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Vanneman MW, Thuraiappah M, Feinstein I, Fielding-Singh V, Peterson A, Kronenberg S, Angst MS, Aghaeepour N. Variability and relative contribution of surgeon- and anesthesia-specific time components to total procedural time in cardiac surgery. J Thorac Cardiovasc Surg 2024; 168:559-568.e6. [PMID: 37574007 PMCID: PMC10859543 DOI: 10.1016/j.jtcvs.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Decreasing variability in time-intensive tasks during cardiac surgery may reduce total procedural time, lower costs, reduce clinician burnout, and improve patient access. The relative contribution and variability of surgeon control time (SCT) and anesthesia control time (ACT) to total procedural time is unknown. METHODS A total of 669 patients undergoing coronary artery bypass graft (CABG) surgery were enrolled. Using linear regression, we estimated adjusted SCTs and ACTs, controlling for patient and procedural covariates. The primary endpoint compared overall SCTs and ACTs. The secondary endpoint compared the variability in adjusted SCTs and ACTs. Sensitivity analyses quantified the relative importance of the specific surgeon and anesthesiologist in the adjusted linear models. RESULTS The median SCT was 4.1 hours (interquartile range [IQR], 3.4-4.9 hours) compared to a median ACT of 1.0 hours (IQR, 0.8-1.2 hours; P < .001). Using linear regression, the variability in adjusted SCT among surgeons (range, 1.8 hours) was 3.5-fold greater than the variability in adjusted ACT among anesthesiologists (range, 0.5 hour; P < .001). The specific surgeon and anesthesiologist accounted for 50% of the explanatory power of the predictive model (P < .001). CONCLUSIONS SCT variability is significantly greater than ACT variability and is strongly associated with the surgeon performing the procedure. Although these results suggest that SCT variability is an attractive operational target, further studies are needed to determine practitioner specific and modifiable attributes to reduce variability and improve efficiency.
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Affiliation(s)
- Matthew William Vanneman
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif.
| | - Melan Thuraiappah
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Igor Feinstein
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Vikram Fielding-Singh
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Ashley Peterson
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Scott Kronenberg
- Department of Cardiovascular Health Quality, Stanford Healthcare, Stanford, Calif
| | - Martin S Angst
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Nima Aghaeepour
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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Duran HT, Kingeter M, Reale C, Weinger MB, Salwei ME. Decision-making in anesthesiology: will artificial intelligence make intraoperative care safer? Curr Opin Anaesthesiol 2023; 36:691-697. [PMID: 37865848 PMCID: PMC11100504 DOI: 10.1097/aco.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW This article explores the impact of recent applications of artificial intelligence on clinical anesthesiologists' decision-making. RECENT FINDINGS Naturalistic decision-making, a rich research field that aims to understand how cognitive work is accomplished in complex environments, provides insight into anesthesiologists' decision processes. Due to the complexity of clinical work and limits of human decision-making (e.g. fatigue, distraction, and cognitive biases), attention on the role of artificial intelligence to support anesthesiologists' decision-making has grown. Artificial intelligence, a computer's ability to perform human-like cognitive functions, is increasingly used in anesthesiology. Examples include aiding in the prediction of intraoperative hypotension and postoperative complications, as well as enhancing structure localization for regional and neuraxial anesthesia through artificial intelligence integration with ultrasound. SUMMARY To fully realize the benefits of artificial intelligence in anesthesiology, several important considerations must be addressed, including its usability and workflow integration, appropriate level of trust placed on artificial intelligence, its impact on decision-making, the potential de-skilling of practitioners, and issues of accountability. Further research is needed to enhance anesthesiologists' clinical decision-making in collaboration with artificial intelligence.
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Affiliation(s)
- Huong-Tram Duran
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Carrie Reale
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Megan E. Salwei
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Maloney JA, D’Souza RS, Buckner Petty SA, Turkiewicz MJ, Sinha D, Patel A, Strand NH. Job Satisfaction Among Pain Medicine Physicians in the US. J Pain Res 2023; 16:1867-1876. [PMID: 37284326 PMCID: PMC10239623 DOI: 10.2147/jpr.s406701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Data are lacking on the factors that contribute to job satisfaction among pain medicine physicians. We sought to determine how sociodemographic and professional characteristics relate to job satisfaction among pain medicine physicians. Methods In this nationwide, multicenter, cross-sectional observational study, an electronic questionnaire related to job satisfaction was emailed in 2021 to pain medicine physicians who were members of the American Society of Anesthesiologists or the American Society of Pain and Neuroscience. The 28-item questionnaire asked physicians about sociodemographic and professional factors. Eight questions related to job satisfaction were based on a 10-point Likert scale, and 1 question was a binary (yes/no) variable. Differences in responses based on sociodemographic and professional factors were assessed with the Kruskal-Wallis rank sum test for Likert scale questions and with the Pearson χ2 test for yes/no questions. Results We determined that several variables, including gender, parental status, geographic location, specialty, years of practice, and volume of patients, are associated with pain medicine physicians' outlook on job satisfaction. Overall, 74.9% of respondents surveyed would choose pain medicine as a specialty again. Conclusion High rates of poor job satisfaction persist among pain medicine physicians. This survey study identified several sociodemographic and professional factors that are associated with job satisfaction among pain medicine physicians. By identifying physicians at high risk for poor job satisfaction, healthcare leadership and occupational health agencies can aim to protect physicians' well-being, enhance working conditions, and raise awareness about burnout.
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Affiliation(s)
- Jillian A Maloney
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Debarshi Sinha
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Ajay Patel
- Department of Rehabilitation & Regenerative Medicine (Patel), New York-Presbyterian Hospital-University Hospital of Columbia and Cornell, New York, NY, USA
| | - Natalie H Strand
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ, USA
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Provenchère S. [The operating room, at the center of the danger]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:42-45. [PMID: 37127389 DOI: 10.1016/j.soin.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Cardiac anesthesiologists face a demanding and stressful practice that requires a sense of well-being at work that is essential to patient safety and quality of care. Like all cardiac caregivers, they are exposed to the death of the people they care for and must nevertheless overcome the difficulties associated with the management of heavy patients.
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Affiliation(s)
- Sophie Provenchère
- Département d'anesthésie-réanimation, Hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, 75877 Paris cedex 18, France; Comité anesthésie-réanimation cœur-thorax-vaisseaux, Société française d'anesthésie et de réanimation, 74 rue Raynouard, 75016 Paris, France; Société française de chirurgie thoracique et cardiovasculaire, 56 boulevard Vincent-Auriol, 75013 Paris, France.
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Robertson AC, Shi Y, Shotwell MS, Fowler LC, Tiwari V, Freundlich RE. Automated Emails to Improve Evening Staffing for Anesthesiologists. J Med Syst 2023; 47:22. [PMID: 36773173 PMCID: PMC9918833 DOI: 10.1007/s10916-023-01919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
Scheduling flexibility and predictability to the end of a clinical workday are strategies aimed at addressing physician burnout. A voluntary relief shift was created to increase the pool of anesthesiologists providing end of the day relief. We hypothesized that an automated email reminder would improve the number of evening relief shifts filled and increase the number of anesthesiologists participating in the program. An automated email reminder was implemented, which selectively emailed anesthesiologists without a clinical assignment one day in advance when the voluntary relief shifts were not filled, and anticipated case volume past 4:00 PM was expected to exceed the capacity of the on-call team. After implementation of the automated email reminder, the median number of providers who worked the relief shift on a typical day was 2.6, compared to 1.75 prior to the intervention. After the initial increase in the number of volunteers post-intervention, the trend in the weekly average number of volunteers tended to decrease but remained higher than before the intervention. A total of 22 unique anesthesiologists chose to participate in this program after the intervention. An automated email reminder increased the number of anesthesiologists volunteering for a relief shift. Leveraging automation to match staffing needs with case volume allows for recruitment of additional personnel on the days when volunteers are most needed. Increasing the pool of anesthesiologists available to provide relief is one strategy to improve end of the day predictability and work-life balance.
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Affiliation(s)
- Amy C Robertson
- Department of Anesthesiology, Vanderbilt University Medical Center, The Vanderbilt Clinic, 1301 Medical Center Dr, 4648, 37232-5614, Nashville, TN, USA.
| | - Yaping Shi
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Leslie C Fowler
- Department of Anesthesiology, Vanderbilt University Medical Center, The Vanderbilt Clinic, 1301 Medical Center Dr, 4648, 37232-5614, Nashville, TN, USA
| | - Vikram Tiwari
- Department of Anesthesiology, Vanderbilt University Medical Center, The Vanderbilt Clinic, 1301 Medical Center Dr, 4648, 37232-5614, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert E Freundlich
- Department of Anesthesiology, Vanderbilt University Medical Center, The Vanderbilt Clinic, 1301 Medical Center Dr, 4648, 37232-5614, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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De Leon-Casasola O. American Society of Regional Anesthesia and Pain Medicine 2021 John J. Bonica Award Lecture. Reg Anesth Pain Med 2023; 48:67-73. [PMID: 36328376 DOI: 10.1136/rapm-2022-104050] [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: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
I am as deeply inspired and humbled to receive this prestigious award, as I am profoundly indebted to the Bonica Award selection committee and the American Society of Regional Anesthesia and Pain Medicine Board of Directors for recognizing my contributions to the development, teaching, and practice of pain medicine in the tradition of Dr John J Bonica. I would also like to recognize my parents, Aura and Tito for providing me with the support and the environment to fulfill my professional goals. Moreover, the support that I have gotten from my team at the hospital, and the Chair of my Department, Dr Mark Lema needs to be underscored.
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Affiliation(s)
- Oscar De Leon-Casasola
- Department of Anesthesiology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA .,Roswell Park Comprehensive Cancer Institute and Department of Anesthesiology, University at Bufalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Zador L, Nowak K, Sitarik A, MacLean L, Han X, Kalsi M, Yeldo N, Sibai N, Penning D, Lewis M. The Burnout Epidemic Within A Viral Pandemic: Impact of a Wellness Initiative. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2022; 27:100251. [PMID: 35382030 PMCID: PMC8970611 DOI: 10.1016/j.pcorm.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/09/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
Background Anesthesiologists are at high risk of developing burnout, a condition which can lead to many deleterious effects for the physician, and far-reaching effects on their patients and hospital systems. The COVID-19 pandemic has presented new challenges that have further exacerbated the risk of burnout in anesthesiologists. It is critical to develop effective strategies to promote well-being and decrease burnout for physicians in this specialty. The purpose of this observational study was to evaluate the impact of a Physician Well-Being Initiative on distress and well-being in anesthesiologists. It was hypothesized that the wellness intervention would promote an improvement in well-being scores. Methods The Physician Well-Being Initiative was launched in August 2019 in the Department of Anesthesiology, Pain Management and Perioperative Medicine at Henry Ford Hospital in Detroit, Michigan. The Physician Well-Being Initiative was designed to address several of the key factors that improve physician wellness, including 1) a sense of autonomy; 2) positive view of leadership; and 3) flexible schedule opportunities. To assess the impact of the Physician Well-Being Initiative on the well-being and distress scores of participating anesthesiologists, the physicians were emailed the validated Well-Being Index survey at baseline and 3, 6 and 12 months. The Well-Being Index evaluates multiple items of distress in the healthcare setting. The sample size was limited to the 54 anesthesiologists at Henry Ford Hospital. Results Forty-four of the 54 anesthesiologists completed the baseline questionnaire. A total of 44 physicians answered the questionnaire at baseline, with more male than female physicians (35 males and 7 females) and the majority (17/44) in practice for 5-10 years. Thirty-two physicians completed the survey at 3 and 6 months, and 31 physicians at 12 months after the launch of the Physician Well-Being Initiative. Twenty-one physicians completed the questionnaire at all 4 time points. Although the COVID-19 pandemic started shortly after the 6-month surveys were submitted, results indicated that there was a 0.05 decrease in the Well-Being Index sum score for every 1-month of time (coefficient -0.05, 95% CI -0.01, -0.08, P = 0.013). This study shows that, with the wellness initiative in place, the department was able to maintain and potentially even reduce physician distress despite the concurrent onset of the pandemic. Conclusions Following the launch of a sustained wellness initiative, this study demonstrates that physician wellness improved with time. This suggests that it takes time for a wellness initiative to have an effect on well-being and distress in anesthesiologists.
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Affiliation(s)
- Lara Zador
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Katherine Nowak
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Alexandra Sitarik
- Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, Michigan 48202
| | - Lisa MacLean
- Department of Psychiatry, Henry Ford Health System, 1 Ford Place, Detroit, Michigan 48202
| | - Xiaoxia Han
- Public Health Sciences, Henry Ford Health System, One Ford Place, 3E, Detroit, Michigan 48202
| | - Mandip Kalsi
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York City, New York 10021
| | - Nicholas Yeldo
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Nabil Sibai
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Donald Penning
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
| | - Michael Lewis
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Hospital, 2850 W. Grand Boulevard, Detroit, Michigan 48202
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Motta P P, Kreeger R, Resheidat AM, Faraoni D, Nasr VG, Mossad EB, Mittnacht AJ. Selected 2021 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2022; 36:2265-2270. [DOI: 10.1053/j.jvca.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
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A field on fire: Why has there been so much attention focused on burnout among anesthesiologists? J Clin Anesth 2021; 73:110356. [PMID: 34062474 DOI: 10.1016/j.jclinane.2021.110356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
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10
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Abd-Elsayed A. Burnout among chronic pain anesthesiologists. Reg Anesth Pain Med 2021; 46:388. [PMID: 33574157 DOI: 10.1136/rapm-2021-102530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Alaa Abd-Elsayed
- Anesthesiology, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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