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  • 1
    Online Resource
    Online Resource
    Disruptive Education
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Anesthesiology Vol. 125, No. 2 ( 2016-08-01), p. 266-268
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 125, No. 2 ( 2016-08-01), p. 266-268
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000000978
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2016092-6
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  • 2
    Online Resource
    Online Resource
    Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesiology Vol. 127, No. 2 ( 2017-08-01), p. 250-271
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. 2 ( 2017-08-01), p. 250-271
    Abstract: Perioperative mortality rate is regarded as a credible quality and safety indicator of perioperative care, but its documentation in low- and middle-income countries is poor. We developed and tested an electronic, provider report–driven method in an East African country. Methods We deployed a data collection tool in a Kenyan tertiary referral hospital that collects case-specific perioperative data, with asynchronous automatic transmission to central servers. Cases not captured by the tool (nonobserved) were collected manually for the last two quarters of the data collection period. We created logistic regression models to analyze the impact of procedure type on mortality. Results Between January 2014 and September 2015, 8,419 cases out of 11,875 were captured. Quarterly data capture rates ranged from 423 (26%) to 1,663 (93%) in the last quarter. There were 93 deaths (1.53%) reported at 7 days. Compared with four deaths (0.53%) in cesarean delivery, general surgery (n = 42 [3.65%]; odds ratio = 15.80 [95% CI, 5.20 to 48.10] ; P & lt; 0.001), neurosurgery (n = 19 [2.41%]; odds ratio = 14.08 [95% CI, 4.12 to 48.10] ; P & lt; 0.001), and emergency surgery (n = 25 [3.63%]; odds ratio = 4.40 [95% CI, 2.46 to 7.86] ; P & lt; 0.001) carried higher risks of mortality. The nonobserved group did not differ from electronically captured cases in 7-day mortality (n = 1 [0.23%] vs. n = 16 [0.58%] ; odds ratio =3.95 [95% CI, 0.41 to 38.20]; P = 0.24). Conclusions We created a simple solution for high-volume, prospective electronic collection of perioperative data in a lower- to middle-income setting. We successfully used the tool to collect a large repository of cases from a single center in Kenya and observed mortality rate differences between surgery types.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001713
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2016092-6
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  • 3
    Online Resource
    Online Resource
    Standard Setting for Clinical Performance of Basic Perioperative Transesophageal Echocardiography
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesiology Vol. 126, No. 4 ( 2017-04-01), p. 718-728
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 126, No. 4 ( 2017-04-01), p. 718-728
    Abstract: Credible methods for assessing competency in basic perioperative transesophageal echocardiography examinations have not been reported. The authors’ objective was to demonstrate the collection of real-world basic perioperative transesophageal examination performance data and establish passing scores for each component of the basic perioperative transesophageal examination, as well as a global passing score for clinical performance of the basic perioperative transesophageal examination using the Angoff method. Methods National Board of Echocardiography (Raleigh, North Carolina) advanced perioperative transesophageal echocardiography–certified anesthesiologists (n = 7) served as subject matter experts for two Angoff standard-setting sessions. The first session was held before data analysis, and the second session for calibration of passing scores was held 9 months later. The performance of 12 anesthesiology residents was assessed via the new passing score grading system. Results The first standard-setting procedure resulted in a global passing score of 63 ± 13% on a basic perioperative transesophageal examination. The global passing score from the second standard-setting session was 73 ± 9%. Three hundred seventy-one basic perioperative transesophageal examinations from 12 anesthesiology residents were included in the analysis and used to guide the second standard-setting session. All residents scored higher than the global passing score from both standard-setting sessions. Conclusions To the authors’ knowledge, this is the first demonstration that the collection of real-world anesthesia resident basic perioperative transesophageal examination clinical performance data is possible and that automated grading for competency assessment is feasible. The authors’ findings demonstrate at least minimal basic perioperative transesophageal examination clinical competency of the 12 residents.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001538
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2016092-6
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  • 4
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    A perioperative consult service results in reduction in cost and length of stay for colorectal surgical patients: evidence from a healthcare redesign project
    Springer Science and Business Media LLC ; 2016
    In:  Perioperative Medicine Vol. 5, No. 1 ( 2016-12)
    Details
    In: Perioperative Medicine, Springer Science and Business Media LLC, Vol. 5, No. 1 ( 2016-12)
    Type of Medium: Online Resource
    ISSN: 2047-0525
    URL: Article
    DOI: 10.1186/s13741-016-0028-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2016
    detail.hit.zdb_id: 2683800-X
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  • 5
    Online Resource
    Online Resource
    Automated Case Cancellation Review System Improves Systems-Based Practice
    Springer Science and Business Media LLC ; 2015
    In:  Journal of Medical Systems Vol. 39, No. 11 ( 2015-11)
    Details
    In: Journal of Medical Systems, Springer Science and Business Media LLC, Vol. 39, No. 11 ( 2015-11)
    Type of Medium: Online Resource
    ISSN: 0148-5598 , 1573-689X
    URL: Article
    DOI: 10.1007/s10916-015-0330-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 2017001-4
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  • 6
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    Online Resource
    Decision Support Tool Improves Real and Perceived Anesthesiology Resident Relief Equity
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Anesthesia & Analgesia Vol. 127, No. 2 ( 2018-08), p. 513-519
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 127, No. 2 ( 2018-08), p. 513-519
    Abstract: The Accreditation Council of Graduate Medical Education requires monitoring of resident clinical and educational hours but does not require tracking daily work patterns or duty hour equity. Lack of such monitoring may allow for inequity that affects resident morale. No defined system for resident relief of weekday operating room (OR) clinical duties existed at our institution, leaving on-call residents to independently decide daily relief order. We developed an automated decision support tool (DST) to improve equitable decision making for clinical relief and assessed its impact on real and perceived relief equity. METHODS: The DST sent a daily e-mail to the senior resident responsible for relief decisions. It contained a prioritized relief list of noncall residents who worked in the OR beyond 5 pm the prior clinical day. We assessed actual relief equity using the number of times a resident worked in the OR past 5:30 pm on 2 consecutive weekdays as our outcome, adjusting for the mean number of open ORs each day between 5:00 pm and 6:59 pm in our main OR areas. We analyzed 14 months of data before implementation and 16 months of data after implementation. We assessed perceived relief equity before and after implementation using a questionnaire. RESULTS: After implementing the DST, the percentage of residents held 2 consecutive weekdays over the total of resident days worked decreased from 1.33% to 0.43%. The percentage of residents held beyond 5:30 pm on any given day decreased from 18.09% to 12.64%. Segmented regression analysis indicated that implementation of the DST was associated with a reduction in biweekly time series of residents kept late 2 days in a row, independent of the mean number of ORs in use. Surveyed residents reported the DST aided their ability to make equitable relief decisions (pre 60% versus post 94%; P = .0003). Eighty-five percent of residents strongly agreed that a prioritized relief list based on prior day work hours after 5 pm aided their decision making. After implementation, residents reported fewer instances of working past 5 pm within the past month ( P 〈 .005). CONCLUSIONS: A DST systematizing the relief process for anesthesiology residents was associated with a lower frequency of residents working beyond 5:30 pm in the OR on 2 consecutive days. The DST improved the perceived ability to make equitable relief decisions by on-call senior residents and residents being relieved. Success with this tool allows for broader applications in resident education, enabling enhanced monitoring of resident experiences and support for OR assignment decisions.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000003479
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2018275-2
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  • 7
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    Use of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator During Preoperative Risk Discussion: The Patient Perspective
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Anesthesia & Analgesia Vol. 128, No. 4 ( 2019-04), p. 643-650
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 4 ( 2019-04), p. 643-650
    Abstract: The American College of Surgeons (ACS) National Surgical Quality Improvement Program Surgical Risk Calculator (ACS Calculator) provides empirically derived, patient-specific risks for common adverse perioperative outcomes. The ACS Calculator is promoted as a tool to improve shared decision-making and informed consent for patients undergoing elective operations. However, to our knowledge, no data exist regarding the use of this tool in actual preoperative risk discussions with patients. Accordingly, we performed a survey to assess (1) whether patients find the tool easy to interpret, (2) how accurately patients can predict their surgical risks, and (3) the impact of risk disclosure on levels of anxiety and future motivations to decrease personal risk. METHODS: Patients (N = 150) recruited from a preoperative clinic completed an initial survey where they estimated their hospital length of stay and personal perioperative risks of the 12 clinical complications analyzed by the ACS Calculator. Next, risk calculation was performed by entering participants’ demographics into the ACS Calculator. Participants reviewed their individualized risk reports in detail and then completed a follow-up survey to evaluate their perceptions. RESULTS: Nearly 90% of participants desire to review their ACS Calculator report before future surgical consents. High-risk patients were 3 times more likely to underestimate their risk of any complication, serious complication, and length of stay compared to low-risk patients ( P 〈 .001). After reviewing their calculated risks, 70% stated that they would consider participating in prehabilitation to decrease perioperative risk, and nearly 40% would delay their surgery to do so. Knowledge of personal ACS risk calculations had no effect on anxiety in 20% and decreased anxiety in 71% of participants. CONCLUSIONS: The ACS Calculator may be of particular benefit to high-risk surgical populations by providing realistic expectations of outcomes and recovery. Use of this tool may also provide motivation for patients to participate in risk reduction strategies.
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000003718
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2018275-2
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  • 8
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    Online Resource
    Ketorolac Use and Anastomotic Leak in Elective Colorectal Surgery: A Detailed Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Diseases of the Colon & Rectum Vol. 61, No. 12 ( 2018-12), p. 1426-1434
    Details
    In: Diseases of the Colon & Rectum, Ovid Technologies (Wolters Kluwer Health), Vol. 61, No. 12 ( 2018-12), p. 1426-1434
    Abstract: Recent population-level analyses have linked ketorolac use to adverse outcomes. However, its use is also associated with decreased opioids and faster return of bowel function. OBJECTIVE: This study aims to assess the association between ketorolac and anastomotic leak. We hypothesize that receiving at least 1 dose of ketorolac will not be associated with anastomotic leak in elective colorectal surgery. DESIGN: This is a retrospective, observational cohort study of a prospectively collected data base. Anastomotic leak rates and other patient outcomes were adjusted for patient-level factors and then compared via a multivariable logistic regression. A secondary analysis assessed a dose-response association with anastomotic leak. SETTING: This study was conducted at a tertiary care colorectal surgery service. PATIENTS: Consecutive patients undergoing elective colorectal surgery with a nondiverted anastomosis were identified from 2012 to 2016. INTERVENTION: Exposure was defined as any administration of ketorolac during the perioperative time period. MAIN OUTCOME MEASURES: The primary outcome measured was anastomotic leak. RESULTS: A total of 877 patients met inclusion criteria. Of these, 479 (54.6%) were women, and the median age was 55 years. Overall, 566 (64.5%) patients were exposed to ketorolac. In the cohort, 27 (3.1%) patients experienced an anastomotic leak. In an unadjusted analysis, there was no association between ketorolac exposure and anastomotic leak (ketorolac: 3.1% vs no ketorolac: 3.3%; p = 0.84). This persisted in a multivariable model (OR, 0.98; 95% CI, 0.38–2.57; p = 0.98). Neither AKI (OR, 3.24; 95% CI, 0.51–20.6; p = 0.21), return to the operating room (OR, 1.07; 95% CI, 0.40–2.85; p = 0.88), nor readmission (OR, 1.03; 95% CI, 0.59–1.80; p = 0.93) was associated with ketorolac use. In a secondary analysis of patients receiving ketorolac, there was no association between total ketorolac dosing and anastomotic leak (OR, 0.99; 95% CI, 0.99–1.00; p = 0.20). LIMITATIONS: This study was a retrospective review, and there was a low incidence of anastomotic leak. CONCLUSION: Ketorolac exposure was associated with neither anastomotic leak nor other important postoperative outcomes. See Video Abstract at http://links.lww.com/DCR/A784.
    Type of Medium: Online Resource
    ISSN: 0012-3706
    URL: Article
    DOI: 10.1097/DCR.0000000000001244
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2046914-7
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  • 9
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    An enhanced recovery program for bariatric surgical patients significantly reduces perioperative opioid consumption and postoperative nausea
    Elsevier BV ; 2018
    In:  Surgery for Obesity and Related Diseases Vol. 14, No. 6 ( 2018-06), p. 849-856
    Details
    In: Surgery for Obesity and Related Diseases, Elsevier BV, Vol. 14, No. 6 ( 2018-06), p. 849-856
    Type of Medium: Online Resource
    ISSN: 1550-7289
    URL: Article
    DOI: 10.1016/j.soard.2018.02.010
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
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  • 10
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    Online Resource
    Implementation and Evaluation of the Z-Score System for Normalizing Residency Evaluations
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Anesthesiology Vol. 128, No. 1 ( 2018-01-01), p. 144-158
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 128, No. 1 ( 2018-01-01), p. 144-158
    Abstract: Assessment of clinical competence is essential for residency programs and should be guided by valid, reliable measurements. We implemented Baker’s Z-score system, which produces measures of traditional core competency assessments and clinical performance summative scores. Our goal was to validate use of summative scores and estimate the number of evaluations needed for reliable measures. Methods We performed generalizability studies to estimate the variance components of raw and Z-transformed absolute and peer-relative scores and decision studies to estimate the evaluations needed to produce at least 90% reliable measures for classification and for high-stakes decisions. A subset of evaluations was selected representing residents who were evaluated frequently by faculty who provided the majority of evaluations. Variance components were estimated using ANOVA. Results Principal component extraction from 8,754 complete evaluations demonstrated that a single factor explained 91 and 85% of variance for absolute and peer-relative scores, respectively. In total, 1,200 evaluations were selected for generalizability and decision studies. The major variance component for all scores was resident interaction with measurement occasions. Variance due to the resident component was strongest with raw scores, where 30 evaluation occasions produced 90% reliable measurements with absolute scores and 58 for peer-relative scores. For Z-transformed scores, 57 evaluation occasions produced 90% reliable measurements with absolute scores and 55 for peer-relative scores. The results were similar for high-stakes decisions. Conclusions The Baker system produced moderately reliable measures at our institution, suggesting that it may be generalizable to other training programs. Raw absolute scores required few assessment occasions to achieve 90% reliable measurements.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000001919
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2016092-6
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