An Examination of Collaborative Practice in Anesthesia Care Team Settings and Occupational Sress in Nurse Anesthetists

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.

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Patients and anesthesia care team members differ in their assessment of the value of a preoperative phone contact

Anesthesiology ◽

10.1097/00000542-199809010-00029 ◽

1998 ◽

Vol 89 (Supplement) ◽

pp. 29A ◽

Cited By ~ 2

Author(s):

Robert S. Weller ◽

Phillip E. Scuderi

Keyword(s):

Care Team ◽

Anesthesia Care ◽

Team Members ◽

Phone Contact

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What is an Ideal of Anesthesia Care Team? : Learning in Medical and Nursing Education of Foreign Countries

THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA ◽

10.2199/jjsca.36.198 ◽

2016 ◽

Vol 36 (2) ◽

pp. 198-203

Author(s):

Mai TAKI

Keyword(s):

Nursing Education ◽

Team Learning ◽

Care Team ◽

Anesthesia Care ◽

Foreign Countries

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Intraoperative Pacemaker Rate Changes Associated with the Rest Mode

Anesthesiology ◽

10.1097/aln.0b013e31818db8a6 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1137-1139 ◽

Cited By ~ 3

Author(s):

Scott C. Streckenbach

Keyword(s):

Cardiac Rhythm ◽

Perioperative Management ◽

Care Team ◽

Anesthesia Care ◽

The Status ◽

Dependent Patient

Anesthesiologists frequently are required to provide perioperative management for patients with cardiac rhythm management devices. Here, I describe a case in which, despite efforts to ensure that the anesthesia care team understood the pacemaker and its settings, unanticipated pacing events occurred that created confusion about the status of the pacemaker in a pacemaker-dependent patient. The confusion was created by a relatively new function found in many current pacemakers, a rest mode.

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Curare: from laboratory to law court

Clinical & Investigative Medicine ◽

10.25011/cim.v41i2.31419 ◽

2018 ◽

Vol 41 ◽

pp. 17-20

Author(s):

David R Bevan

Keyword(s):

Neuromuscular Blockade ◽

Mount Sinai Hospital ◽

Care Team ◽

Anesthesia Care ◽

Health Network ◽

Seminal Work ◽

University Of Toronto ◽

Mcgill University ◽

The University ◽

Team Concept

Dr. David Bevan held the Wesley-Bourne Chair of Anesthesia at McGill University, Chair of Anesthesia at UBC, Anesthetist-in-Chief at the University Health Network/Mount Sinai Hospital and subsequently Chair of the Department of Anesthesia at University of Toronto until his retirement in 2006. Dr. Bevan’s research contributions included seminal work in neuromuscular blockade and this work, in addition to his expertise as a reviewer, led to several editorial appointments, including Editor-in-Chief for CIM (2003–2010). Dr. Bevan played a role in the introduction of the Anesthesia Care Team concept in Ontario. He published widely and was awarded multiple international pro-fessional honors.

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Anesthetic Considerations and Perioperative Management of Spinal Cord Stimulators: Literature Review and Initial Recommendations

January 2018 - Pain Physician ◽

10.36076/ppj.2017.329 ◽

2017 ◽

Vol 4 (20;4) ◽

pp. 319-329 ◽

Cited By ~ 9

Author(s):

Michael E. Harned

Keyword(s):

Spinal Cord ◽

Perioperative Management ◽

Care Team ◽

Cochrane Library ◽

Anesthesia Care ◽

Spinal Cord Stimulator ◽

Cardiac Devices ◽

Anesthetic Considerations ◽

Monopolar Electrocautery ◽

Full Body

Background: Patients with implanted spinal cord stimulators (SCS) present to the anesthesia care team for management at many different points along the care continuum. Currently, the literature is sparse on the perioperative management. What is available is confusing; monopolar electrocautery is contraindicated but often used, full body magnetic resonance imaging (MRI) is safe with particular systems but with other manufactures only head and specific extremities exams are safe. Moreover, there are anesthetizing locations outside of the operating room where implanted SCS can interact with surrounding medical equipment and pose significant risk to patient and device. Objectives: The objective of this review is to present relevant known literature about the safe management of SCS in the perioperative period and to begin to develop recommendations. Study Design: A review of current literature and each manufacturers’ labeling was performed to assess risk of interference and patient harm between SCS and technology used in and around typical anesthetizing locations. Methods: A systematic search of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A computerized search was conducted for English articles in print up to April 2016 via PubMed www.ncbi.nlm.nih.gov/pubmed; EMBASE www.embase. com; and Cochrane Library www.thecochranelibrary.com. Search terms included “spinal cord stimulator AND MRI,” “spinal cord stimulator AND ECG,” “spinal cord stimulator AND implanted cardiac device,” “spinal cord stimulator AND electrocautery,” and “spinal cord stimulator AND obstetrics.” In addition, a search of Google and Google Scholar was performed. Websites of SCS manufactures were reviewed. Results: Generalized recommendations include turning the amplitude of the SCS to the lowest possible setting and turning off prior to any procedure. Monopolar electrocautery is contraindicated but is still often utilized; placing grounding pads as far away from the device can reduce the risk to device and patient. Bipolar cautery is favored. Implanted cardiac devices can interfere with SCS, but risks can be minimized. Neuraxial anesthesia can be attempted in a patient with implanted SCS, provided the device is not in the expected path. MRI labeling differences present the biggest difference among SCS manufactures. Medtronic’s SureScan SCS, Boston Scientific’s Precision system, St. Jude’s Proclaim, and Stimwave’s Freedome SCS are full body MRI compatible under specific conditions, while other manufacturers have labeling that restricts exams of the trunk and certain extremities. Limitations: This review was intended to be a comprehensive, cumulative review of recommendations for perioperative SCS management; however, the limitations of a review of this nature is the complete reliance on previously published research and the availability of these studies using the methods outlined. Conclusions: SCS is being used earlier in the treatment algorithm for patients with chronic pain. The anesthesia care team needs working knowledge of where the device resides in the neuraxial space and what risks different medical technologies pose to the patient and device. This understanding will lead to appropriate perioperative management which can reduce risk and improve patient outcomes. Key words: Spinal cord stimulation, perioperative management, MRI, anesthetic considerations, CT scan, interventional pain management

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Intraoperative Transitions of Anesthesia Care and Postoperative Adverse Outcomes

Anesthesiology ◽

10.1097/aln.0000000000000401 ◽

2014 ◽

Vol 121 (4) ◽

pp. 695-706 ◽

Cited By ~ 53

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.

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Nurse Anesthetists' Perspectives on Improving the Anesthesia Care of Culturally Diverse Patients

Journal of Transcultural Nursing ◽

10.1177/104365969800900205 ◽

1998 ◽

Vol 9 (2) ◽

pp. 26-33 ◽

Cited By ~ 1

Author(s):

Betty J. Horton

Keyword(s):

Culturally Diverse ◽

Nurse Anesthetists ◽

Anesthesia Care

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

PLoS ONE ◽

10.1371/journal.pone.0250122 ◽

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.

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