Anesthesia Services Research Articles

Comparison of two formulas for estimating number of staff for a veterinary anesthesia service

Comparison of two formulas for estimating number of staff for a veterinary anesthesia service

The Infinite Game: Opportunities and Lessons About Possible Futures of Anesthesia Service Delivery from the United Kingdom.

The Infinite Game: Opportunities and Lessons About Possible Futures of Anesthesia Service Delivery from the United Kingdom.

A Comparison among Score Systems for Discharging Patients from Recovery Rooms: A Narrative Review.

The recovery room (RR) is a hospital area where patients are monitored in the early postoperative period before being transferred to the surgical ward or other specialized units. The utilization of scores in the RR context facilitates the assignment of patients to the appropriate ward and directs necessary monitoring. Some scoring systems allow nurses to select patients who can be discharged directly to their homes. The aim of this narrative review was to describe and compare the scoring systems employed to discharge postoperative patients from RR, with a focus on item characteristics. Nine scoring systems were identified and discussed: the "Aldrete Score System" and its modified version, the "Respiration, Energy, Alertness, Circulation, Temperature Score", the "Post Anesthetic Discharge Scoring System", the "White and Song Score", the "Readiness for Discharge Assessment Tool", the "Anesthesia and Perioperative Medicine Service Checklist", the "Post-Anesthetic Care Tool", the "Post-operative Quality Recovery Scale", and the "Discerning Post Anesthesia Readiness for Transition" instrument. To obtain a comprehensive overview, the items included in the scoring systems were compared. Despite the availability of guidelines for patients' discharge readiness from the RR, there is no universally recommended scoring system. Next-generation scores must be improved to ease their use, minimize errors, and increase safety. The main goals of the scores included in this narrative review were to be simple to use, feasible, intuitive, comprehensive, and flexible. However, these goals frequently conflict because patient assessment takes time, and a smart and comprehensive score may not consider some clinical parameters that may be crucial for the discharge decision. Therefore, further research should be conducted on this topic.

A Survey of Obstetric Anaesthesia Services and Practices in the United Kingdom.

Background Variability in obstetric anaesthetia practice and care delivered within the UK is under-explored. The ObsQoR study explored structures, processes, and outcomes of obstetric anaesthesia in 107 hospitals within the UK's National Health Service, and the results of the hospital-level survey are reported here. Methods Hospitals were surveyed to assess obstetric anaesthesia provision, practice, and care delivery. Questions explored staffing, service provision and training, facilities present, clinical practices, outcome measurement, and key indicators of quality in obstetric anaesthesia. Results We received responses from 106 participating hospitals, representing 69% of all UK obstetric units. One hundred (94%) hospitals had a dedicated consultant obstetric anaesthetist within working hours, with 27 (25%) of hospitals' duty anaesthetists having additional clinical responsibilities outside the care of obstetric patients outside of working hours. Around 102 hospitals (98%) offer multidisciplinary team training, of which 95 (93%) use a simulation-based method. Dedicated high-risk antenatal clinics were present in 50 (47%) hospitals. The majority of hospitals provide written patient information in multiple languages for discussing obstetric anaesthesia options (77, 82%). Seventy-three hospitals (69%) use point-of-care testing to estimate haemoglobin concentration. Labour epidural analgesia is most commonly delivered via patient-controlled epidural analgesia in 80 (76%) hospitals, and the incidence of post-dural puncture headaches was recorded by 80 (76%) hospitals. Conclusions These results demonstrate variation in the provision of staffing, facilities, clinical practices, and outcome measurements across the UK. To deliver safe and equitable care across the UK, there needs to be standardisation of anaesthetic peripartum care based on national recommendations and the benchmarking and measurement of appropriate markers of quality.

The Israeli anesthesiology workforce crisis: a reassessment survey

BackgroundAnesthesiologists provide crucial anesthesiology services in the operating room and non-operating room locations. Combined with an aging and growing Israeli population, there is an increasing demand for anesthesiology services. A previous study performed in 2005 showed that most anesthesiologists are immigrant physicians with few Israeli medical school graduates. Since then, physician immigration decreased, many have retired and demand for anesthesia services has increased while insufficient numbers of new anesthesiologists were trained, leading to a shortage, limiting surgeries and other procedures in many hospitals. The present study examined the composition of the Israeli anesthesiology workforce in 2021and compared it to the 2005 workforce.MethodsA cross-sectional survey of demographic and professional information about each Israeli hospital anesthesiologists was solicited from 34 anesthesiology department chairs responsible for 36 Israeli acute care hospitals.ResultsThere are 1313 anesthesiologists in the 36 hospitals, resulting in a ratio of 14.2 anesthesiologists per 100,000 population. 22.6% of anesthesiologists will reach retirement age over the next ten years. The proportion of female anesthesiologists was 28.7%. While Israeli medical school graduates increased to 18.1% from 12.2% in 2005, non-Israeli citizens and non-permanent residents comprised 8.5% of the workforce.ConclusionsDespite growth in the ratio of anesthesiologists per population, a workforce shortage is expected to worsen over the next ten years due to retirements, shortened call hours, and the Yatziv reform which bans graduates of certain overseas medical schools from obtaining Israeli Medical Licenses. The current workforce has compensated for the existing shortage of anesthesiologists by enlisting non-Israeli trainees from overseas. Yet, it is crucial to maintain and enlarge the local Israeli workforce to forestall a worsening shortage.

Improving Endoscopy Nursing Staff's Patient Management Through the Implementation of an Education Initiative.

Endoscopic procedure areas have high-volume, fast-paced work environments. This practice requires a diverse range of knowledge and skills that are continuously changing with the evolution of high-acuity procedures and the shift toward routine use of anesthesia services. Endoscopy nursing staff have recently shown higher levels of stress and emotional exhaustion than their colleagues in similar practice settings. Patient management and recovery from anesthesia are identified by this group of nurses as a perceived stressor with high priority for improvement in competencies. Standardized education in collaboration with anesthesia services regarding these topics does not exist. As an improvement initiative, a standardized education guide was developed and implemented in an urban endoscopy unit situated within a Level 1 trauma center to improve nursing staff's patient management, knowledge, and readiness. Nursing knowledge was evaluated before and after the delivery of an educational presentation. Results demonstrated a substantial improvement in nursing knowledge and preparedness for complex procedures and high-acuity patients. Implementation of a similar standardized endoscopy nursing education guide has the potential to positively impact endoscopy nursing staff's knowledge and preparedness related to complex endoscopy patient care delivery, possibly relieving a source of stress for endoscopy staff and improving patient safety.

Characteristics and Outcomes of Home-Ventilated Children Undergoing Noncardiac Surgery.

To determine the frequency of children with chronic respiratory failure (CRF) and home ventilator dependence undergoing surgery at a tertiary children's hospital, and to describe periprocedural characteristics and outcomes. We conducted a retrospective cohort study of patients with CRF and home ventilator dependence who underwent noncardiac surgery from January 1, 2013, to December 31, 2019. Descriptive statistics were used to report patient and procedural characteristics. Univariable and multivariable analyses were used to assess for factors associated with 30-day readmission. We identified 416 patients who underwent 1623 procedures. Fifty-one percent of patients used transtracheal mechanical ventilation (trach/vent) support at the time of surgery; this cohort was younger (median age 5.5 vs 10.8 years) and more complex according to American Society of Anesthesiologists status compared with bilevel positive airway pressure-dependent patients. Postoperatively, compared with bilevel positive airway pressure-dependent patients, trach/vent patients were more likely to be admitted to the ICU with longer ICU length of stay (median 5 vs 2 days). Overall 30-day readmission rate was 12% (n = 193). Presence of chronic lung disease (adjusted odds ratio 1.65, 95% confidence interval 1.01-1.69) and trach/vent dependence (adjusted odds ratio 1.65, 95% confidence interval 1.02-2.67) were independently associated with increased odds for readmission. Children with CRF use anesthetic and surgical services frequently and repeatedly. Those with trach/vent dependence have higher hospital and ICU resource utilization. Although overall mortality for these patients is quite low, underlying diagnoses, nuances of technology dependence, and other factors for frequent readmission require further study to optimize resource utilization and outcomes.

Distribution and outcomes of paediatric anaesthesia services in Sweden: an epidemiological study

BackgroundCentralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. MethodsIn this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019–22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. ResultsData from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30–39) compared with other university hospitals (95% CI 6.1–12), county (95% CI 1.9–4.8), district (95% CI 0.07–2.2), and smaller hospitals (95% CI 0.0–22). ConclusionsMost procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants.

Effective Epidural Analgesia during Labor: A Feasible Method to Decrease Unnecessary Cesarean Deliveries in Thailand

Thailand has reported a high rate of cesarean delivery (45%–55%), prompting global concern about an increase in cesarean delivery rates. Fear of labor pains is one of the most common reasons pregnant women opt for cesarean delivery. Labor pain is associated with cervix dilation and fetal descent into the birth canal, which is exacerbated by ischemic pain caused by uterine contraction. Modern medical and non-medical techniques have demonstrated efficacy in reducing pain and ensuring safety during labor and delivery. Neuraxial labor analgesia is a highly effective medical pain relief method but has no effect on the rate of cesarean or assisted vaginal delivery. Medication administration for pain relief during labor, using a combination of a local anesthetic and an opioid, was observed to be transmitted across the placenta to the fetus, but had no significant effects on fetal outcomes in mothers who chose epidural analgesia. There are several techniques for administering neuraxial labor analgesia that can be customized for each pregnant woman. To achieve the most wonderful feasible labor and delivery experience, effective epidural labor analgesia is a crucial technique for reducing anxiety and suffering about labor pain. It is safe, widely used world-wide, and effective. Implementing a policy to increase public and medical providers awareness and acceptance of labor pain relief, as well as establishing a safe obstetric anesthesia service provided by obstetric anesthesiologists, could improve maternal and neonatal safety while significantly lowering the rate of unnecessary cesarean deliveries.

Parental Acceptance of Dental Treatment Options for Primary Teeth

Introduction: Due to the importance of preserving baby teeth, it is necessary for parents to have correct information about dental services for these teeth, the present study was conducted with the aim of investigating the acceptance of suggested treatments for baby teeth by parents. Methods: In this descriptive-cross-sectional study, 218 parents of children under 12 years old who were referred to the Pediatric Dentistry Department of Yazd Faculty of Dentistry in 2022 were randomly included in this study. The acceptance rate of dental treatments was asked by a checklist with 7 comprehensive questions and the answers were recorded. Data were analyzed using SPSS version 16 and Chi-square statistical test. Results: Out of 218 parents who participated in this study, 38 (17.4%) were male and 180 (82.6%) were female. The most acceptable treatments by parents were: pulp treatment (98.6%), dental radiographs (97.7%), tooth extraction (97.2%) and stainless-steel crowns (95%). The lowest rate of acceptance was for general anesthesia (23.4 %), fissure sealant (30.7 %) and sedation technique (36.2 %), respectively. Acceptance of fluoride gel and sedation by mothers was significantly higher than fathers (P <0.05). No statistically significant difference was observed in terms of the age and gender of the child with the acceptance of treatment by their parents (P<0.05). Conclusion: Based on the findings of the present study, the most and the least acceptable treatments according to parents were pulp therapy and general anesthesia services, respectively. Parents' level of education, monthly income, child's age،, and gender did not have a significant impact on parents' acceptance of treatment.

A Cognitive Load Theory Perspective of the Undergraduate Anesthesia Curricula in South Africa.

Safe anesthesia is indispensable to achieve global safe surgery and equitable health care access. The disease burden and lack of specialists in South Africa (SA) require junior, nonspecialist doctors to be fit-for-purpose from day 1 when they provide anesthetic services in peripheral hospitals with limited supervision. Graduating students report low self-perceived preparedness for administering anesthesia, but it is not known how their curricular experiences influence their learning. Cognitive load theory defines intrinsic, extraneous, and germane cognitive loads (subtypes). Intrinsic load relates to learning tasks, extraneous load to distractions, and germane load to students' learning processes. This study used a cognitive load theory lens to explore SA students' experiences of their undergraduate anesthesia training. In a constructivist cross-sectional descriptive study, we explored the qualitative factors that influenced students' curricular experience of undergraduate anesthesia training in SA. Two investigators analyzed the data independently in an initial coding round. An emerging theme of lack of time to achieve the expected outcomes, prompted the use of cognitive load theory as a conceptual framework for further analysis by the 3 authors. The subsequent analysis informed the development and refinement of a final cognitive load theory framework for anesthesia training, the COLOAD (COgnitive LOad in Anesthesia eDucation) framework. Data were collected between November 2017 and February 2019. The 1336 respondents (79% participation) reported a variety of determinants of learning pertaining to all 3 cognitive load subtypes. Participants were novices in an inherently complex environment and experienced a high cognitive load during anesthesia training. The number-, complexity-, and interactivity of tasks influenced intrinsic load, while extraneous load was affected by ineffective instructional methods, external- and internal distractors. Program design, metacognition, and learner motivation impacted germane load. Cognitive load theory provided a useful theoretical basis for understanding students' curricular experiences. The COLOAD framework suggests a microlevel interrelatedness of the constituting elements of the 3 cognitive load subtypes. This has implications for curriculum design, pedagogy, and student support. Learning outcomes development and curriculum mapping are important to ensure a lean curriculum, but measures to enhance germane cognitive load might be equally important to achieve competence. Attention to the hidden curriculum and active promotion of reflective practice might reduce cognitive load in complex learning environments such as anesthesia training.

Impact of changes in anaesthesia staff assignments on billing compliance, financial margins, and costs of anaesthesia services: development and application of a margin-cost estimation tool

BackgroundThe US Centers for Medicare and Medicaid Services provide guidelines for the coverage of anaesthesia residents and certified registered nurse anaesthetists (CRNAs) by anaesthesiologists. We tested the hypothesis that changes in the anaesthesia staffing model increase billing compliance. MethodsWe analysed 13 926 anaesthesia cases performed between September 2019 and November 2019 (baseline), and between September 2020 and November 2020 (after change in staff model) at a US academic medical centre using an estimation tool. The intervention was assignment of additional 12-h weekday CRNAs plus an additional anaesthesiologist who covered weekdays after 17:00, weekends, and holidays. The proportion of cases with billing compliant coverage (covered either by solo anaesthesiologist or anaesthesiologist covering two or fewer residents or four or fewer CRNAs) was analysed using logistic and segmented regression analyses. ResultsThe change in staff model was associated with a decrease in non-optimal anaesthesia staff assignments from 4.2% to 1.2% of anaesthesia cases (adjusted odds ratio 0.25; 95% confidence interval [CI] 0.20–0.32; P<0.001) and an increase in billable anaesthesia units of 0.6 per anaesthesia case (95% CI 0.4–0.8; P<0.001). An increased revenue margin associated with optimal staffing levels would only be achieved with salary levels at the 25th percentile of relevant benchmark compensation levels. Total staff overtime for all anaesthesia providers decreased (adjusted absolute difference −4.1 total overtime hours per day; 95% CI −7.0 to −1.3; P=0.004). ConclusionsImplementation of a change in anaesthesia staffing model was associated with improved billing compliance, higher billable anaesthesia units, and reduced overtime. The effects of the anaesthesia staff model on revenue and financial margin can be determined using our web-based margin-cost estimation tool.

Improving the Functionality of the Electronic Health Record System through the Development of the Anesthesia Module

Background: With the advancement of healthcare technology, the use of Electronic Health Records (EHR) has become more effective, providing benefits such as cost reduction, improved healthcare quality, and enhanced data recording and mobility. To remain effective, EHRs must meet requirements such as data completeness, failure resilience, high availability, and security. Pekanbaru army hospital has adopted EHR since 2022 for several main services, except for the anesthesia service. The anesthesia service still uses paper records, which are inefficient and lag behind other services. The anesthesia process, involving extensive information and coordination, greatly requires an EHR system. The development of an anesthesia module is expected to facilitate anesthesiologists and nurse anesthetists in managing patient medical information and assist in the execution of surgical procedures. Objective: This study aims to improve the functionality of the electronic health record system (EHRS) in managing medical records in the anesthesia installation service by developing an anesthesia module at the Pekanbaru Army Hospital. Method: The software development methodology used in this research is Agile Methodology where the process of analyzing user needs, collecting data, implementing the system, and evaluating and validating the system. Result: The Anesthesia Module that has been built has various features including: anesthesia patient registration, pre-anesthesia patient data recording, anesthesia induction, post-anesthesia, anesthesia reports, and integration with laboratory and radiology systems. Through testing carried out with the black box test technique, 98% of the system functionality runs well and with the user acceptance test technique, 94% of the system functionality can be accepted by users.

Development of the LAPOR PAK System for Pre-Anesthesia and Patient Condition Information to Enhance Anesthesia Service Quality

Development of the LAPOR PAK System for Pre-Anesthesia and Patient Condition Information to Enhance Anesthesia Service Quality

Enhanced perioperative communication elevates patients' understanding, perception, and satisfaction for anesthesia services: Insights from a survey study.

Anesthesiologists' services extend to many critical areas of any healthcare setup. However, there needs to be more understanding among the public regarding their crucial role. Preanesthesia evaluation (PAE) visits can disseminate information about anesthesiologists and services. We aimed to evaluate patient's knowledge and the impact of interview-based surveys on increasing knowledge about anesthesiologists and anesthesia services. It was a single-center, cross-sectional survey involving 550 patients aged 18-65 undergoing elective surgeries. Pre- and postoperative interviewer-assisted questionnaires were administered to assess patients' baseline knowledge and perception of anesthesia and anesthesiologists. Statistical analysis focused on demographic, educational, and previous anesthesia exposure among subgroups; a P-value <0.05 was considered significant. Less than half comprehended anesthesia's role as a specialist in inducing unconsciousness. 55.3% were unaware of general anesthesia, and 69.6% were unaware of regional anesthesia as a technique. Higher education and previous anesthesia exposure correlated with better awareness with regard to the perioperative role of anesthesiologists and their fields of work (P < 0.05). The postoperative survey indicated good satisfaction with anesthesiologists' services, which might be attributable to the survey-based interaction. A significant need for more understanding regarding anesthesia and anesthesiologists' roles still prevails. Interview-based effective communication during PAE visits, perioperative period, and shared decision-making (SDM) improves patients' knowledge, comprehension, and satisfaction.

Obstetric Anesthesia Manpower and Service Provision Issues: Introduction and European Perspective

Obstetric Anesthesia Manpower and Service Provision Issues: Introduction and European Perspective

The correlation of risk factors with mortality of geriatric patients in non-operating room anesthesia services

The correlation of risk factors with mortality of geriatric patients in non-operating room anesthesia services

Non-physician anaesthesia providers’ perspectives on task sharing practices in Zambia and Somaliland: a qualitative study

IntroductionThe 68th World Health Assembly, in 2015, called for surgical and anaesthesia services strengthening. Acknowledging the healthcare staff shortages, they referred to task sharing, among others, as a more effective...

Subjective items to be considered in lipoabdominoplasty procedures under epidural anesthesia to increase their satisfaction

Background: Patient satisfaction is increasingly recognized as a vital indicator of healthcare service quality. It aids in identifying healthcare system shortcomings and improving patient trust. Factors influencing patient satisfaction during anesthesia services have been studied globally, but there is a lack of research in the context of lipoabdominoplasty under combined lumbar spinal-epidural anesthesia (CLSEA). Objective: To evaluates patient satisfaction with lipoabdominoplasty under CLSEA, focusing on various intraoperative factors that may affect satisfaction. Patients and Methods: This prospective observational cross-sectional study included adult patients undergoing lipoabdominoplasty under CLSEA without complications. Patients completed a structured questionnaire assessing satisfaction with intraoperative care. The questionnaire addressed factors related to the information provided, decision-making involvement, physical comfort, emotional support, and respect for patient values. Results: The questionnaire encompassed three types of questions: anesthesia quality, factors causing intraoperative annoyance, and patient-team interaction. The majority of patients found epidural anesthesia favorable. Factors causing moderate annoyance included surgery duration, stress, fixed position, feeling cold, and shivering. Patients reported low annoyance with factors like team discussions, anxiety, surgical light, dizziness, thirst, itching, nausea, vomiting, noise, pain, and dyspnea. Patients generally had a high rate of good reactions toward the surgical team, but less than 50% requested more respect and thorough medication information. Conclusion: This study offers insights into patient satisfaction with lipoabdominoplasty under CLSEA, shedding light on factors affecting their experiences. The findings underline the importance of addressing patient concerns and expectations to enhance overall satisfaction and quality of care.

Advances in pediatric anesthesia services over the past 10 years in French-speaking sub-Saharan Africa.

To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French-speaking sub-Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French-speaking SSA over the past 10 years (2013-2022). This is a descriptive, multicenter, cross-sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. Progress have been made over the last 10 years in French-speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French-speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated.