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Dexter F, Scheib S, Xie W, Epstein RH. Bibliometric Analysis of Contributions of Anesthesiology Journals and Anesthesiologists to Operating Room Management Science. Anesth Analg 2024; 138:1120-1128. [PMID: 38091575 DOI: 10.1213/ane.0000000000006694] [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: 04/17/2024]
Abstract
BACKGROUND Anesthesiology journals appear to have been progressively publishing a smaller percentage of operating room (OR) management studies. Similarly, non-anesthesiologists have increasingly been authors of these publications. Five hypotheses were formulated to evaluate these impressions based on 2 of the authors' curation of an online, comprehensive bibliography of OR management articles and corresponding referenced course materials. METHODS We studied all 2938 publications having Scopus' SciVal topic T.6319 (OR management) more than 28 years from 1996 through May 2023, including 8608 distinct authors. RESULTS Half (50%) of the publications were absent from PubMed, and the percentage absent has been increasing progressively (Kendall's τ = 0.71; P < .0001). Fewer than half were published in journals including anesthesiology as the sole classification (20%) or as one of the classifications (27%). The anesthesiology journals have been publishing a progressively decreasing fraction (τ = -0.61; P < .0001). Among the 11 authors each contributing at least 1% of the OR management science publications, 9 were anesthesiologists and the other 2 had anesthesiologists as coauthors on all these publications. Only 3% of authors had at least 10 OR management publications from earlier years. There were 75% of authors with no such earlier publications and 85% with 0 or 1. There was a progressive increase in the number of authors publishing OR management annually and with at most 1 such earlier publication (τ = 0.90; P < .0001). Only 20% of publications had any author with at least 10 earlier OR management publications, 48% had every author with no such earlier publications, and 60% had all authors with 0 or 1. CONCLUSIONS Although most of the authors with the greatest production of OR management science were anesthesiologists, the percentage of publications in anesthesiology journals has been decreasing progressively. Anesthesiologists cannot rely solely on anesthesiology journals to keep up with the field. For most publications, every author had few or no earlier publications on the topic. Clinicians and managers relying on OR management science will continue to need to apply more information when judging whether published results can reliably be applied to their facilities.
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Affiliation(s)
- Franklin Dexter
- From the Department of Anesthesia, University of Iowa College of Medicine, Iowa City, Iowa
| | - Sara Scheib
- University of Iowa Libraries, Iowa City, Iowa
| | - Wei Xie
- University of Iowa Libraries, Iowa City, Iowa
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Dexter F, Epstein RH, Fahy BG. Association of surgeons' gender with elective surgical lists in the State of Florida is explained by differences in mean operative caseloads. PLoS One 2023; 18:e0283033. [PMID: 36920948 PMCID: PMC10016664 DOI: 10.1371/journal.pone.0283033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND A recent publication reported that at three hospitals within one academic health system, female surgeons received less surgical block time than male surgeons, suggesting potential gender-based bias in operating room scheduling. We examined this observation's generalizability. METHODS Our cross-sectional retrospective cohort study of State of Florida administrative data included all 4,176,551 ambulatory procedural encounters and inpatient elective surgical cases performed January 2017 through December 2019 by 8875 surgeons (1830 female) at all 609 non-federal hospitals and ambulatory surgery centers. There were 1,509,190 lists of cases (i.e., combinations of the same surgeon, facility, and date). Logistic regression adjusted for covariables of decile of surgeon's quarterly cases, surgeon's specialty, quarter, and facility. RESULTS Selecting randomly a male and a female surgeons' quarter, for 66% of selections, the male surgeon performed more cases (P < .0001). Without adjustment for quarterly caseloads, lists comprised one case for 44.2% of male and 54.6% of female surgeons (difference 10.4%, P < .0001). A similar result held for lists with one or two cases (difference 9.1%, P < .0001). However, incorporating quarterly operative caseloads, the direction of the observed difference between male and female surgeons was reversed both for case lists with one (-2.1%, P = .03) or one or two cases (-1.8%, P = .05). CONCLUSIONS Our results confirm the aforementioned single university health system results but show that the differences between male and female surgeons in their lists were not due to systematic bias in operating room scheduling (e.g., completing three brief elective cases in a week on three different workdays) but in their total case numbers. The finding that surgeons performing lists comprising a single case were more often female than male provides a previously unrecognized reason why operating room managers should help facilitate the workload of surgeons performing only one case on operative (anesthesia) workdays.
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Affiliation(s)
- Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, United States of America
| | - Richard H. Epstein
- Department of Anesthesiology, Perioperative Medicine & Pain Management, Miller School of Medicine, University of Miami, Miami, Florida
- * E-mail:
| | - Brenda G. Fahy
- Department of Anesthesiology, University of Florida, Gainesville, Florida
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Epstein RH, Dexter F, Fahy BG, Diez C. Most surgeons' daily elective lists in Florida comprise only 1 or 2 elective cases, making percent utilization unreliable for planning individual surgeons' block time. J Clin Anesth 2021; 75:110432. [PMID: 34280684 DOI: 10.1016/j.jclinane.2021.110432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/26/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE Operating room (OR) utilization has been shown in multiple studies to be an inappropriate metric for planning OR time for individual surgeons. Among surgeons with low daily caseloads, percentage utilization cannot be measured accurately because confidence limits are extremely wide. In Iowa, a largely rural state, most surgeons performed only 1 or 2 elective cases on their OR days. To assess generalizability, we analyzed Florida, a state with many high-population density areas. DESIGN Observational cohort study. SETTING The 602 facilities in Florida that performed inpatient or outpatient elective surgery from January 2010 through December 2019. SUBJECTS The providers licensed to perform surgery in Florida (physician, oral surgeons, dentists, and podiatrists) were identified by their national provider number. Hospitals were deidentified before analysis. MEASUREMENTS The primary endpoint was the mean among facilities in percentages of surgeon-day combinations ("lists") containing 1 or 2 cases. Proportions were calculated using Freeman-Tukey transformation and the harmonic mean of the number of lists at each facility. Comparison to "most" (>50%) used Student's two-sided one-group t-test. MAIN RESULTS Averaging among hospitals, most surgeons' lists included 1 or 2 cases (64.4%; 99% confidence interval [CI] 61.3%-67.4%) P < 0.00001). Many lists had 1 case (44.2%, 99% CI 41.2%-47.2%). Nearly all (96.7%) surgeons operated at just one hospital on their OR days. CONCLUSIONS Most surgeons' lists of elective surgical cases comprised 1 or 2 cases in the largely urban state of Florida, as previously found in the largely rural state of Iowa. Results were insensitive to organizational size or county population. Thus, our finding is generalizable in the United States. Consequently, neither adjusted nor raw utilization should be used solely when allocating OR time to individual surgeons. Anesthesia and nursing coverage of cases can be based on maximizing the efficiency of use of OR time.
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Affiliation(s)
- Richard H Epstein
- Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1400 NW 12th Avenue, Suite 4022, Miami, Florida 33136, United States of America.
| | - Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, United States of America.
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32608, United States of America.
| | - Christian Diez
- Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, 1611 NW 12(th) Avenue, Central Building, Suite C300, Miami, Florida 33136, United States of America.
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Dexter F, Elhakim M, Loftus RW, Seering MS, Epstein RH. Strategies for daily operating room management of ambulatory surgery centers following resolution of the acute phase of the COVID-19 pandemic. J Clin Anesth 2020; 64:109854. [PMID: 32371331 PMCID: PMC7188624 DOI: 10.1016/j.jclinane.2020.109854] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022]
Abstract
We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery. Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., S. aureus transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons. Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h). For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases. When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned. In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.
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Affiliation(s)
| | - Mohamed Elhakim
- Department of Anesthesia and Critical Care Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
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Ahn PH, Dexter F, Fahy BG, Van Swol LM. Demonstrability of analytics solutions and shared knowledge of statistics and operating room management improves expected performance of small teams in correctly solving problems and making good decisions. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pcorm.2020.100090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vasilopoulos T, Dexter F, Van Swol LM, Fahy BG. Trust improves during one-day resident operating room management course preceded by directed study of required statistical content. J Clin Anesth 2019; 55:43-49. [DOI: 10.1016/j.jclinane.2018.12.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/20/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022]
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Riveros-Perez E, Arthur ME, Jain A, Kumar V, Rocuts A. Multifaceted remediation program: experience of a residency program to rescue residents who failed the American Board of Anesthesiology basic examination. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:865-871. [PMID: 30538598 PMCID: PMC6263215 DOI: 10.2147/amep.s180627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PROBLEM Passing the American Board of Anesthesiology (ABA) basic examination is required to progress through anesthesiology training in USA. Failing the test may be related to medical knowledge gaps, presence of negative psychosocial factors, and/or individual approaches to learning. This article describes the experience of development and implementation of a multifaceted remediation program (MRP) in residents who failed the ABA basic test. INTERVENTION This is a retrospective analysis of four cases of residents who failed the ABA basic test between 2016 and 2017. The MRP is described. Pedagogical diagnosis, objectives, teaching strategies and assessment, and their constructive alignment are presented. Information regarding test performance is also presented. CONTEXT This study involves accredited anesthesiology residency program in USA. Outcomes: Four subjects (11% of program residents) failed the ABA basic test. Superficial approach to learning was observed in 100% of cases. The total possible number of participants was 4. The actual number of participants was 4, and the response rate was 100%. Four residents fell under 10th percentile on the first attempt, and 100% passed the test on the second attempt. There was 38% improvement in the number of failed keywords between the two attempts. LESSONS LEARNED Implementation of the MRP developed at our institution is successful to remediate anesthesiology residents who fail the ABA basic examination. We learned that the deep analysis of learning approaches, psychosocial factors, and medical knowledge gaps can be used to develop a remediation program based on the constructive alignment between objectives, curriculum, and assessment.
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Affiliation(s)
- Efrain Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA,
| | - Mary E Arthur
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA,
| | - Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA,
| | - Vikas Kumar
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA,
| | - Alexander Rocuts
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA,
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At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric. J Clin Anesth 2017; 42:88-92. [DOI: 10.1016/j.jclinane.2017.08.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/31/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022]
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With directed study before a 4-day operating room management course, trust in the content did not change progressively during the classroom time. J Clin Anesth 2017; 42:57-62. [DOI: 10.1016/j.jclinane.2017.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 01/07/2023]
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Cole DC, Giordano CR, Vasilopoulos T, Fahy BG. Resident Physicians Improve Nontechnical Skills When on Operating Room Management and Leadership Rotation. Anesth Analg 2017; 124:300-307. [PMID: 27918336 DOI: 10.1213/ane.0000000000001687] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Anesthesiology residency primarily emphasizes the development of medical knowledge and technical skills. Yet, nontechnical skills (NTS) are also vital to successful clinical practice. Elements of NTS are communication, teamwork, situational awareness, and decision making. METHODS The first 10 consecutive senior residents who chose to participate in this 2-week elective rotation of operating room (OR) management and leadership training were enrolled in this study, which spanned from March 2013 to March 2015. Each resident served as the anesthesiology officer of the day (AOD) and was tasked with coordinating OR assignments, managing care for 2 to 4 ORs, and being on call for the trauma OR; all residents were supervised by an attending AOD. Leadership and NTS techniques were taught via a standardized curriculum consisting of leadership and team training articles, crisis management text, and daily debriefings. Resident self-ratings and attending AOD and charge nurse raters used the Anaesthetists' Non-Technical Skills (ANTS) scoring system, which involved task management, situational awareness, teamwork, and decision making. For each of the 10 residents in their third year of clinical anesthesiology training (CA-3) who participated in this elective rotation, there were 14 items that required feedback from resident self-assessment and OR raters, including the daily attending AOD and charge nurse. Results for each of the items on the questionnaire were compared between the beginning and the end of the rotation with the Wilcoxon signed-rank test for matched samples. Comparisons were run separately for attending AOD and charge nurse assessments and resident self-assessments. Scaled rankings were analyzed for the Kendall coefficient of concordance (ω) for rater agreement with associated χ and P value. RESULTS Common themes identified by the residents during debriefings were recurrence of challenging situations and the skills residents needed to instruct and manage clinical teams. For attending AOD and charge nurse assessments, resident performance of NTS improved from the beginning to the end of the rotation on 12 of the 14 NTS items (P < .05), whereas resident self-assessment improved on 3 NTS items (P < .05). Interrater reliability (across the charge nurse, resident, and AOD raters) ranged from ω = .36 to .61 at the beginning of the rotation and ω = .27 to .70 at the end of the rotation. CONCLUSIONS This rotation allowed for teaching and resident assessment to occur in a way that facilitated resident education in several of the skills required to meet specific milestones. Resident physicians are able to foster NTS and build a framework for clinical leadership when completing a 2-week senior elective as an OR manager.
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Affiliation(s)
- Devon C Cole
- From the Department of Anesthesiology, University of Florida, College of Medicine, Gainesville, Fla
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Muñoz Alameda LE, Macario A. Advances in operating room management. The role of operating room director. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2017; 64:121-124. [PMID: 28089320 DOI: 10.1016/j.redar.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Affiliation(s)
- L E Muñoz Alameda
- Servicio de Anestesiología, Reanimación y tratamiento del dolor, Hospital Universitario Fundación Jiménez Díaz-Quirón Salud, Madrid, España.
| | - A Macario
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, Estados Unidos
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Dexter F, Van Swol LM. Influence of Data and Formulas on Trust in Information from Journal Articles in an Operating Room Management Course. ACTA ACUST UNITED AC 2016; 6:329-34. [DOI: 10.1213/xaa.0000000000000298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Shi P, Dexter F, Epstein RH. Comparing Policies for Case Scheduling Within 1 Day of Surgery by Markov Chain Models. Anesth Analg 2016; 122:526-38. [DOI: 10.1213/ane.0000000000001074] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dexter F, Epstein RH. Associated Roles of Perioperative Medical Directors and Anesthesia. Anesth Analg 2015; 121:1469-78. [DOI: 10.1213/ane.0000000000001011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sakai T, Emerick TD, Patel RM. A retrospective review of required projects in systems-based practice in a single anesthesiology residency: a 10-year experience. J Clin Anesth 2015; 27:451-6. [DOI: 10.1016/j.jclinane.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/20/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022]
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Prahl A, Dexter F, Swol LV, Braun MT, Epstein RH. E-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task. Anesth Analg 2015; 121:669-677. [DOI: 10.1213/ane.0000000000000658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Epstein RH, Dexter F. Management Implications for the Perioperative Surgical Home Related to Inpatient Case Cancellations and Add-On Case Scheduling on the Day of Surgery. Anesth Analg 2015; 121:206-218. [DOI: 10.1213/ane.0000000000000789] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hastings RH, Rickard TC. Deliberate Practice for Achieving and Maintaining Expertise in Anesthesiology. Anesth Analg 2015; 120:449-59. [DOI: 10.1213/ane.0000000000000526] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Martinelli SM, McGraw KA, Kalbaugh CA, Vance S, Viera AJ, Zvara DA, Mayer DC. A Novel Core Competencies-Based Academic Medicine Curriculum: Description and Preliminary Results. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2014; 16:E076. [PMID: 27175398 PMCID: PMC4719544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Physicians practice health care in a rapidly changing system that requires more than the delivery of safe and effective care. Modern physicians must also acquire skills beyond direct patient care. Residency programs must, therefore, prepare physicians to meet these demands by providing appropriate education and training. METHODS We designed, implemented and assessed an academic medicine curriculum in the first post-graduate year. This curriculum provides comprehensive exposure to necessary non-patient contact related physician skills. Topics centered around four domains: critical appraisal of literature of literature, quality improvement, professional development, and teaching. Each of these domains is linked to the six core competencies established by the Accreditation Council for Graduate Medical Education's (ACGME). Instruction includes small-group learning sessions with additional time for self-directed online modules and a faculty-mentored quality improvement research project that is presented at a graduation symposium. All residents completed a survey evaluation of the curriculum before and after the course via open-ended questions and Likert responses (0-5). We assessed improvement in resident confidence with each curricular domain using mean Likert score change and 95% confidence intervals (CI). RESULTS Residents improved at all curricular domains measured. The most significant mean changes included confidence in: poster presentations (2.7; 95% CI: 1.9-3.5), plan-do-check-act cycle (2.5; 95% CI: 2.1-2.9), quality improvement projects (2.4; 95% CI: 1.9-2.9), and abstract presentation (2.3; 95% CI: 1.6-3.0). CONCLUSIONS We found that the academic medicine rotation (AMR) is feasible in a large academic setting. Furthermore, the AMR allows early exposure to and improvement in essential non-patient contact related physician skills required by the ACGME core competencies and assessed through the milestones.
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Affiliation(s)
- Susan M. Martinelli
- Assistant Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
| | - Kathleen A. McGraw
- Librarian, Health Sciences Library, University of North Carolina at Chapel Hill
| | - Corey A. Kalbaugh
- Doctoral Student, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Stephen Vance
- Medical Student, School of Medicine, University of North Carolina at Chapel Hill
| | - Anthony J. Viera
- Distinguished Associate Professor, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - David A. Zvara
- Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
| | - David C. Mayer
- Professor, Department of Anesthesiology, School of Medicine, University of North Carolina at Chapel Hill
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Dexter F, Wachtel RE. Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home. Anesth Analg 2014; 118:1062-71. [DOI: 10.1213/ane.0000000000000173] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dexter F, Maxbauer T, Stout C, Archbold L, Epstein RH. Relative Influence on Total Cancelled Operating Room Time from Patients Who Are Inpatients or Outpatients Preoperatively. Anesth Analg 2014; 118:1072-80. [DOI: 10.1213/ane.0000000000000118] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Difficulties and Challenges Associated with Literature Searches in Operating Room Management, Complete with Recommendations. Anesth Analg 2013; 117:1460-79. [DOI: 10.1213/ane.0b013e3182a6d33b] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Prahl A, Dexter F, Braun MT, Van Swol L. Review of Experimental Studies in Social Psychology of Small Groups When an Optimal Choice Exists and Application to Operating Room Management Decision-Making. Anesth Analg 2013; 117:1221-9. [DOI: 10.1213/ane.0b013e3182a0eed1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Epstein RH, Dexter F. Rescheduling of Previously Cancelled Surgical Cases Does Not Increase Variability in Operating Room Workload When Cases Are Scheduled Based on Maximizing Efficiency of Use of Operating Room Time. Anesth Analg 2013; 117:995-1002. [DOI: 10.1213/ane.0b013e3182a0d9f6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tiwari V, Dexter F, Rothman BS, Ehrenfeld JM, Epstein RH. Explanation for the Near-Constant Mean Time Remaining in Surgical Cases Exceeding Their Estimated Duration, Necessary for Appropriate Display on Electronic White Boards. Anesth Analg 2013; 117:487-93. [DOI: 10.1213/ane.0b013e31829772e9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wang J, Dexter F, Yang K. A Behavioral Study of Daily Mean Turnover Times and First Case of the Day Start Tardiness. Anesth Analg 2013; 116:1333-41. [DOI: 10.1213/ane.0b013e3182841226] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dexter F. Case Scenario Consistent with Lack of Knowledge and Psychological Bias. Anesthesiology 2013; 118:990-1. [DOI: 10.1097/aln.0b013e318286078d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lack of Value of Scheduling Processes to Move Cases from a Heavily Used Main Campus to Other Facilities Within a Health Care System. Anesth Analg 2012; 115:395-401. [DOI: 10.1213/ane.0b013e3182575e05] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bayman EO, Dexter F, Laur JJ, Wachtel RE. National incidence of use of monitored anesthesia care. Anesth Analg 2011; 113:165-9. [PMID: 21596866 DOI: 10.1213/ane.0b013e31821c3e8e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Sedation or monitored anesthesia care (MAC), alone or after peripheral regional nerve block, is currently administered by anesthesiologists and/or certified registered nurse anesthetists. Some of this care may be at risk for substitution by other providers or by reductions in reimbursement. METHODS Data from the 2006 United States of America National Survey of Ambulatory Surgery were analyzed to determine national rates for the percentage of total ambulatory anesthesia operating room (OR) time that was either (1) sedation and/or MAC, or (2) peripheral regional nerve block with/without sedation or MAC. RESULTS MAC cases alone comprised 29%± 2% of OR time with an anesthesiologist and/or certified registered nurse anesthetist. MAC and/or peripheral block comprised 34% ± 2% of OR time. Percentages by cases were larger than by OR time (P < 0.0001). Among cases with anesthesia, 42% ± 3% were MAC and 47% ± 2% were MAC with/without peripheral block. Percentages of American Society of Anesthesiologists' Relative Value Guide units for MAC would be intermediate between the 29% and 42%, and for MAC and/or peripheral block between the 34% and 47%. CONCLUSIONS MAC alone or after peripheral nerve block accounts for a relatively high percentage of ambulatory anesthetics nationwide.
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Affiliation(s)
- Emine O Bayman
- Department of Anesthesia, University of Iowa, Anesthesia 6JCP, Iowa City, Iowa 52242, USA
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Dexter F, Wachtel RE, Epstein RH. Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data. BMC Med Inform Decis Mak 2011; 11:2. [PMID: 21214905 PMCID: PMC3031196 DOI: 10.1186/1472-6947-11-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 01/07/2011] [Indexed: 11/29/2022] Open
Abstract
Background No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. Methods A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Results Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments. Conclusions Our technical advance is the development and use of automated event-based knowledge elicitation to identify suboptimal OR management decisions that decrease the efficiency of use of OR time. The adapted scenarios can be used in future decision-making.
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Affiliation(s)
- Franklin Dexter
- Department of Anesthesia, University of Iowa, Iowa City, 52242, USA.
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