including developing competence in clinical anaesthesia practice, identifying barriers and facilitators influencing collaboration and teamwork, improving patient safety and outcomes through structured assessment, and identifying other organisational factors affecting the delivery of healthcare to surgical patients. Conclusions Working in the PAC contributed to competence development among the personnel. Additionally, teamwork was considered important for the proper functioning of the PAC. Patient safety was perceived as improved owning to the structured assessment in PAC, with patients getting the opportunity to improve their knowledge and being more involved in the upcoming anaesthesia. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01852-w.
Collapse
Affiliation(s)
- Eirunn Wallevik Kristoffersen
- Department of Health and Nursing Science, University of Agder, Grimstad, Kristiansand, Norway. .,Department of Anaesthesiology & Intensive Care, Sørlandet Hospital, Kristiansand, Norway.
| | - Anne Opsal
- Department of Health and Nursing Science, University of Agder, Grimstad, Kristiansand, Norway.,Department of Clinical Research, Sørlandet Hospital, Kristiansand, Norway
| | - Tor Oddbjørn Tveit
- Department of Health and Nursing Science, University of Agder, Grimstad, Kristiansand, Norway.,Department of Anaesthesiology & Intensive Care, Sørlandet Hospital, Kristiansand, Norway.,Department of Technology and E-Health, Sørlandet Hospital, Kristiansand, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, University of Agder, Grimstad, Kristiansand, Norway
| |
Collapse
|
8
|
Thusini S, Milenova M, Nahabedian N, Grey B, Soukup T, Henderson C. Identifying and understanding benefits associated with return-on-investment from large-scale healthcare Quality Improvement programmes: an integrative systematic literature review. BMC Health Serv Res 2022; 22:1083. [PMID: 36002852 PMCID: PMC9404657 DOI: 10.1186/s12913-022-08171-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We previously developed a Quality Improvement (QI) Return-on-Investment (ROI) conceptual framework for large-scale healthcare QI programmes. We defined ROI as any monetary or non-monetary value or benefit derived from QI. We called the framework the QI-ROI conceptual framework. The current study describes the different categories of benefits covered by this framework and explores the relationships between these benefits. METHODS We searched Medline, Embase, Global health, PsycInfo, EconLit, NHS EED, Web of Science, Google Scholar, organisational journals, and citations, using ROI or returns-on-investment concepts (e.g., cost-benefit, cost-effectiveness, value) combined with healthcare and QI. Our analysis was informed by Complexity Theory in view of the complexity of large QI programmes. We used Framework analysis to analyse the data using a preliminary ROI conceptual framework that was based on organisational obligations towards its stakeholders. Included articles discussed at least three organisational benefits towards these obligations, with at least one financial or patient benefit. We synthesized the different QI benefits discussed. RESULTS We retrieved 10 428 articles. One hundred and two (102) articles were selected for full text screening. Of these 34 were excluded and 68 included. Included articles were QI economic, effectiveness, process, and impact evaluations as well as conceptual literature. Based on these literatures, we reviewed and updated our QI-ROI conceptual framework from our first study. Our QI-ROI conceptual framework consists of four categories: 1) organisational performance, 2) organisational development, 3) external outcomes, and 4) unintended outcomes (positive and negative). We found that QI benefits are interlinked, and that ROI in large-scale QI is not merely an end-outcome; there are earlier benefits that matter to organisations that contribute to overall ROI. Organisations also found positive aspects of negative unintended consequences, such as learning from failed QI. DISCUSSION AND CONCLUSION Our analysis indicated that the QI-ROI conceptual framework is made-up of multi-faceted and interconnected benefits from large-scale QI programmes. One or more of these may be desirable depending on each organisation's goals and objectives, as well as stage of development. As such, it is possible for organisations to deduce incremental benefits or returns-on-investments throughout a programme lifecycle that are relevant and legitimate.
Collapse
Affiliation(s)
| | | | | | - Barbara Grey
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | |
Collapse
|
9
|
Fuchs A, Haller M, Riva T, Nabecker S, Greif R, Berger-Estilita J. Translation and application of guidelines into clinical practice: A colour-coded difficult airway trolley. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.1016/j.tacc.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
Peden CJ, Ghaferi AA, Vetter TR, Kain ZN. Perioperative Health Services Research: Far Better Played as a Team Sport. Anesth Analg 2021; 133:553-557. [PMID: 34257198 DOI: 10.1213/ane.0000000000005590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carol J Peden
- From the Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amir A Ghaferi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Thomas R Vetter
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Zeev N Kain
- Departments of Anesthesiology and Perioperative Care and Medicine, University of California, Irvine.,Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,CHOC Children's Hospital, Orange, California
| |
Collapse
|
11
|
Romare C, Enlöf P, Anderberg P, Jildenstål P, Sanmartin Berglund J, Skär L. Nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care: A qualitative study. PLoS One 2021; 16:e0250122. [PMID: 33882100 PMCID: PMC8059852 DOI: 10.1371/journal.pone.0250122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To describe nurse anesthetists' experiences using smart glasses to monitor patients' vital signs during anesthesia care. METHODS Data was collected through individual semi-structured interviews with seven nurse anesthetists who had used smart glasses, with a customized application for monitoring vital signs, during clinical anesthesia care. Data was analyzed using thematic content analysis. RESULTS An overarching theme became evident during analysis; Facing and embracing responsibility. Being a nurse anesthetist entails a great responsibility, and the participants demonstrated that they shouldered this responsibility with pride. The theme was divided in two sub-themes. The first of these, A new way of working, comprised the categories Adoption and Utility. This involved incorporating smart glasses into existing routines in order to provide safe anesthesia care. The second sub-theme, Encountering side effects, consisted of the categories Obstacles and Personal affect. This sub-theme concerned the possibility to use smart glasses as intended, as well as the affect on nurse anesthetists as users. CONCLUSION Smart glasses improved access to vital signs and enabled continuous monitoring regardless of location. Continued development and improvement, both in terms of the application software and the hardware, are necessary for smart glasses to meet nurse anesthetists' needs in clinical practice.
Collapse
Affiliation(s)
- Charlotte Romare
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Intensive Care Unit, Department of Anesthesiology, Region Blekinge, Karlskrona, Sweden
| | - Per Enlöf
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Anderberg
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Department of Health Sciences, University of Skövde, Skövde, Sweden
| | - Pether Jildenstål
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska academy, Gothenburg, Sweden
- Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| |
Collapse
|
12
|
Enlöf P, Romare C, Jildenstål P, Ringdal M, Skär L. Smart Glasses for Anesthesia Care: Initial Focus Group Interviews with Specialized Health Care Professionals. J Perianesth Nurs 2020; 36:47-53. [PMID: 33041201 DOI: 10.1016/j.jopan.2020.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/06/2020] [Accepted: 06/07/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE Smart glasses are a kind of wearable technology that gives users sustained, hands-free access to data and can transmit and receive information wirelessly. Earlier studies have suggested that smart glasses have the potential to improve patient safety in anesthesia care. Research regarding health care professionals' views of the potential use of smart glasses in anesthesia care is limited. The purpose of this study was to describe anesthesia health care professionals' views of smart glasses before clinical use. DESIGN A qualitative descriptive study. METHODS Data were collected from focus group interviews and analyzed using thematic content analysis. FINDINGS Three categories of participants' views of smart glasses were created during the analysis: views of integrating smart glasses in clinical setting; views of customized functionality of smart glasses; and views of being a user of smart glasses. One theme, striving for situational control, was identified in the analysis. CONCLUSIONS Smart glasses were seen as a tool that can impact and improve access to patient-related information, and aid health care professionals in their struggle to gain situational control during anesthesia care. These are factors related to increased patient safety.
Collapse
Affiliation(s)
- Per Enlöf
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Charlotte Romare
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden; Region Blekinge, Intensive Care Unit, Karlskrona, Sweden
| | - Pether Jildenstål
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Anesthesiology, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mona Ringdal
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Skär
- Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| |
Collapse
|
13
|
Mertes PM, Hopkins PM. Mast cell activation tests: a new tool in the investigation of suspected perioperative allergic reactions? Br J Anaesth 2020; 125:856-859. [PMID: 32988603 DOI: 10.1016/j.bja.2020.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Paul-Michel Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France.
| | - Philip M Hopkins
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| |
Collapse
|
14
|
Buhl LK, Bastos AB, Pollard RJ, Arle JE, Thomas GP, Song Y, Boone MD. Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present. J Intensive Care Med 2020; 36:1237-1249. [PMID: 32985340 DOI: 10.1177/0885066620962453] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraoperative neuromonitoring was introduced in the second half of the 20th century with the goal of preventing patient morbidity for patients undergoing complex operations of the central and peripheral nervous system. Since its early use for scoliosis surgery, the growth and utilization of IOM techniques expanded dramatically over the past 50 years to include spinal tumor resection and evaluation of cerebral ischemia. The importance of IOM has been broadly acknowledged, and in 1989, the American Academy of Neurology (AAN) released a statement that the use of SSEPs should be standard-of-care during spine surgery. In 2012, both the AAN and the American Clinical Neurophysiology Society (ACNS) recommended that: "Intraoperative monitoring (IOM) using SSEPs and transcranial MEPs be established as an effective means of predicting an increased risk of adverse outcomes, such as paraparesis, paraplegia, and quadriplegia, in spinal surgery." With a multimodal approach that combines SSEPs, MEPs, and sEMG with tEMG and D waves, as appropriate, sensitivity and specificity can be maximized for the diagnosis of reversible insults to the spinal cord, nerve roots, and peripheral nerves. As with most patient safety efforts in the operating room, IOM requires contributions from and communication between a number of different teams. This comprehensive review of neuromonitoring techniques for surgery on the central and peripheral nervous system will highlight the technical, surgical and anesthesia factors required to optimize outcomes. In addition, this review will discuss important trouble shooting measures to be considered when managing ION changes concerning for potential injury.
Collapse
Affiliation(s)
- Lauren K Buhl
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andres Brenes Bastos
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Richard J Pollard
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey E Arle
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - George P Thomas
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yinchen Song
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - M Dustin Boone
- Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
15
|
Borshoff DC, Sadleir P. Nonoperating room anaesthesia: safety, monitoring, cognitive aids and severe acute respiratory syndrome coronavirus 2. Curr Opin Anaesthesiol 2020; 33:554-560. [PMID: 32628402 PMCID: PMC7363376 DOI: 10.1097/aco.0000000000000895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments. RECENT FINDINGS Despite limited nonoperating room anaesthesia outcome data, analysis of malpractice claims, anaesthesia-related medical disputes and clinical outcome registries have suggested higher morbidity and mortality. Complications were often associated with suboptimal monitoring, nonadherence to recommended guidelines and sedationist or nonanaesthesiologist caregivers. More recently, clear monitoring guidelines, global patient safety initiatives and widespread implementation of cognitive aids may have contributed to nonoperating room anaesthesia (NORA) outcomes approaching that of traditional operating rooms. SUMMARY As NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.
Collapse
Affiliation(s)
- David C. Borshoff
- Director, Department of Anaesthesia and Pain Medicine, St John of God Murdoch Hospital
| | - Paul Sadleir
- Consultant Cardiac Anaesthetist and Medical Perfusionist, Department of Anaesthesia, Sir Charles Gairdner Hospital
- Senior Lecturer, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
16
|
Sanfilippo F, Noto A, Palumbo GJ, Ippolito M, Gagliardone M, Scarlata M, Bignami E, Sangalli F, Cattaneo S, Blangetti I, Scolletta S, Locatelli A, Tritapepe L, Lorini FL, Arcadipane A. Burnout in Cardiac Anesthesiologists: Results From a National Survey in Italy. J Cardiothorac Vasc Anesth 2018; 32:2459-2466. [PMID: 29929893 DOI: 10.1053/j.jvca.2018.05.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists. DESIGN National survey conducted on burnout. SETTING Italian cardiac centers. PARTICIPANTS Cardiac anesthesiologists. INTERVENTIONS The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment. MEASUREMENTS AND MAIN RESULTS The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in "high" or "moderate-high" risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists. CONCLUSION A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology.
Collapse
Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
| | - Alberto Noto
- Department of Anaesthesia and Intensive Care, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | - Gaetano J Palumbo
- School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Mariachiara Ippolito
- Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia Analgesia Intensive Care and Emergency. Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Mariapia Gagliardone
- Cardiothoracic Anesthesiology Unit, Transplant Center and De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Maria Scarlata
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Sangalli
- Department of Anesthesia and Intensive Care Medicine, San Gerardo Hospital, Monza, Italy
| | - Sergio Cattaneo
- Department of Anesthesia and Intensive Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ilaria Blangetti
- Department of Emergency and Critical Care, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Sabino Scolletta
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Locatelli
- Department of Emergency and Critical Care, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Luigi Tritapepe
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Ferdinando L Lorini
- Department of Anesthesia and Intensive Care Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| |
Collapse
|
17
|
Valsamis EM, Sadler J, Kennedy T, Thornhill C, Carey C, Ricketts D. Anaesthesia: what a surgeon needs to know. Br J Hosp Med (Lond) 2018; 79:270-278. [PMID: 29727235 DOI: 10.12968/hmed.2018.79.5.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgeons and anaesthetists work closely together, sometimes in challenging circumstances. To help surgeons cooperate with anaesthetists to deliver high quality care for patients, a working knowledge of modern anaesthetic practice is useful. The specialty of anaesthetics is developing rapidly, and periodic updating of this knowledge is likely to be required. This article provides an update of anaesthetic practice for surgeons, covering the varied roles of anaesthetists, preoperative assessment, management on the day of surgery (induction, maintenance and reversal of anaesthetic), general anaesthesia, the role of regional blocks and sedation. It also discusses safety issues, the management of frail patients and future challenges.
Collapse
Affiliation(s)
- E M Valsamis
- Core Surgical Trainee, Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE
| | - J Sadler
- Clinical Fellow in Anaesthesia, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - T Kennedy
- Anaesthetic Trainee, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - C Thornhill
- Medical Student, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - C Carey
- Consultant in Anaesthetics, Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton
| | - D Ricketts
- Consultant Orthopaedic Surgeon, Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton
| |
Collapse
|
18
|
|