Anesthesia Professionals Research Articles

Comparison of anesthesia professionals' preferences of delivery method with other health professionals

Objective: Work areas and clinical practices have an effect on cesarean rates, which are also high in health professionals. Anestehsia professionals and the health professionals who are far from surgical practices may have different views on delivery methods. In this study, it was aimed to investigate which delivery method between vaginal delivery and cesarean delivery was selected by the anesthesia professionals and the health professionals outside the operating room, and why they selected it. Material and methods: 137 anesthesia professionals and 151 health professionals who had never worked in the operating room were included in this study. The participants' ages, professions and methods of delivery and reasons were questioned by the survey method. Results: While 58.3% of all the participants preferred the cesarean delivery method at their first birth, 41.7% preferred vaginal delivery. The preference rates of anesthesia professionals for cesarean delivery (69.9%) were found higher than those of the professionals working outside the operating room (46.6%),(p<0.05). As the reason of preference for cesarean delivery, the option of “not putting the baby at risk” is higher among anesthesia professionals than the professionals outside the operating room (p<0.05). As the reason of vaginal delivery, “more physiological”, “fear of anesthesia and surgery”, “early recovery and desire to breastfeed baby” higher compared to anesthesia professionals (p<0.05). Conclusions: Knowing, practicing and seeing the anesthesia and surgical procedures every day have given the idea that these practices are simple, comfortable and have low risks, so the cesarean delivery rate has increased in anesthesia professionals.

Practice of Regional Anesthesia and Its Associated Factors among Anesthesia Professionals Working in Teaching Referral Hospitals of Ethiopia; A Multi-center Study

Background: Regional Anesthesia (RA) provides site-specific, complete pain relief, early mobilization, and rehabilitation; and it is preferred than general anesthesia due to associated risks in the later technique. It also ensures prolonged analgesia while reducing the need for systemic drugs with their side effects. Despite these advantages, the techniques have not been embraced as alternatives to general anesthesia in Ethiopia. Objective: The study aimed to assess the magnitude of regional anesthesia practice and its associated factors among Anesthesia Care Providers (ACPs) working in Ethiopian teaching referral hospitals, 2019. Materials and Methods: Multi-center-based crossectional study was conducted among all ACPs working in three institutions (Jimma Medical Center, Black Lion hospital and Wolaita Sodo teaching referral hospital) which were randomly selected among six government teaching referral hospitals running postgraduate anesthesia programs; from August 1-September 1, 2019. The practice of RA was considered significant if the participants performed &gt;5 types of RA, assuming as minimum representation (30%) of all types of RA. Data were entered into Epidata manager version 4.3 and exported to SPSS version 22 for further analysis. Logistic regression was applied to determine predictors of RA practice. Adjusted odds ratio and 95% CI interval were used to measure the association and P-value &lt;0.05 was declared as statistically significant. Results: Out of 143 participants, a total of 130 anesthesia professionals participated in the study, making the response rate of 90% . The mean age was 30.77±7.049 years that ranges from 22-56 years. Majority of the respondents were males, 88(67.7%). About 59.2% of ACPs practiced RA. The most performed types of RA were spinal anesthesia (98.5%), caudal anesthesia (72.3%) and axillary block (69.2%), while sub gluteal sciatic block and IV RA were the least practiced types of RA (8.5% each). Finally, two variables (years of experience (1-5 years) and academic qualification (above MSc)) were identified as the independent predictors of RA practice among ACPs with AOR of 6(1.7-21.6), p-v =0.005 and 10.4(1.9-56.9), p-v =0.007 respectively. Conclusion: In a nutshell, the practice of RA in teaching government hospitals of Ethiopia was relatively low despite some RA types like SA were almost practiced well. Thus, ACPs were expected to practice all types of RA than routinely abusing GA for patient safety and welfare in all dimensions.

Analysis of Failure Modes in Anesthesia for Cardiac Surgery Using the Healthcare Failure Mode and Effects Analysis (HFMEA) Technique

Background: Healthcare statistics, issued by various international organizations, show that medical errors in health centers impose high costs on patients and hospitals and increase the rates of morbidity and mortality around the world. Due to the potential risks of cardiovascular diseases, the occurrence of any errors can potentially endanger the patients’ lives and incur costs on them, as well as hospitals. On the other hand, anesthesia is one of the priorities for risk management in clinical care. Objectives: This study aimed to identify, classify, and evaluate anesthesia failures in open heart surgeries, using the healthcare failure mode and effects analysis (HFMEA) technique. Methods: The anesthesia process in open heart surgery was reviewed using the HFMEA technique, and four processes, 25 sub-processes, 95 activities, and 204 risks were extracted. The causes of failure were also identified, and four failure modes were determined as the most important failures, based on the qualitative and quantitative methods; finally, some solutions were proposed. Changes in the level of healthcare workers’ knowledge and competence, computer use and timing, and the amount of administered medications were identified as the potential risk factors and errors. Results: The inadequate awareness and knowledge of healthcare workers, non-use of computers, prescription errors, technique errors, and timing and amount of medication administration were identified as the errors and risk factors. Based on the present findings, another expert needs to evaluate the design, feasibility, and prioritization of techniques, including continuing medical education for anesthesia professionals and experts, statutory documentation, and control of the individuals’ activities. Conclusions: Based on the present findings, establishing a risk management committee seems essential to identify errors and improve the design and plan of different techniques so as to execute, monitor, control, and review errors in a cycle of continuous improvement.

The Current Practice of Spinal Anesthesia in Anesthetists at a Comprehensive Specialized Hospital: A Single Center Observational Study.

BackgroundSpinal anesthesia block is the most widely practiced anesthesia technique due to its safety margin. It is an invasive procedure that could be associated with a variety of complications like total spinal, cardiovascular collapse, meningitis, paralysis, and even death. The aim of this study to assess the current practice of spinal anesthesia.MethodsA Cross-sectional study design was conducted in Debre Tabor Comprehensive Specialized Hospital from November 01 to December 15, 2020. All anesthesia professionals who are working in the study Hospital were surveyed by the Purposive sampling technique. A standardized structured checklist prepared from recommendations of New York school of regional anesthesia guideline regarding the current Practice of spinal anesthesia was used to collect the data after taking written informed consent. Descriptive statistics were employed to summarize the results.ResultsA total of 24 anesthetists were observed of their practice before, during, and after administer of spinal anesthesia. All of the anesthetists were practicing the preparation and assembling of all necessary anesthesia equipments, resuscitation drugs, and basic monitors while all of the anesthetists did not wash their hands, wore a sterile gown, and draped the back of the patient with fenestrated drapes in a sterile fashion.ConclusionMost of the anesthesiology professionals in our setting have a good preparation of all necessary anesthesia equipments, and resuscitation drugs, while the assessment of patient’s emotional reaction and pain during injection, the skin preparation allowed to being dry and assessment of the degree of sensory and motor block of the patient were insufficient.

Tracheal Intubation-related adverse events in pediatrics anesthesia in Ethiopia.

Tracheal intubation is a common intervention for many pediatric surgical patients. Even though it can be lifesaving, it carries a risk of morbidity and even mortality. Evidence is lacking regarding the adverse events related to pediatric intubation in Ethiopia. This study is aimed to assess the scale of tracheal intubation-related adverse events with its associated factors in pediatrics surgical patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. An Institutional-based cross-sectional study was conducted on 310 pediatric surgical patients who underwent major surgery from December 30, 2019, to February 30, 2020. All pediatrics patients scheduled for surgery under general anesthesia in the study period were included in this study. Data with complete information were entered into Epi Info version 7 and exported to SPSS version 22 for analysis. Descriptive statistics, bivariate, and multivariable logistic regression were computed to identify factors associated with tracheal intubation-related adverse events. The level of statistical significance was declared at a P-value of less than .05. In this study, the overall incidence of tracheal intubation-related adverse events in pediatrics patients was 36.5%. Being a neonate (AOR=4.13, 95% CI: 1.26-13.49), emergency surgery (AOR=3.39, 95% CI: 1.41-8.13), difficult intubation (AOR, 4.08, 95% CI: 1.01-7.50), intubation without using premedication (AOR=1.75, 95% CI: 1.45-10.83), intubation without using muscle relaxant (AOR=1.81; 95% CI: 1.10-8.14), and tracheal intubation attempted more than three times (AOR=3.92, 95% CI: 0.16-7.39) were identified as independent predictors of tracheal intubation-related adverse events. The incidence of tracheal intubation-related adverse events in pediatric surgical patients is high. Anesthesia professionals should be vigilant and have a preplanned strategy to avoid intubation-related adverse events, especially in high-risk patients. The use of difficult airway algorithms, oxygen saturation monitoring, and training in simulation room are very important strategies to help reduce patient harm.

Positive communication behaviour during handover and team-based clinical performance in critical situations: a simulation randomised controlled trial

BackgroundPositive communication behaviour within anaesthesia teams may decrease stress response and improve clinical performance. We aimed to evaluate the effect of positive communication during medical handover on the subsequent team-based clinical performance in a simulated critical situation. We also assessed the effect of positive communication behaviour on stress response. MethodsThis single-centre RCT involved anaesthesia teams composed of a resident and a nurse in a high-fidelity scenario of anaesthesia-related paediatric laryngospasm after a standardised handover. During the handover, similar information was provided to all teams, but positive communication behaviour was adopted only for teams in the intervention group. Primary outcome was team-based clinical performance, assessed by an independent blinded observer, using video recordings and a 0-to 100-point scenario-specific scoring tool. Three categories of tasks were considered: safety checks before the incision, diagnosis/treatment of laryngospasm, and crisis resource management/non-technical skills. Individual stress response was monitored by perceived level of stress and HR variability. ResultsThe clinical performance of 64 anaesthesia professionals (grouped into 32 teams) was analysed. The mean (standard deviation) team-based performance score in the intervention group was 44 (10) points vs 35 (12) in the control group (difference: +8.4; CI95% [0.4–16.4]; P=0.04). The effects were homogeneous over the three categories of tasks. Perceived level of stress and HR variability were not significantly different between groups. ConclusionsPositive communication behaviour between healthcare professionals during medical handover improved team-based performance in a simulation-based critical situation. Clinical trial registrationNCT03375073.

Anesthesia management in obstetric patients with positive COVID-19

The COVID-19 pandemic, is an ongoing pandemic caused by corona virus.It can lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).As of 9 March 2021, more than 117 million cases have been confirmed, with more than 2.6 million deaths attributed to COVID-19, making it one of the deadliest pandemics in history. As the pandemic evolves rapidly, there are data emerging to suggest that pregnant women diagnosed as having coronavirus disease 2019 can have severe morbidities (up to 9%). The aim of this article is to bring attention to all steps that should be followed in obstetric patients with positive COVID-19. This is a litterature review, refering to international guidelines and international collegues experiences , especially from Wuhan and USA. In contrast to earlier data that showed good maternal and neonatal outcomes, the latest data suggest that pregnant woman can have severe morbidities. Exposure to virus predisposes both mother and fetus to an increased risk of infection and severe adverse maternal and perinatal outcomes. The anesthesia management of the patient with a suspected or confirmed COVID-19 infection presents a major challenge for anesthesia professionals because of the pathophysiologic and confirmed rapid human-to- human transmission of the virus through symptomatic and asymptomatic carriers. As with SARS and MERS, the most critical goal in the OR is to prevent cross-contamination by implementing stringent anesthesia guidelines and infection control strategies in the perioperative setting. Pregnant women with suspected or confirmed COVID-19 should be triaged and their condition categorized as mild, severe, or critical. Asymptomatic and mild cases should be isolated at home, and be taken care throw all the process until the day of the delivery. Severe and MOF patients should be taken care in the hospital by a multidisciplinary group. Vaginal delivery is recommended in stable patients because viral shedding and vertical transmission have not been reported. There are international recommendations starting to continuous CTG monitoring due to possible increased risk of fetal distress, monitor temperature, respiratory rate. Under normal labor progression, vaginal examinations should be minimized. Neuraxial analgesia is not contraindicated, and by providing good analgesia, it may reduce cardiopulmonary stress from pain and anxiety. Although evidence of mother-to-child transmission is lacking, early cord clamping may be discussed with the patient. The patient could informedly decide skin-to-skin contact with the newborn , ensuring precautions for respiratory droplets with the use of a mask as well as hand and skin hygiene. Caesarean section should follow usual obstetric indications. The potential risk of vertical transmission is not an indication for caesarean section. Because of pulmonary complication known in COVID-19, the regional anesthesia is recommended unless there are no contraindication. Before neuraxial anesthesia must be done blood count test, especially to asses the platelet count. If general anesthesia is required , the anesthesia machine must be prepared with an HMEF between the circuit and the patient’s airway. The most experienced anesthesia provider should be dedicated to the intubation. The anesthetist should manage the pain, preferably with NSAIDS, the PONV using antiemetics and VTE prophylaxis. COVID-19 is highly contagious, and this must be taken into consideration when planning intrapartum care. Rational use of personal protective equipment is key in preventing infection in attending professionals. The first of all is ’’ Primum non nocere’’, it should be done the best for the pregnant patient and for the newborn protecting the personnel. There are still limited data on the care and management of the parturient with COVID-19. It is paramount that our profession shares our experiences and practices to help guide our multidisciplinary approach in delivering the best care possible to these women.

Congruency Between Planned and Performed Procedures and Adherence to Recommended Perioperative Practices: A Chart Audit of High-Risk Surgical Patients.

Documentation in an electronic health record system helps ensure that perioperative personnel provide appropriate treatment and care to surgical patients. A retrospective chart review performed with an audit instrument sought to describe the extent to which the documented preoperative plan for a surgery corresponded to the procedure performed. The secondary aim was to describe to what extent perioperative nurses' and physicians' documented care was in accordance with national and international guidelines. Extracted data consisted of physicians' and nurses' documentation of 24 high-risk surgical patients who died within 30 days after a procedure at two hospitals within a single health system. Surgeons documented a planned surgical method for 23 of the 24 patients and the surgical team performed 20 surgeries as planned. Perioperative nurses' and anesthesia professionals' documentation showed a lack of adherence to recommended practices: compliance with guidelines concerning antibiotic prophylaxis and preoperative hygiene preparation were low.

Medication-related problems among hospitalized pregnant women in a tertiary teaching hospital in Ethiopia: a prospective observational study

BackgroundStudies on medication-related problems (MRPs) among pregnant women are scarce, despite the potential consequences for both mother and child. This study aimed to describe the prevalence, clinical significance, and risk factors for MRPs among hospitalized pregnant or postpartum women at Jimma University Medical Centre (JUMC) in Ethiopia.MethodsA prospective follow-up and clinical audit of 1117 hospitalized pregnant or postpartum women in the maternity and gynaecology wards at JUMC was carried out between February and June 2017. Patients were followed throughout their stay in the hospital to assess the presence and development of MRPs. Pre-tested data extraction form and an interview-guided structured questionnaire were used to collect data. Descriptive statistics were used to describe MRPs. Logistic regression analysis was used to identify factors associated with MRPs.ResultsOne or more MRPs occurred among 323 (28.9%) study participants, mostly in relation to lack of iron supplementation. A total of 278 (70.6%) of all MRPs were considered to be of moderate to high clinical significance. When excluding MRPs due to iron from the analysis, chronic disease (adjusted OR 1.91; 95% CI 1.02, 3.58), medication use prior to admission (adjusted OR 2.38; 95% CI 1.24, 4.56), nulliparity (adjusted OR 1.99; 95% CI 1.22, 3.24) and multiparity (adjusted OR 1.91; 95% CI 1.17, 3.12) were significantly associated with experiencing an MRP.ConclusionsNearly 3 out of 10 hospitalized pregnant women at JUMC had one or more MRPs. The need for additional iron therapy was by far the most common type of MRP. Improved adherence to guidelines on iron supplementation are required. Multidisciplinary approaches including physicians, nurses, anesthesia professionals and clinical pharmacists in the maternity and gynaecology wards could possibly prevent MRPs and promote patient safety for women and children.

AneSBAR Handoff Rubric for Nurse Anesthesia Students

BackgroundPoorly executed handoffs, particularly those omitting important clinical information or conveying ambiguous instructions, increase the risk of adverse events among anesthetized patients. Currently, there are no specific standards for the training and assessment of anesthesia care handoff among student registered nurse anesthetists. The Anesthesia SBAR (AneSBAR) Handoff Rubric was developed to assess nurse anesthesia students on their SBAR (Situation, Background, Assessment, Recommendation) reporting skills. MethodNine anesthesia professionals participated in instrument validation. Thirty-four nurse anesthesia students participated in simulations involving patient handoff. Anesthesia professionals were surveyed on validity of the rubric. Nurse anesthesia students practiced simulated performances of surgical patient handoff and were rated using the rubric. ResultsThe rubric was determined reliable and valid. ConclusionThe AneSBAR Rubric may be useful to teach, assess, and implement in simulation as a cognitive aid to assure complete and accurate transfer of patient information.

Anesthesiologist to Patient Communication

Many patients are admitted to the intensive care unit following surgery, and some of them will experience incomplete recovery. For patients in this situation, preoperative discussions regarding patient values and preferences may direct care decisions. Existing literature shows that it is uncommon for surgeons to have these conversations preoperatively; it is unclear whether anesthesia professionals engage with patients on this topic prior to surgery. To review the literature on communication between patients and anesthesia professionals, with a focus on discussions related to postoperative critical care. MEDLINE and Web of Science were searched using specific search criteria from January 1980 to April 2020. Studies describing encounters between patients and anesthesia professionals were selected, and data regarding study objectives, study design, methodology, measures, outcomes, patient characteristics, and clinical setting were extracted and collated. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. A total of 12 studies including 1284 individual patient encounters were eligible for inclusion in the review. These studies demonstrated that communication between patients and anesthesia professionals related to postoperative care is rare: only 2 studies reported communication regarding adverse postoperative events, and this communication behavior was reported in only 46 of 1284 consultations (3.6%) across all studies. Additional findings were that communication during these encounters is dominated by anesthetic planning and perioperative logistics, with variable discussion of perioperative risks vs benefits and infrequent elicitation of patient values and preferences. Some data suggest that patients wish to be involved in perioperative decision-making but are often limited by an incomplete understanding of risks and benefits. This systematic review found that communication in anesthesia is dominated by anesthetic planning and discussion of preoperative logistics, whereas postoperative critical care is rarely discussed. Most patients who are admitted to an intensive care unit after a major operation will not have had a discussion regarding goals of care specific to protracted recovery or prolonged intensive care with their anesthesiologist.

Assigning OR staff members to assist anesthesia professionals during the COVID-19 pandemic.

Assigning OR staff members to assist anesthesia professionals during the COVID-19 pandemic.

Blood Pressure Management by Anesthesia Professionals: Evaluating Clinician Skill From Electronic Medical Records.

Avoiding intraoperative hypotension might serve as a measure of clinician skill. We, therefore, estimated the range of hypotension in patients of nurse anesthetists, and whether observed differences were associated with a composite of serious complications. First, we developed a multivariable model to predict the amount of hypotension, defined as minutes of mean arterial pressure (MAP) <65 mm Hg, for noncardiac surgical cases from baseline characteristics excluding nurse anesthetist. Second, we compared observed and predicted amounts of hypotension for each case and summarized "excess" amounts across providers. Third, we estimated the extent to which hypotension on an individual case level was independently associated with a composite of serious complications. Finally, we assessed the range of actual and excess minutes of MAP <65 mm Hg on a provider level, and the extent to which these pressure exposures were associated with complications. We considered 110,391 hours of anesthesia by 99 nurse anesthetists. A total of 69% of 25,702 included cases had at least 1 minute of MAP <65 mm Hg, with a median (quartiles) of 4 (0-15) minutes on the case level. We were unable to explain much variance of intraoperative hypotension from baseline patient characteristics. However, cases in the highest 2 quartiles (>10 and >24 min/case more than predicted) were an estimated 27% (95% confidence interval [CI], 1.1-1.4) and 31% (95% CI, 1.2-1.5) more likely to experience complications compared to those with 0 excess minutes (both P < .001). There was little variation of the average excess minutes <65 mm Hg across the nurse anesthetists, with median (quartiles) of 1.6 (1.2-1.9) min/h. There was no association in confounder-adjusted models on the nurse anesthetist level between average excess hypotension and complications, either for continuous exposure (P = .09) or as quintiles (P = .30). Hypotension is associated with complications on a case basis. But the average amount of hypotension for nurse anesthetists over hundreds of cases differed only slightly and was insufficient to explain meaningful differences in complications. Avoiding hypotension is a worthy clinical goal, but does not appear to be a useful metric of performance because the range of average amounts per clinician is not meaningfully associated with patient outcomes, at least among nurse anesthetists in 1 tertiary center.

Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings.

Safe and accessible surgical and anesthetic care is critically limited for over half of the world’s population, particularly in Sub-Saharan African and Southeast Asian countries. Increasing the use of regional anesthesia in these areas has potential benefits regarding access, safety, and cost-effectiveness. Perioperative anesthesia-related mortality is significantly higher in resource-limited countries and every effort should be made to encourage the use of anesthetic techniques in these countries that are safest under the present conditions. Studies from Sub-Saharan Africa, although limited in number, have shown a lower risk of death with regional compared to general anesthesia. Regional anesthesia has the further benefit of decreasing the risk of COVID-19 spread to healthcare providers by avoiding the aerosol-generating procedures that occur during general anesthesia. Neuraxial regional anesthesia is relatively easy to teach and perform and is considered the anesthetic of choice for surgeries below the umbilicus in resource-limited settings due to its safety, efficacy, and low cost. Although regional anesthesia has multiple potential advantages, education and training of anesthetic providers in low-and-middle-income countries (LMIC) are a significant barrier to growth. Anesthesia professionals, especially in Sub-Saharan Africa, are often poorly supported and undervalued, and recruitment and retention of adequate numbers of trained practitioners are a continuing problem. Greater use of regional anesthesia could be one way to safely increase anesthesia access and simultaneously create value and enthusiasm for the field. Deficits in anesthesia infrastructure, equipment, and drugs also limit anesthesia capacity in low-and middle-income countries. Ultrasound-guided regional anesthesia may be helpful in improving access to safe and reliable anesthesia in low-resource countries as it continues to become more user-friendly, durable, and affordable.

Environmental Surface Hygiene in the OR: Strategies for Reducing the Transmission of Health Care–Associated Infections

Health care-associated infections (HAIs) cost billions of dollars annually in the United States and cause patient morbidity and mortality. There is increasing evidence that environmental surfaces in the OR setting, including anesthesia work areas, can harbor pathogens that can lead to HAIs. Patient-care equipment used routinely in the OR, such as electrocardiograph wires, blood pressure cuffs, pulse oximetry probes, and monitor cables, can become contaminated with pathogens during surgical procedures; without proper cleaning and disinfection between procedures, these items pose a risk for pathogen transmission and subsequent patient infections. This article discusses the association between contaminated surfaces in the OR and the risk for HAIs. It is essential that perioperative nurses, environmental services personnel, anesthesia technicians, and anesthesia professionals properly disinfect environmental surfaces to prevent HAIs.

Exposure to Covid-19: Assessing the Knowledge, Attitudes, and Practices of Anaesthetists in the Prevention of COVID-19 Spread in Ghana-A Multicenter Cross-Sectional Survey

The number of health workers infected with COVID-19 is increasing exponentially. Recent reports indicate that about 787 frontline health workers died of COVID-19 in the United States of America. In Ghana, not less than 779 health workers especially doctors, certified registered Anaesthetists and nurses have been infected with COVID-19, with nine death. Aerosol and fomite transmission of SARS-CoV-2 to individuals is plausible. Anaesthesia professionals who are in close contact as they help patients breathe through airway equipment are at maximum risk of exposure to COVID-19. This study aimed to assess the knowledge, attitudes, and practices of Anaesthetists towards the prevention of the spread of the COVID-19 infection. Certified Registered Anaesthetists were required to complete a self-administered structured questionnaire. A total of 356 respondents were recruited in this study. The data showed that 73.3 % of the respondents recruited for this study were males and 26.7 % of them were females. The mean age of the respondents was 37.1 ± 5.3 years old. We realized that 4.8% of them always had access to appropriate personal protective equipment, whereas 95.2 % of them had no access during work. The data also showed that 34.0 % of them always had access to a face mask and hand sanitizers, while 66.0 % of them had no access to a face mask and hand sanitizers during work. There is, the need for regular inservice training of Certified Registered Anaesthetists and other health workers on the right attitude and practices to prevent the spread of the virus among health workers. Policymakers should ensure the regular supply of basic PPE at the various hospitals.

Clinical Uses and Impacts of Emergency Manuals During Perioperative Crises.

Performing key actions efficiently during crises can determine clinical outcomes, yet even expert clinicians omit key actions. Simulation-based studies of crises show that correct performance of key actions dramatically increases when emergency manuals (EMs) are used. Despite widespread dissemination of EMs, there is a need to understand in clinical contexts, when, how, and how often EMs are used and not used, along with perceived impacts. We conducted interviews with the anesthesia professionals involved in perioperative crises, identified with criterion-based sampling, occurring between October 2014 and May 2016 at 2 large academic medical centers with a history of EM training and implementation. Our convergent, mixed-methods study of the interview data extracted quantitative counts and qualitative themes of EM use and nonuse during clinical crises. Interviews with 53 anesthesia professionals yielded 80 descriptions of applicable clinical crises, with varying durations and event types. Of 69 unique patients whose cases involved crises, the EM was used during 37 (54%; 95% confidence interval [CI], 41-66). Impacts on clinician team members included decreased stress for individual anesthesia professionals (95%), enabled teamwork (73%), and calmed atmosphere (46%). Impacts on delivery of patient care included specific action improvements, including catching errors of omission, for example, turning off anesthetic during cardiac arrest, only after EM use (59%); process improvements, for example, double-checking all actions were completed (41%); and impediments (0%). In 8% of crises, EM use was associated with potential distractions, although none were perceived to harm delivery of patient care. For 32 EM nonuses (46%; 95% CI, 34-59), participants self-identified errors of omission or delays in key actions (56%), all key actions performed (13%), and crisis too brief for EM to be used (31%). This study provides evidence that EMs in operating rooms are being used during many applicable crises and that clinicians perceive EM use to add value. The reported negative effects were minimal and potentially offset by positive effects.

Correlation between Antibiotic Consumption and Hand Hygiene Compliance Among Anesthesia and Intensive Care Healthcare Professionals

Aims: The aim of this study was to investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals working in the Department of Anesthesia and Intensive Care of a tertiary care University Hospital. Background: Two centuries have passed since the discovery of Semmelweis that the “puerperal fever” was due to an infection transmitted by the hands. Currently the hand hygiene is still not well performed, rather it is often replaced by the improper use of gloves. Microbial transmission is estimated to occur in one-fifth of all contact cases. Objective: To investigate the correct use of gloves and alcohol-based products for hand hygiene and identify opportunities for hand hygiene replacement with gloves among healthcare professionals. Furthermore, to correlate the consumption data of the hydroalcoholic solution and the amount of antibiotics used for the treatment of hospital-acquired infections. Method: The study was conducted over six months period (from January to June 2018); during this period, 20 monitoring sessions were performed. The following indicators were evaluated: a) Non-adherence to hand hygiene with concomitant use of gloves; b) Adhesion to alcoholic friction of hands; c) Hand-washing adhesion. Instead, the consumption data, provided by the hospital ward itself, were used for the evaluation of d) The antibiotics used in the treatment of hospital-acquired infections; e) The hydro-alcoholic solution used by the healthcare professionals for hand hygiene. Results: The frequency of non-adherence to hand hygiene was very high at the beginning of the study, subsequently it decreased to about a half percent to that at the initial stage. The adhesion to alcoholic friction of hands increased during the study period. Otherwise, the hand-washing adhesion slightly reduced, especially in March probably due to the recruitment of new inadequately trained nursing staff. The trend of antibiotic consumption was similar to handwashing. The consumption of hydro-alcoholic solution was very low, however over time, it increased considerably until the end of the study. Conclusion: In light of the findings from this work, it is necessary to make the hospital staff increasingly aware of the correct practice of hand hygiene and to organize training and informative sessions to promote the health of the individual and the community.

A week-long instructional design approach to teach postoperative pain management knowledge among Afghan anesthesiology faculty: a potential global health teaching blueprint

Background Anesthesia-focused short courses might be an effective and sustainable way to further the ongoing training and evidence-based practice skills of anesthesia professionals in low- and middle-income countries (LMICs). Instructional design, the process by which formalized learning theory is incorporated into education planning and delivery, is a tool that can strengthen learning in these short courses. As part of an ongoing multilateral project between the University of Minnesota (UMN) and Kabul University of Medical Sciences (KUMS), this project sought to identify the feasibility and potential educational impact of a newly designed postoperative analgesia short-course employing instructional design principles. The Afghan faculty learners’ subjective viewpoint of the short course experience was also investigated and is described in this article. Methods Afghan learners and United States based faculty met in Bangalore, India in August 2018 for this short course. During the 6-day course, learners participated in didactics and workshops discussing regional anesthesia techniques, multimodal analgesia, safety, pain assessment and management, and the influence of ethno-cultural context on pain control. Interactive games, model-based nerve block simulations, and flipped classroom approaches were educational strategies used in the course. The Afghan faculty also participated in instructional design workshops designed to strengthen their teaching skills for use with both students and faculty colleagues. Pretests, posttests, and opinion surveys were completed by the Afghan faculty learners. Results All learners completed the course with full participation. A median of 5 out of 10 technical questions were answered correctly by the learners on the pretest; this score improved to a median of 6.5 on the posttest. The number of learners who ranked their understanding of the role of regional anesthesia in their perioperative care practice as “very well” increased from 2 to 5 faculty. Likewise, the number of learners who described their understanding of postoperative pain and their ability to perform regional anesthesia as “not well at all” decreased from 2 to 0 in both categories. Further, the majority of the participants agreed that at the end of the course their ability to understand and apply instructional design concepts had improved. Conclusions The short course in postoperative pain management appeared to improve short-term knowledge among Afghan faculty participants. Afghan faculty had a favorable opinion of the course and increased confidence in their ability to use instructional design best practices. The results of this project suggest that short courses based in instructional design can be useful and effective for short-term knowledge gain in an LMIC setting such as Afghanistan.

A Network Analysis of Perioperative Communication Patterns.

To foster teamwork, improve clinical excellence, and promote a culture of safety, perioperative leaders should have a clear understanding of the dynamics that affect clinician communication in the OR. We used social network analysis to characterize the typical OR clinician communication patterns at a military surgery center and determine how clinician relationships influenced individual behavior. We surveyed 50 surgical teams and used the data to develop six relational networks and a clinician communication effectiveness index. The study results showed that communication effectiveness increased in networks in which clinicians reported interacting frequently, having close working relationships, socializing, and seeking advice and providing advice to others. Increases in individual clinician centrality were associated with increased communication effectiveness. Participants rated anesthesia professionals as the most effective communicators, followed by perioperative nurses, surgeons, and surgical technologists. Perioperative leaders should consider surgical team familiarity as a potential option to optimize surgical care and improve communication effectiveness.