Investigating Intraoperative and Intraprofessional Handoffs in Anesthesia

2018 ◽  
Vol 62 (1) ◽  
pp. 469-473
Author(s):  
Katherina Jurewicz ◽  
Myrtede Alfred ◽  
David M. Neyens ◽  
Ken Catchpole ◽  
Anjali Joseph ◽  
...  
Keyword(s):  
International Organizations ◽  
Medical Errors ◽  
Maintenance Phase ◽  
Healthcare Systems ◽  
Surgical Team ◽  
High Quality ◽  
Effective Strategies ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Contextual Elements

Handoffs occur frequently in healthcare systems, and miscommunications and critical omissions within handoffs have been linked to serious medical errors. Handoff quality is a priority of patient safety initiatives across several international organizations. The majority of previous research in handoffs have focused on postoperative handoffs; yet, there is a need to specifically investigate intraoperative handoffs, especially within individual professions or subspecialties. Each subspecialty within a surgical team may approach handoffs differently. The anesthesia team is especially unique as they take a team-based approach to patient care where multiple anesthesia providers may be involved in one surgical case. We describe an observational study of intraoperative and intraprofessional handoffs in anesthesia. Temporary and permanent handoffs were investigated as well as the contextual elements that influenced handoff procedures. In a sample of 35 video recorded surgeries, a total of 16 handoffs were identified for the maintenance phase of surgery. These handoffs ranged between 33 seconds and 7.42 minutes in duration. Our study revealed variability in intraoperative handoffs during the maintenance phase of anesthesia and emphasizes that intraoperative and intraprofessional handoffs warrant more in-depth examination in order to develop effective strategies or tools for high quality handoffs in anesthesia.

scholarly journals Variability in Anesthesia Models of Care in Cardiac Surgery

Surgeries ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 1-8
Author(s):  
Dianne McCallister ◽  
Bethany Malone ◽  
Jennifer Hanna ◽  
Michael S. Firstenberg
Keyword(s):  
Cardiac Surgery ◽  
Best Practices ◽  
Operating Room ◽  
Models Of Care ◽  
Surgical Team ◽  
Cardiac Anesthesia ◽  
Complex Environment ◽  
Surgical Case ◽  
Cardiac Procedures ◽  
Cardiac Operations

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.

scholarly journals COVID-19: Spatial Analysis of Hospital Case-Fatality Rate in France

2020 ◽  
Author(s):  
Marc SOURIS ◽  
Jean-Paul Gonzalez
Keyword(s):  
International Organizations ◽  
Rate Ratio ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Healthcare Systems ◽  
Fatality Rate ◽  
Average Case ◽  
Hospital Case ◽  
Reporting Systems ◽  
Overall Efficiency

When the population risk factors and reporting systems are similar, the assessment of the case-fatality (or lethality) rate (ratio of cases to deaths) represents a perfect tool for analyzing, understanding and improving the overall efficiency of the health system. The objective of this article is to estimate the influence of the hospital care system on lethality in metropolitan France during the inception of the COVID-19 epidemic, by analyzing the spatial variability of the hospital case-fatality rate between French districts (i.e. French departements). The results show that the higher case-fatality rates observed by districts are mostly related to the level of morbidity, therefore to the overwhelming of the healthcare systems during the acute phases of the epidemic. However, the magnitude of this increase of case-fatality rate represents less than 10 per cent of the average case-fatality rate and cannot explain the magnitude of the variations in case-fatality rate reported per country by international organizations or information sites. These differences can only be explained by the systems for reporting cases and deaths, which, indeed, vary greatly from country to country, and not attributed to the care or treatment of patients, even during hospital stress due to epidemic peaks.

scholarly journals Impact of the COVID-19 Pandemic on Student and Resident Teaching and Training in Surgical Oncology

2020 ◽  
Vol 9 (11) ◽  
pp. 3431
Author(s):  
Hans-Michael Hau ◽  
Jürgen Weitz ◽  
Ulrich Bork
Keyword(s):  
Medical Education ◽  
Surgical Training ◽  
Surgical Education ◽  
Surgical Oncology ◽  
Healthcare Systems ◽  
Skills Development ◽  
High Quality ◽  
The Face ◽  
And Training

The COVID-19 pandemic has tremendously changed private and professional interactions and behaviors worldwide. The effects of this pandemic and the actions taken have changed our healthcare systems, which consequently has affected medical education and surgical training. In the face of constant disruptions of surgical education and training during this pandemic outbreak, structured and innovative concepts and adapted educational curricula are important to ensure a high quality of medical treatment. While efforts were undertaken to prevent viral spreading, it is important to analyze and assess the effects of this crisis on medical education, surgical training and teaching at large and certainly in the field of surgical oncology. Against this background, in this paper we introduce practical and creative recommendations for the continuity of students’ and residents’ medical and surgical training and teaching. This includes virtual educational curricula, skills development classes, video-based feedback and simulation in the specialty field of surgical oncology. In conclusion, the effects of COVID 19 on Surgical Training and Teaching, certainly in the field of Surgical Oncology, are challenging.

scholarly journals Forging clinical collaborations and cooperation in overcoming challenges for non–COVID-19 patients during COVID-19 times: Surgical case studies requiring a multidisciplinary and inter-agency approach in Malaysia

2021 ◽  
pp. 201010582110555
Author(s):  
Muhammad 'Abid Amir ◽  
M Juffri Samsuddin ◽  
Shah Jumaat Md Yusoff ◽  
Saufee Ismail ◽  
Juliana Abd Latiff
Keyword(s):  
Global Health ◽  
Case Studies ◽  
Healthcare Systems ◽  
Public Hospitals ◽  
Healthcare Resources ◽  
Private Partnership ◽  
Surgical Case ◽  
National Healthcare ◽  
Patient Admissions ◽  
Global Pandemic

The COVID-19 pandemic has brought global health services to a standstill. National healthcare systems and medical staffing in many countries have reached crisis levels due to the phenomenal outbreak. Healthcare resources have been strained to meet the unprecedented numbers of patient admissions with a significant amount of funding and manpower being channelled towards tackling this global pandemic. Despite the rollout of vaccinations, the development of new viral strains has now presented a new challenge. With the inevitable conversion of tertiary public hospitals to specialized COVID-19 centres with ‘Full Covid Status’ and the mobilization of its doctors from all specialities to care for these patients, the non–COVID-19 patients are becoming more neglected. The lack of elective surgeries performed and non-emergent admissions due to the unavailability of beds and personnel to care for this group of patients are concerning. As most of the focus and resources are now aimed at COVID-19 patients, the need to forge collaborations and cooperation between hospitals, agencies and healthcare systems are pertinent to ensure the provision of quality treatment for those suffering from non–COVID-19 diseases. To highlight this effort in Malaysia, we would like to present 2 case studies of non–COVID-19 patients undergoing elective surgeries through intergovernmental ministerial collaborations and a public–private partnership.

scholarly journals THE PRINCIPLES OF USING SPECIFIC TREATMENT PROTOCOLS IN THE DAILY PRACTICE OF AN ENDODONTIST

2020 ◽  
Vol 1 (28(55)) ◽  
pp. 31-32
Author(s):  
A.E. Bratus ◽  
S.V. Kuznecov
Keyword(s):  
Medical Errors ◽  
Dental Care ◽  
Specific Treatment ◽  
Daily Practice ◽  
Dental Practice ◽  
Multilevel System ◽  
High Quality ◽  
Treatment Protocols ◽  
Effective Diagnosis

The main goals in dental practice are the high quality of the work, reductionof the risk of medical errors and effective diagnosis and treatment of oral tissues diseases; the whole multilevel system of medical care is willing to increase these indicators. Therefore, it is important to find ways to improve and maintain the dental care for the population [1]. One of these ways is the implementation of dental care standards. These standards are developed by the Dental Association of Russia and updated in 2018. There are specific algorithms and clinical recommendations for the treatment of patients with pulp and periapical tissue diseases

scholarly journals Software Test Suite Minimization using Ant Colony Optimization

2019 ◽  
Vol 8 (9S) ◽  
pp. 948-952
Keyword(s):  
Ant Colony Optimization ◽  
Software Maintenance ◽  
Software Industry ◽  
Optimal Solution ◽  
Maintenance Phase ◽  
Regression Testing ◽  
Ant Colony ◽  
Test Suite ◽  
High Quality ◽  
Area Of Interest

In the fast pacing technological era, the key to a successful software industry is quick delivery of high quality software to the clients. This high quality is achieved by performing software testing on the product. The high quality product ensures stakeholder’s satisfaction which in turn spreads good word about the software industry making it a success. In this paper, we will focus on the problems faced during regression testing and how the same can be handled. Regression testing is a critical activity done during the software maintenance phase of the software development cycle. However, it has countless underlying issues like effective test case generation and prioritization, etc which need to be dealt with. These issues demand effort, time and cost of the testing. Different techniques and methodologies have been proposed for taking care of these issues. Use of Ant Colony Optimization (ACO) for test suite minimization has been an area of interest for many researchers. This paper presents an implementation of ACO for test suite minimization, showcasing how arbitrary nature of ACO helps choose an optimal solution to the problem.

scholarly journals A Novel Approach to Objective Validation of YouTube™ Educational Videos for the Instruction of Regional Anesthesia Nerve Blocks

2020 ◽  
Author(s):  
George Tewfik ◽  
Adam Work ◽  
Steven Shulman ◽  
Patrick Discepola
Keyword(s):  
Regional Anesthesia ◽  
Educational Quality ◽  
Educational Tool ◽  
High Quality ◽  
Nerve Blocks ◽  
Objective Standard ◽  
Novel Approach ◽  
Anesthesia Providers ◽  
Educational Sources

Abstract Background YouTube™ (“YouTube”) is often used as an educational tool to instruct anesthesia providers on regional anesthesia nerve blocks. However, there is no current objective standard to assess the educational quality of these user-uploaded videos. A new approach was used to objectively validate these videos by comparing them to high quality educational sources for the seven most commonly used nerve blocks. Objective We sought to evaluate the educational quality of user-uploaded videos when compared to the highest quality anesthesia society websites (NYSORA, ACEP, USRA) Methods We first catalogued the characteristics of the instructional material on three of the highest quality anesthesia society websites (NYSORA, ACEP, USRA) into 18 different items. Next, we surveyed the five most popular anesthesia block videos on YouTube for each of the seven peripheral nerve blocks in question. The presence or absence of each category was recorded. Results Although there were varying degrees of correlation between the high quality sources and the videos, rarely did YouTube videos contain as high a percentage of these educational characteristics as the well-established sources. Some videos contained very few of these important educational characteristics. Conclusion Although YouTube has been used an educational tool, we recommend that only high quality sources be used to teach or illustrate regional anesthesia nerve blocks.

scholarly journals Perceptions of a Surgical Team About the Ethical and Legal Responsibilities of Forgetting Foreign Bodies in Patient Bodies and Other Errors

2021 ◽  
Author(s):  
Díaz-Pérez Anderson ◽  
Zilena Ardila González ◽  
Moraima Del Toro ◽  
Elkin Navarro Quiroz
Keyword(s):  
Content Analysis ◽  
Medical Errors ◽  
Foreign Bodies ◽  
Surgical Patients ◽  
Surgical Team ◽  
Human Errors ◽  
Legal Problems ◽  
Patients At Risk ◽  
Qualitative Descriptive ◽  
Legal Responsibilities

Abstract Background: Retained surgical items (RSIs) represent a real and ongoing problem, but it is preventable. Its real incidence is unknown because of underreporting resulting from the fear of lawsuits for medical errors. This study aimed to describe the perception of the members of a surgical team about their ethical and legal responsibilities related to medical errors, specifically concerning the presence of RSIs. Methods: This qualitative, descriptive, and interpretative study focused on the perceptions of the members of a surgical team on the ethical and legal problems they may face because of the presence of RSIs. Continuous saturation sampling was performed by interviewing 17 professional members of the surgical team. Atlas Ti 8.0® program was used for analyzing the data obtained. It traced the categories by means of content analysis of the perceptions and practices during possible ethical and legal responsibilities because of medical errors. Results: The interviewees were conflicted between complicity and justice, as it is a duty to report events or actions that put the lives of surgical patients at risk.Conclusions: The lack of awareness about the rules and believing that human errors are inevitable lead to normalizing errors, which does not allow professionals to face the risk and, therefore, to avoid it.

Successful Management of Massive Air Embolism During Cardiopulmonary Bypass Using Multimodal Neuroprotection Strategies

2018 ◽  
Vol 23 (3) ◽  
pp. 324-332 ◽  
Author(s):  
Olga L. Quintero ◽  
Juan C. Giraldo ◽  
Néstor F. Sandoval
Keyword(s):  
Cardiopulmonary Bypass ◽  
Near Infrared ◽  
Air Embolism ◽  
Cost Effective ◽  
Surgical Team ◽  
Cerebral Air Embolism ◽  
Effective Strategies ◽  
Management Protocol ◽  
Intraoperative Management ◽  
The Impact

Complications and critical events during cardiopulmonary bypass (CPB) are very challenging, difficult to manage, and in some instances have the potential to lead to fatal outcomes. Massive cerebral air embolism is undoubtedly a feared complication during CPB. If not diagnosed and managed early, its effects are devastating and even fatal. It is a catastrophic complication and its early diagnosis and intraoperative management are still controversial. This is why the decision-making process during a massive cerebral air embolism represents a challenge for the entire surgical, anesthetic, and perfusion team. All caregivers involved in this event must synchronize their responses quickly, harmoniously, and in such a way that all interventions lead to minimizing the impact of this complication. Its occurrence leaves important lessons to the surgical team that faces it. The best management strategy for a complication of this type is prevention. Nevertheless, a surgical team may ultimately be confronted with such an occurrence at some point despite all the prevention strategies, as was the case with our patient. That is why, in each institution, no effort should be spared to establish cost-effective strategies for early detection and a clear and concise management protocol to guide actions once this complication is detected. It is the duty of each surgical team to determine and clearly organize which strategies will be followed. The purpose of this case study was to demonstrate that a massive air embolism can be rapidly detected using near-infrared spectroscopy monitoring and can be successfully corrected with a multimodal neuroprotection strategy.

scholarly journals An Ophthalmology Resident-Led Quality Improvement Initiative to Decrease the Incidence of Perioperative Corneal Injury

2019 ◽  
Vol 11 (02) ◽  
pp. e49-e53
Author(s):  
Amanda L. Ely ◽  
Mark Goerlitz-Jessen ◽  
Ingrid U. Scott ◽  
Erik Lehman ◽  
Tabassum Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Quality Improvement ◽  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Corneal Injury ◽  
Surgical Case ◽  
Anesthesia Providers ◽  
Academic Medical

Abstract Objective This article evaluates the effectiveness of an ophthalmology resident-led quality improvement (QI) initiative to decrease the incidence of perioperative corneal injury at an academic medical center Design Retrospective chart review. Methods A retrospective chart review was conducted of all surgical cases performed 6 months prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative at an academic medical center. The QI initiative (which focused on perioperative corneal injury awareness, understanding of risk factors, and presentation of an algorithm designed to prevent perioperative corneal injury) consisted of a lecture and distribution of educational materials to anesthesia providers. Data collected through the chart review included type of surgical case, presence of diabetes mellitus or thyroid disease, patient age and gender, patient positioning (supine, prone, or lateral), level of anesthesia provider training, length of surgical case, surgical service, type of anesthesia, and type (if any) of perioperative eye injury. The rates of perioperative corneal injury pre- versus post-initiative were compared. Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9 per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180 vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23), nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under the general surgery service (OR general surgery service vs. other subspecialty services = 6.50, 95% CI 2.39–24.76). Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers was associated with a significant decrease in the rate of perioperative corneal injury.

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