scholarly journals Anesthesia Care Team Composition and Surgical Outcomes

2018 ◽  
Vol 129 (4) ◽  
pp. 700-709 ◽  
Author(s):  
Eric C. Sun ◽  
Thomas R. Miller ◽  
Jasmin Moshfegh ◽  
Laurence C. Baker
Keyword(s):  
Length Of Stay ◽  
The United States ◽  
Nurse Anesthetists ◽  
Care Team ◽  
Perioperative Outcomes ◽  
Anesthesia Care ◽  
Team Composition ◽  
Nurse Anesthetist ◽  
Medical Spending ◽  
Publicly Insured

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes. Methods A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding. Results The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70). Conclusions The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.

scholarly journals Intraoperative Transitions of Anesthesia Care and Postoperative Adverse Outcomes

2014 ◽  
Vol 121 (4) ◽  
pp. 695-706 ◽  
Author(s):  
Leif Saager ◽  
Brian D. Hesler ◽  
Jing You ◽  
Alparslan Turan ◽  
Edward J. Mascha ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Odds Ratio ◽  
Care Transitions ◽  
Cleveland Clinic ◽  
Nurse Anesthetists ◽  
Adverse Outcomes ◽  
Anesthesia Care ◽  
Nurse Anesthetist ◽  
Intraoperative Care ◽  
Anesthesia Providers

Abstract Background: Transfers of patient care and responsibility among caregivers, “handovers,” are common. Whether handovers worsen patient outcome remains unclear. The authors tested the hypothesis that intraoperative care transitions among anesthesia providers are associated with postoperative complications. Methods: From the records of 138,932 adult Cleveland Clinic (Cleveland, Ohio) surgical patients, the authors assessed the association between total number of anesthesia handovers during a case and an adjusted collapsed composite of in-hospital mortality and major morbidities using multivariable logistic regression. Results: Anesthesia care transitions were significantly associated with higher odds of experiencing any major in-hospital mortality/morbidity (incidence of 8.8, 11.6, 14.2, 17.0, and 21.2% for patients with 0, 1, 2, 3, and ≥4 transitions; odds ratio 1.08 [95% CI, 1.05 to 1.10] for an increase of 1 transition category, P < 0.001). Care transitions among attending anesthesiologists and residents or nurse anesthetists were similarly associated with harm (odds ratio 1.07 [98.3% CI, 1.03 to 1.12] for attending [incidence of 9.4, 13.9, 17.4, and 21.5% for patients with 0, 1, 2, and ≥3 transitions] and 1.07 [1.04 to 1.11] for residents or nurses [incidence of 9.4, 13.0, 15.4, and 21.2% for patients with 0, 1, 2, and ≥3 transitions], both P < 0.001). There was no difference between matched resident only (8.5%) and nurse anesthetist only (8.8%) cases on the collapsed composite outcome (odds ratio, 1.00 [98.3%, 0.93 to 1.07]; P = 0.92). Conclusion: Intraoperative anesthesia care transitions are strongly associated with worse outcomes, with a similar effect size for attendings, residents, and nurse anesthetists.

scholarly journals Nurse anesthetists’ experiences using smart glasses to monitor patients’ vital signs during anesthesia care: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250122
Author(s):  
Charlotte Romare ◽  
Per Enlöf ◽  
Peter Anderberg ◽  
Pether Jildenstål ◽  
Johan Sanmartin Berglund ◽  
...  
Keyword(s):  
Continuous Monitoring ◽  
Vital Signs ◽  
Nurse Anesthetists ◽  
Anesthesia Care ◽  
Nurse Anesthetist ◽  
Structured Interviews ◽  
Smart Glasses ◽  
Great Responsibility ◽  
Safe Anesthesia ◽  
Clinical Anesthesia

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.

scholarly journals National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Akshay Pendyal ◽  
Craig Rothenberg ◽  
Jean E. Scofi ◽  
Harlan M. Krumholz ◽  
Basmah Safdar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Emergency Department ◽  
Length Of Stay ◽  
Real World ◽  
The United States ◽  
Emergency Department Care ◽  
Care Processes ◽  
Ed Visits

Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real‐world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11‐year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST‐segment–elevation myocardial infarction (STEMI) and non‐STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence‐based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same‐hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%–31% and 10%–27%, respectively). Conclusions National, real‐world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high‐intensity antiplatelet therapy, early invasive strategies, and regionalization of care.

scholarly journals Early Outcomes After Surgical Management of Geriatric Patella Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932098769
Author(s):  
Jaclyn Kapilow ◽  
Junho Ahn ◽  
Kathryn Gallaway ◽  
Megan Sorich
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Geriatric Patients ◽  
The United States ◽  
Unplanned Readmission ◽  
Patella Fracture ◽  
Factors Associated ◽  
Prolonged Hospitalization ◽  
Patella Fractures

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

An update on the epidemiology, length of stay, and cost of Kawasaki disease hospitalisation in the United States

2019 ◽  
Vol 29 (06) ◽  
pp. 828-832 ◽  
Author(s):  
Laxmi V. Ghimire ◽  
Fu-Sheng Chou ◽  
Narayan B. Mahotra ◽  
Sharan P. Sharma
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Length Of Stay ◽  
Coronary Artery Aneurysm ◽  
Artery Aneurysm ◽  
Developed Countries ◽  
The United States ◽  
Hospital Charge ◽  
Acquired Heart Disease ◽  
The Developed Countries

AbstractBackground:Kawasaki disease is an acute vasculitis of childhood and is the leading cause of acquired heart disease in the developed countries.Methods:Data from hospital discharge records were obtained from the National Kids Inpatient Database for years 2009 and 2012. Hospitalisations by months, hospital regions, timing of admission, insurance types, and ethnicity were analysed. Length of stay and total charges were also analysed.Results:There were 10,486 cases of Kawasaki disease from 12,678,005 children hospitalisation. Kawasaki disease was more common between 0 and 5 years old, in male, and in Asian. The January–March quarter had the highest rate compared to the lowest in the July–September quarter (OR=1.62, p < 0.001). Admissions on the weekend had longer length of stay [4.1 days (95 % CI: 3.97–4.31)] as compared to admissions on a weekday [3.72 days (95 % CI: 3.64–3.80), p < 0.001]. Blacks had the longest length of stay and whites had the shortest [4.33 days (95 % CI: 4.12–4.54 days) versus 3.60 days (95 % CI: 3.48–3.72 days), p < 0.001]. Coronary artery aneurysm was identified in 2.7 % of all patients with Kawasaki disease. Children with coronary artery aneurysm were hospitalised longer and had higher hospital charge. Age, admission during weekend, and the presence of coronary artery aneurysm had significant effect on the length of stay.Conclusions:This report provides the most updated epidemiological information on Kawasaki disease hospitalisation. Age, admissions during weekend, and the presence of coronary artery aneurysm are significant contributors to the length of stay.

Standardizing Robotic Lobectomy

2017 ◽  
Vol 12 (2) ◽  
pp. 77-81 ◽  
Author(s):  
John F. Lazar ◽  
Laurence N. Spier ◽  
Alan R. Hartman ◽  
Richard S. Lazzaro
Keyword(s):  
Lung Cancer ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Meta Analysis ◽  
Stage I ◽  
Clinical Staging ◽  
Perioperative Outcomes ◽  
Vats Lobectomy ◽  
End Points ◽  
Nodal Upstaging

Objective Single-surgeon cohorts assessing robotically assisted video-assisted thoracic (RA-VATS) lobectomy have reported good outcomes, but there are little data regarding multiple surgeons applying a standard technique in separate hospitals. The purpose of this study was to show how a standardized robotic technique is both safe and reproducible between surgeons and institutions. Methods From July 1, 2012, to October 1, 2013, patients undergoing RA-VATS lobectomy for both benign and malignant disease were identified from a prospectively collected database of two thoracic surgeons from different hospitals within the same healthcare system and retrospectively analyzed. Each surgeon employed an identical “rule of 10” completely port-based approach through all 128 cases. The primary end points of the study were in-hospital and 30-day mortality. Secondary end points were differences in morbidity and perioperative outcomes between the two surgeons based on their “rule of 10” technique. Results A total of 128 cases were performed with 121 lobectomies, 3 bilobectomies, and 4 pneumonectomies for both malignant and benign disease. Each surgeon had 64 cases without a single in-hospital or 30-day mortality. Overall morbidity was 16.4%. Each surgeon had one readmission and take back to operating room (a washout and a mechanical pleurodesis). The most common complication was prolonged air leak (38.1%, 8/21 patients). There was no statistical difference in length of stay, complications, severity of illness, and clinical staging between the two surgeons. There was a significant difference in resected lymph nodes (11.79 vs 14.45, P = 0.0086). Compared with published national meta-analysis on RA-VAT lobectomies, there was a significantly reduced length of stay (4.2 vs 6 days, P = 0.0436) and bleeding (0.8 vs 1.8%, P = 0.0003). Nodal upstaging from cN0 to pN1 was 8% and cN0 to pN2 was 2% for an overall nodal upstaging of 10% for stage I nonsmall cell lung cancer. Conclusions By standardizing how a robotic lobectomy is performed, we were able to show that RA-VATS lobectomy is safe and may allow for the expansion of minimally invasive lobectomy to surgeons who otherwise have failed to adopt traditional VATS. When compared with the most recent national meta-analysis, we had reduced morbidity, mortality, bleeding, and length of stay. Robotic nodal upstaging for stage I nonsmall lung cancer was consistent with larger multicenter study. We hope that these results will help lead to the standardization robotic lobectomy and a larger multisurgeon/institutional study that could pave the way for greater adoption of minimally invasive lobectomy.

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