1
|
Neilipovitz D, Cooke-Lauder J, Bryson GL, McIsaac DI. Canadian public perception of anesthesiologists: results from a national survey. Can J Anaesth 2023; 70:1425-1432. [PMID: 37498439 DOI: 10.1007/s12630-023-02541-z] [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: 11/30/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE As Canadian health systems experience greater pressure to deliver timely perioperative care, public opinion is likely to influence health care policy decisions. Since Canadian public perception of anesthesiologists is unknown, the goal of this Canadian-wide survey was to begin to quantify public opinion regarding anesthesiologists in Canada. METHODS The Maru/Blue international market research group was contracted to survey the Canadian public on their perceptions of anesthesiologists. The anonymous bilingual polling surveys were presented to consenting Canadians, who earn credits from Maru/Blue that provide financial reward for participation, by means of an online survey tool. Results were weighted by education, age, sex, region, and language to match census data with an estimated margin of error of ± 3.0%, 19 times out of 20. RESULTS In August 2020, 1,511 randomly selected consenting Canadian adults recruited by the Maru/Blue research group in all ten provinces answered five sequential questions with variably presented answers. A total of 812 (54%) respondents identified as female. Most participants were from Ontario (38%) and Quebec (24%). The majority of participants, 778 (52%), were over 55 yr of age, with 496 (33%) having an annual income of between CAD 50,000 and 100,000. Only 41% (624/1,511) of respondents identified the most responsible anesthesia provider as a physician, with the next most frequent response being that the anesthesia provider was unknown (350/1,511; 23%). The median [interquartile range] impression of anesthesiologists was favourable [favourable-somewhat favourable], with 310/1,511 (21%) expressing an unknown impression. CONCLUSIONS Over half of surveyed Canadians did not identify the most responsible anesthesia provider as a physician.
Collapse
Affiliation(s)
- David Neilipovitz
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital - Civic Campus, 1053 Carling Ave., Ottawa, ON, K1Y 4E9, Canada.
| | | | - Gregory L Bryson
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital, Ottawa, ON, Canada
| |
Collapse
|
2
|
Akavipat P, Suraseranivongse S, Yimrattanabowon P, Sriraj W, Ratanachai P, Summart U. Algorithmic prediction of anaesthesia manpower quantity needs: A multicentre study. J Perioper Pract 2023; 33:282-292. [PMID: 35993397 DOI: 10.1177/17504589221113743] [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: 06/15/2023]
Abstract
BACKGROUND A shortage of anaesthetists affects health system globally. This is a study on task-force to develop a predictive model for the appropriate number of anaesthetic providers (Y). METHODS A cross-sectional study was performed with randomisation from every health service region across Thailand. The decision-making criteria for manpower needed were written and provided guidance. The number of personnel was calculated from the sum of total time spent by all anaesthetic providers divided by duration of the service. Linear regression analysis was applied. RESULTS In total 3774 patients were included from 18 hospitals. The factors that affect the anaesthetic providers' allocation needs were included in the predictive model, calculated as Y = 3.53 + [0.56 (standard centre) + 0.36 (advanced centre) + 1.03 (specialty centre)] + 0.07 (American Society of Anesthesiologists physical status IV and V) + 0.61 (advanced anaesthetic medication) + [0.61 (monitored anaesthesia care) + 0.17 (general anaesthesia)] - [0.27 (pre-anaesthetic duration within 31-60 minutes) + (0.61 (over 60 minutes)] - [0.85 (anaesthetic duration within 31-60 minutes) + 1.04 (within 61-120 minutes) + 1.32 (over 120 minutes)] - [0.16 (post-anaesthetic duration within 31-60 minutes) + 0.45 (within 61-90 minutes) + 0.74 (over 90 minutes)]. CONCLUSION The anaesthesia manpower algorithm developed during this study can be used to calculate the number of anaesthetists per population to maintain health services.
Collapse
|
3
|
Hoyler MM, Pryor KO, Gotian R, Brumberger ED, Chan JM. Resident Physicians as Clinical Educators in Anesthesiology: A Narrative Review. Anesth Analg 2023; 136:270-281. [PMID: 36638511 DOI: 10.1213/ane.0000000000006243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The importance of resident physicians as clinical educators is widely acknowledged in many clinical specialties and by national accreditation organizations for medical education. Within anesthesiology training programs, there is growing attention to the role of trainees as clinical educators. This narrative review describes the theoretical and demonstrated benefits of clinical teaching by residents in anesthesiology and other medical fields, summarizes current efforts to support and promote residents as educators, and suggests ways in which anesthesiology training programs can further assess and develop the role of residents as clinical educators.
Collapse
Affiliation(s)
- Marguerite M Hoyler
- From the Department of Anesthesiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | | | | | | | | |
Collapse
|
4
|
Khalafi A, Sarvi Sarmeydani N, Adarvishi S. Workplace health in anesthesia team: A qualitative study in Iran. Front Public Health 2023; 11:1141447. [PMID: 36935702 PMCID: PMC10020197 DOI: 10.3389/fpubh.2023.1141447] [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: 01/10/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Background All anesthesia providers, including nurse anesthetists and anesthesiologists work in a stressful environment with diverse tasks. The profession is characterized by high workload, both dependent and independent job descriptions, and unpredictable conditions. This study was designed and conducted to explain the factors affecting the workplace health of Iranian anesthesia teams. Methods Twenty anesthesia team members including nurse anesthetists and anesthesiologists from 7 different hospitals were enrolled in this phenomenological research. The data were collected in 2022. Semi-structured interviews were used for data collection, and the transcripts were analyzed using qualitative content analysis. Findings The most notable theme emerging from the data which was found to affect workplace health was consistency of anesthesia team. Other themes derived from the data included team tranquility and physical well-being. Conclusion The participants' emphasis was more on behavioral and managerial factors affecting workplace health, and desirable interpersonal cooperation to create a suitable work environment for them was more prominent. These findings can raise the awareness of chief nurse anesthetists and planners to provide more effective teamwork, modify the job description structure, and reduce staff conflicts.
Collapse
Affiliation(s)
- Ali Khalafi
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nooshin Sarvi Sarmeydani
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- *Correspondence: Nooshin Sarvi Sarmeydani
| | - Sara Adarvishi
- Department of Anesthesiology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
5
|
Asemu YM, Nsereko E, McIsaac DI, Bould MD. Nonphysician Sedation Providers in Africa: What Counts and What Is Being Counted? Anesth Analg 2022; 135:246-249. [PMID: 35839496 DOI: 10.1213/ane.0000000000006037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Etienne Nsereko
- Department of Anesthesia, School of Health Sciences, University of Rwanda
| | - Dan Ian McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - M Dylan Bould
- Department of Anesthesiology and Pain Medicine, The Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Burns ML, Saager L, Cassidy RB, Mentz G, Mashour GA, Kheterpal S. Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality. JAMA Surg 2022; 157:807-815. [PMID: 35857304 DOI: 10.1001/jamasurg.2022.2804] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Recent studies have investigated the effect of overlapping surgeon responsibilities or nurse to patient staffing ratios on patient outcomes, but the association of overlapping anesthesiologist responsibilities with patient outcomes remains unexplored to our knowledge. Objective To examine the association between different levels of anesthesiologist staffing ratios and surgical patient morbidity and mortality. Design, Setting, and Participants A retrospective, matched cohort study consisting of major noncardiac inpatient surgical procedures performed from January 1, 2010, to October 31, 2017, was conducted in 23 US academic and private hospitals. A total of 866 453 adult patients (aged ≥18 years) undergoing major inpatient surgery within the Multicenter Perioperative Outcomes Group electronic health record registry were included. Anesthesiologist sign-in and sign-out times were used to calculate a continuous time-weighted average staffing ratio variable for each operation. Propensity score-matching methods were applied to create balanced sample groups with respect to patient-, operative-, and hospital-level confounders and resulted in 4 groups based on anesthesiologist staffing ratio. Groups consisted of patients receiving care from an anesthesiologist covering 1 operation (group 1), more than 1 to no more than 2 overlapping operations (group 1-2), more than 2 to no more than 3 overlapping operations (group 2-3), and more than 3 to no more than 4 overlapping operations (group 3-4). Data analysis was performed from October 2019 to October 2021. Exposure Undergoing a major inpatient surgical operation that involved an anesthesiologist providing care for up to 4 overlapping operations. Main Outcomes and Measures The primary composite outcome was 30-day mortality and 6 major surgical morbidities (cardiac, respiratory, gastrointestinal, urinary, bleeding, and infectious complications) derived from International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision discharge diagnosis codes. Results In all, 578 815 adult patients (mean [SD] age, 55.7 [16.2] years; 55.1% female) were analyzed. After matching operations according to anesthesiologist staffing ratio, 48 555 patients were in group 1; 247 057, group 1-2; 216 193, group 2-3; and 67 010, group 3-4. Increasing anesthesiologist coverage responsibilities was associated with an increase in risk-adjusted surgical patient morbidity and mortality. Compared with patients in group 1-2, those in group 2-3 had a 4% relative increase in risk-adjusted mortality and morbidity (5.06% vs 5.25%; adjusted odds ratio [AOR], 1.04; 95% CI, 1.01-1.08; P = .02) and those in group 3-4 had a 14% increase in risk-adjusted mortality and morbidity (5.06% vs 5.75%; AOR, 1.15; 95% CI, 1.09-1.21; P < .001). Conclusions and Relevance This study's findings suggest that increasing overlapping coverage by anesthesiologists is associated with increased surgical patient morbidity and mortality. Therefore, the potential effects of staffing ratios in perioperative team models should be considered in clinical coverage efforts.
Collapse
Affiliation(s)
- Michael L Burns
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Leif Saager
- Klinik für Anästhesiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ruth B Cassidy
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Graciela Mentz
- Department of Anesthesiology, University of Michigan, Ann Arbor
| | | | | |
Collapse
|
7
|
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.
Collapse
|
8
|
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
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
van Klei WA, Hollmann MW, Sneyd JR. The value of anaesthesiologists in the COVID-19 pandemic: a model for our future practice? Br J Anaesth 2020; 125:652-655. [PMID: 32896431 PMCID: PMC7440078 DOI: 10.1016/j.bja.2020.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Markus W Hollmann
- Amsterdam University Medical Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Robert Sneyd
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| |
Collapse
|
12
|
Mayr NP. Transfemoral Transcatheter Aortic Valve Replacement: Conscious Sedation for Everyone? JACC Cardiovasc Interv 2020; 13:1288-1290. [PMID: 32499019 DOI: 10.1016/j.jcin.2020.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- N Patrick Mayr
- Deutsches Herzzentrum München, Technische Universität München, Institut für Anästhesiologie, Munich, Germany.
| |
Collapse
|
13
|
A Population-based Comparative Effectiveness Study of Peripheral Nerve Blocks for Hip Fracture Surgery. Anesthesiology 2019; 131:1025-1035. [DOI: 10.1097/aln.0000000000002947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Adverse outcomes and resource use rates are high after hip fracture surgery. Peripheral nerve blocks could improve outcomes through enhanced analgesia and decreased opioid related adverse events. We hypothesized that these benefits would translate into decreased resource use (length of stay [primary outcome] and costs), and better clinical outcomes (pneumonia and mortality).
Methods
The authors conducted a retrospective cohort study of hip fracture surgery patients in Ontario, Canada (2011 to 2015) using linked health administrative data. Multilevel regression, instrumental variable, and propensity scores were used to determine the association of nerve blocks with resource use and outcomes.
Results
The authors identified 65,271 hip fracture surgery patients; 10,030 (15.4%) received a block. With a block, the median hospital stay was 7 (interquartile range, 4 to 13) days versus 8 (interquartile range, 5 to 14) days without. Following adjustment, nerve blocks were associated with a 0.6-day decrease in length of stay (95% CI, 0.5 to 0.8). This small difference was consistent with instrumental variable (1.1 days; 95% CI, 0.9 to 1.2) and propensity score (0.2 days; 95% CI, 0.2 to 0.3) analyses. Costs were lower with a nerve block (adjusted difference, −$1,421; 95% CI, −$1,579 to −$1,289 [Canadian dollars]), but no difference in mortality (adjusted odds ratio, 0.99; 95% CI, 0.89 to 1.11) or pneumonia (adjusted odds ratio, 1.01; 95% CI, 0.88 to 1.16) was observed.
Conclusions
Receipt of nerve blocks for hip fracture surgery is associated with decreased length of stay and health system costs, although small effect sizes may not reflect clinical significance for length of stay.
Collapse
|
14
|
Sun EC, Dutton RP, Jena AB. Comparison of Anesthesia Times and Billing Patterns by Anesthesia Practitioners. JAMA Netw Open 2018; 1:e184288. [PMID: 30646351 PMCID: PMC6324364 DOI: 10.1001/jamanetworkopen.2018.4288] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023] Open
Abstract
Importance Most physicians must exercise discretion in choosing billing details that determine payment for their services. Understanding the degree to which physicians inappropriately use this discretion has important implications for payment policies. However, separating higher case complexity from inappropriate billing has made this a challenging issue to study. Anesthesia offers a useful test case because practitioners are partly compensated by self-reported length of time (anesthesia time) spent on a case. Objective To characterize the incidence and consequences of inappropriate billing practices among anesthesia practitioners. Design, Setting, and Participants In this cross-sectional study of data from a large anesthesia registry, 6 261 955 procedures performed by 4221 anesthesia practitioners (physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants) between January 1, 2010, and March 31, 2015, were studied. A total of 3047 practitioners practiced primarily in community hospitals, whereas 453 practiced primarily in university hospitals and 721 practiced in other settings (eg, specialty hospital). Exposures Practitioners with anomalous patterns were identified as those reporting an unusually high number of anesthesia times ending in a multiple of 5 minutes (eg, 65 minutes). Main Outcomes and Measures Incidence of anomalous patterns among anesthesia practitioners and the increase in anesthesia times associated with these patterns. Results This study included 4221 practitioners who each performed at least 300 anesthetic procedures. Practitioners in the top fifth percentile reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 53.7% (13.7%) of the time (range, 36.8%-96.1%), whereas practitioners in the 6th to 10th percentiles reported anesthesia times ending in a multiple of 5 minutes a mean (SD) of 31.8% (2.0%) of the time (range, 29.2%-36.7%). Practitioners in the top fifth percentile submitted billing for anesthesia times that exceeded the expected time by a mean of 21.5 minutes (95% CI, 15.8-27.1 minutes). Conclusions and Relevance In this study, findings suggest that anesthesia practitioners with the highest tendency to report anesthesia times ending in a multiple of 5 minutes did so with high frequency, which reflects anomalous billing. These practitioners also sought payment for longer-than-expected anesthesia times, which would correspond to higher payment for their services.
Collapse
Affiliation(s)
- Eric C. Sun
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Richard P. Dutton
- US Anesthesia Partners, Department of Anesthesiology, Texas A&M School of Medicine, Bryan
| | - Anupam B. Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
- National Bureau of Economic Research, Cambridge, Massachusetts
| |
Collapse
|
15
|
|