Physician Anesthesiologists Research Articles

The Empathic Patient Centered Approach in the Anesthetic Preoperative Interview

Background: Multiple studies in the primary care field have indicated the benefits of using a patient centered approach in communication with the patient; such interviewing methods have been shown to improve patient satisfaction and adherence. There is a scarcity of anesthetic literature regarding communication skills in the perioperative period. The goal is to analyze to what extent empathic patient-centered communication methods are being used by anesthesia providers. Communication scores will be compared among providers, as well as to providers across several different subspecialties. Methods: This study is an observational descriptive study at a large tertiary care center, University Hospital in Newark, NJ. The observer observes and grades patient interviews, scoring against established criteria using an adapted version of the Kalamazoo grading tool. The researcher observes and grades the preoperative interview using the adapted Kalamazoo scale. At the end of the observed encounter, the anesthesia providers are asked to fill out a brief form detailing their demographic history, details regarding the providers’ length and type of clinical education and training, undergraduate education, previous communication training, number of years of practice, primary language, gender, and age will be obtained. Results: Anesthesia providers included in the study were physician anesthesiologists, residents, and nurse anesthetists. The average Kalamazoo score was 28.7 amongst all providers. There was no significant effect of provider level on the score at the p Conclusions: The data revealed anesthesia providers provide patient-centered encounters with a mean score of 28.7, which is higher than the average for providers from multiple different specialties observed in Joyce, et al. study (mean score of 25.25). The subcategories “Understanding patient’s perspective” and “reaches agreement” scored 3.86, and 3.83, respectively. This may indicate that anesthesia providers can improve on allowing the patient to communicate their understanding of anesthesia, as well as collecting information from the patient that can affect their anesthesia (i.e., severe nausea following previous anesthesia).

Knowledge, attitudes and practices of health professionals towards postoperative pain management at a referral hospital in Ethiopia

BackgroundPostoperative pain (POP) is a form of acute pain following surgery. It results from tissue injury during surgical procedure like skin incision, tissue dissection, manipulation and traction. It is one of the immediate postoperative complications. Despite new standards, guidelines and different strategies the practice of postoperative pain management is found to be inadequate. We aimed to assess knowledge, attitude and practice on postoperative pain management practice among Health professionals working at Debre Tabor Referral Hospital. MethodInstitution based cross-sectional study was conducted to assess Knowledge, Attitudes and Practices of Health professionals regarding to Post-operative pain management at Debre Tabor Referral Hospital 2020 from 118 health professionals. Data was collected using structured self-administered questionnaire and was verified, coded and entered to Epi Info Software version 3.5.4 and then it was exported and analyzed by SPSS version 20 Software. After analysis frequency and percentages was used to summarize the finding. ResultThe overall finding of the study revealed that health professionals had good knowledge (58.4%), unfavorable attitude (44.9%), and poor practice (24.58%) towards post-operative pain management. ConclusionNon physician anesthetists have good knowledge, attitude and practice towards post-operative pain management. But the overall attitude and practice of health professionals’ towards post-operative pain management is poor.

Curious Case of the Pretracheal Stethoscope

Curious Case of the Pretracheal Stethoscope

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

A Review of Current Literature of Interest to the Office-Based Anesthesiologist

History of non-physician anaesthesia providers in Papua New Guinea: from heil tultuls to Anaesthetic Scientific Officers.

The most recent estimates, published in 2016, have indicated that around 70% of anaesthesia providers in Papua New Guinea are non-physician anaesthetic providers and that they administer over 90% of anaesthetics, with a significant number unsupervised by a physician anaesthetist. Papua New Guinea has a physician anaesthetist ratio estimated to be 0.25 per 100,000 population, while Australia and New Zealand have a ratio of 19 physician anaesthetists per 100,000, which is 75 times that of Papua New Guinea. To reach a ratio of seven per 100,000, recommended as the minimum acceptable by the Lancet Commission in 2016, there will need to be over 35 practitioners trained per annum until 2030, at a time when the average annual numbers of recent years are less than three physicians and less than five non-physician anaesthetic providers. We review the development of anaesthesia administered by non-physician indigenous staff and the stages of development from heil tultuls, dokta bois, liklik doktas, native medical assistants, aid post orderlies, and Anaesthetic Technical Officers up to the current Anaesthetic Scientific Officers having attained the Diploma in Anaesthetic Science from the University of Papua New Guinea.

Anesthesia Care Provided by Nurses


 One systematic review, 4 primary studies (observational studies: 3 retrospective and 1 prospective), and 1 economic evaluation were identified.
 A definitive conclusion is not possible regarding the clinical effectiveness of anesthesia provided by non-physician anesthetists compared with physician anesthetists, considering the evidence was from studies of low quality that were associated with considerable risk of bias, and there were inconsistencies in the findings.
 The incremental cost-effectiveness ratio (ICER) for physician anesthesiologists compared with nurse anesthetists was US$77,400 per quality-adjusted life-year (QALY) gained. The 1-way sensitivity analyses showed that with an increase in the cost of nurse anesthetist professional services or an increase in the number of unexpected hospital days, the ICER values would fall below US$50,000 per QALY gained.

Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally

BackgroundOne of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown.MethodsA survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May–June 2019.ResultsNo providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance).ConclusionsNo providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.

Operating Room Drugs and, Consumables Distribution Systems: Knowledge, Attitude and, Practice among Operating Room Workforce in a Tertiary Hospital in the Developing World

Drug and consumables distribution system in the operating room is key to the smooth running of the operating room in any hospital. Technological advancements have led to the development of newer and more efficient distribution systems. We aim to assess the knowledge, attitude and, practice of drug and consumable distribution systems among operating room workforce of a tertiary hospital in Nigeria. The study was a questionnaire-based cross-sectional study among the various categories of professionals of the operating room workforce. Two sets of questionnaires with structured questions on the knowledge, attitude and practice of operating room drug and consumables distribution system were administered one after the other on the operating room personnel. 282 of 363 operating room workforce consented and responded to the questionnaires. The workforce is made up of surgeons 198 (70%), physician anaesthetists 28 (10%), nurse anaesthetists 25 (9%) and, perioperative nurses 31 (11%). Their mean age was 42.61+8.74 years, 175 (64%) aged between 30 and 49 years with male to female ratio of 2.9:1. The majority 243 (86%) of respondents did not know the meaning of an operating room drug and consumable distribution system. After explanation, it was discovered that 228 (81%) had experienced the individual prescription order system with its associated wastages 195 (69%), medication errors 130 (46%,) and, delay or scheduling of cases 183 (65%). This study revealed poor knowledge of drug and consumables distribution system among operating room workforce in our institution. The study centre uses individual prescription order system with significant untoward effects. We recommend improved awareness of the theatre workforce on drug and consumable distribution systems.

Partnering Through the Pandemic: How Corporate Partners Pivoted to Support Anesthesiologists During COVID-19

Article| July 2021 Partnering Through the Pandemic: How Corporate Partners Pivoted to Support Anesthesiologists During COVID-19 Debbie Greif Debbie Greif Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor July 2021, Vol. 85, 43. https://doi.org/10.1097/01.ASM.0000758404.83077.e9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Debbie Greif; Partnering Through the Pandemic: How Corporate Partners Pivoted to Support Anesthesiologists During COVID-19. ASA Monitor 2021; 85:43 doi: https://doi.org/10.1097/01.ASM.0000758404.83077.e9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: covid-19, pandemics As Helen Keller once noted, “Alone we can do so little; together we can do so much.” Turns out, that's extra true when managing a crisis. Surviving – and thriving – during a pandemic requires teamwork and collaboration. COVID-19 tested our abilities to pivot quickly, forge new partnerships, and maximize existing resources. In many ways, in many places, and on many fronts, physician anesthesiologists gained the admiration of a nation in distress. Our partnerships were key to that success. From the beginning of the crisis, corporate partners used innovative approaches to technology and education to support ASA members – the physician anesthesiologists who were on the front lines battling the pandemic – and our patients. For example, as hospitals struggled to manage a growing surge of COVID-19 patients, a group of ventilator manufacturers created the Ventilator Training Alliance to put training materials into the hands of practitioners. The seven original... You do not currently have access to this content.

Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda

ObjectiveThis study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed...

Rescanning the Alternative Payment Model Horizon for Physician Anesthesiologists

Payment & Practice Management| June 2021 Rescanning the Alternative Payment Model Horizon for Physician Anesthesiologists David P. Martin, MD, PhD, FASA; David P. Martin, MD, PhD, FASA Search for other works by this author on: This Site PubMed Google Scholar Vanessa Salcedo, MPH; Vanessa Salcedo, MPH Search for other works by this author on: This Site PubMed Google Scholar Sharon K. Merrick, MS, CCS-P Sharon K. Merrick, MS, CCS-P Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor June 2021, Vol. 85, 38–39. https://doi.org/10.1097/01.ASM.0000754272.06470.61 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation David P. Martin, Vanessa Salcedo, Sharon K. Merrick; Rescanning the Alternative Payment Model Horizon for Physician Anesthesiologists. ASA Monitor 2021; 85:38–39 doi: https://doi.org/10.1097/01.ASM.0000754272.06470.61 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Topics: delivery of health care, medicare, value-based care, fee for service payment plan, accountable care organizations, bundled payments for care improvement (bpci) initiative In the future, you probably won't be paid simply for what you do. Increasingly, physician anesthesiologists receive payment through arrangements that tie dollars to quality, outcomes, and value. This shift toward value-based payment has been accelerated by the COVID-19 pandemic. The Payment and Practice Management column in the August 2019 edition of this publication scanned the Alternative Payment Model (APM) horizon. Much has changed since then and many ASA members remain confused about APMs. This article provides an updated overview about the APM horizon and spotlights what ASA committees and staff are doing to ensure physician anesthesiologists are prepared to participate actively and meaningfully in APMs and other value-based arrangements. This article focuses on Medicare APMs. Commercial APMs will be covered in future articles. The 2015 passage of the landmark Medicare Access and CHIP Reauthorization Act (MACRA) created the Quality Payment Program (QPP). The QPP is pivotal in the attempt... You do not currently have access to this content.

Sharing the Story of How Physician Anesthesiologists are ‘Made for This Moment’ and Other ASA Public Relations Initiatives

Sharing the Story of How Physician Anesthesiologists are ‘Made for This Moment’ and Other ASA Public Relations Initiatives

John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero.

A 19th century physician was crucial to the establishment of 2 medical specialties-anesthesiology and public health. Everyone whose interest in public health has increased in the last year will be amazed at Dr John Snow's career in anesthesiology. Those who recognize him as the first full-time physician anesthetist will be struck by his development of medical mapping during the Cholera Pandemic of 1848, resulting in one of the fundamental techniques of epidemiology and public health that has continued through today. Snow's accomplishments in anesthesiology and epidemiology reflected a concatenation of science, focus, and creativity. His training in the early 19th century integrated science, medicine, and his keen interest in respiratory physiology. His early clinical exposure to colliery workers in Newcastle was likely influenced by the earlier development of pneumatic medicine. He was committed to the notion that chemistry, especially the use of medicinal gases, would be transformative for medicine. Thus, he was "primed" when the news of the American anodyne ether reached London in 1846. When the third cholera pandemic reached London shortly thereafter, in the fall of 1848, his academic and practical understanding of gas chemistry and pharmacology, respiratory physiology, and anesthetic agents led him to question the popularly promulgated miasma-based theories of transmission. His methodical investigations, research, and perseverance were mirrored in his scholarly work, numerous presentations, and public advocacy. He articulated many scientific principles essential to the early practice of anesthesia-anesthetic potency, quantitative dosing of anesthetic agents, engineering principles required for conserving the latent heat of vaporization, and minimizing the contribution of anesthetic equipment to airway resistance. He moved easily and methodically between these worlds of physiology, chemistry, engineering, clinical medicine, and public health. In his role as the first medical epidemiologist, Snow understood the power of medical mapping and the graphic presentation of data. He was a pioneer in 2 nascent fields of medicine that were historically and remain contemporarily connected.

Is a Mean Arterial Pressure Less Than 65 mm Hg an Appropriate Indicator of the Quality of Anesthesia Care?

Is a Mean Arterial Pressure Less Than 65 mm Hg an Appropriate Indicator of the Quality of Anesthesia Care?

Ethical dilemmas in anesthesia mission trips.

Health inequities continue to exist globally especially when it comes to surgical and anesthesia services. Due to the lack of physician anesthesiologists in low- and middle-income countries, there has been an increase in the number of medical mission trips. Although these volunteers are attempting to fulfill a need they must be mindful and remember to adhere to ethical principles as they work collaboratively with host institutions. We will review the ethical dilemmas inherent in anesthesia mission trips. Physician volunteers for medical missions may cause significant harm to patients and host communities if they do not work in tandem with host institutions. Medical missions fulfill acute medical needs and have the opportunity to make a positive contribution to host communities by fulfilling local needs and supporting educational efforts for local providers.

Join Us in Advocating for Your Specialty During Physician Anesthesiologists Week 2021

Join Us in Advocating for Your Specialty During Physician Anesthesiologists Week 2021

The Power in Sharing Why Physician Anesthesiologists Are Made for this Moment

The Power in Sharing <i>Why Physician Anesthesiologists Are Made for this Moment</i>

2020 State Affairs Year in Review

Article| December 2020 2020 State Affairs Year in Review Erin Mahrt, JD; Erin Mahrt, JD Search for other works by this author on: This Site PubMed Google Scholar Jason Hansen, MS, JD Jason Hansen, MS, JD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor December 2020, Vol. 84, 44–45. https://doi.org/10.1097/01.ASM.0000724096.21174.b7 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Erin Mahrt, Jason Hansen; 2020 State Affairs Year in Review. ASA Monitor 2020; 84:44–45 doi: https://doi.org/10.1097/01.ASM.0000724096.21174.b7 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Working with ASA's state components and grassroots members, the ASA Department of State Affairs faced a challenging and busy 2020. During the year, the team reviewed more than 2,000 pieces of legislation and at least 1,000 proposed regulations to assist state component societies as they work to protect patient safety in each state. Ultimately, there were no new independent practice states, a number of strong efforts to protect patients against misleading nursing titles, and importantly, patient safety guardrails put in place for several COVID-19-related executive orders impacting physician oversight of nurse anesthetists. COVID-19: This was a unique year for physician anesthesiologists, care team members, state lawmakers, governors, and citizens as the country dealt with, and continues to deal with, a public health crisis caused by the spread of COVID-19. During this pandemic, several state officials acted through executive... © 2020 American Society of Anesthesiologists (ASA), All Rights Reserved.2020 You do not currently have access to this content.

PRACTICE MANAGEMENT™ 2021: Innovation Through Adversity and Adaptation

Article| December 2020 PRACTICE MANAGEMENT™ 2021: Innovation Through Adversity and Adaptation Alexander S. Choi, MD, MPH, FASA Alexander S. Choi, MD, MPH, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor December 2020, Vol. 84, 48. https://doi.org/10.1097/01.ASM.0000724112.99571.d1 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Alexander S. Choi; PRACTICE MANAGEMENT™ 2021: Innovation Through Adversity and Adaptation. ASA Monitor 2020; 84:48 doi: https://doi.org/10.1097/01.ASM.0000724112.99571.d1 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAll PublicationsASA Monitor Search Advanced Search Resilience has never been more defining for anesthesia practices than during this past year. PRACTICE MANAGEMENT 2020 had just concluded when all of us started hearing more about a novel coronavirus that was spreading internationally. Within a few short months, we were in the middle of a pandemic that was infecting many people and bringing them to our hospital's doorsteps and, at the same time, closing our ORs. Through these incredibly difficult times, physician anesthesiologists stepped up to help in various areas of the hospital, including taking care of COVID-19 patients in the ICUs. The phrase “the new normal” became widespread as we adjusted to the changes that were created. One of these changes was the shift from in-person meetings to the ubiquitous virtual meetings. The ASA PRACTICE MANAGEMENT conference (January 29–31, 2021) is no exception. The ANESTHESIOLOGY 2020... © 2020 American Society of Anesthesiologists (ASA), All Rights Reserved.2020 You do not currently have access to this content.

Assessment of Anesthesia Capacity in Public Surgical Hospitals in Guatemala.

International standards for safe anesthetic care have been developed by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). Whether these standards are met is unknown in many nations, including Guatemala, a country with universal health coverage. We aimed to establish an overview of anesthesia care capacity in public surgical hospitals in Guatemala to help guide public sector health care development. In partnership with the Guatemalan Ministry of Public Health and Social Assistance (MSPAS), a national survey of all public hospitals providing surgical care was conducted using the WFSA anesthesia facility assessment tool (AFAT) in 2018. Each facility was assessed for infrastructure, service delivery, workforce, medications, equipment, and monitoring practices. Descriptive statistics were calculated and presented. Of the 46 public hospitals in Guatemala in 2018, 36 (78%) were found to provide surgical care, including 20 district, 14 regional, and 2 national referral hospitals. We identified 573 full-time physician surgeons, anesthesiologists, and obstetricians (SAO) in the public sector, with an estimated SAO density of 3.3/100,000 population. There were 300 full-time anesthesia providers working at public hospitals. Physician anesthesiologists made up 47% of these providers, with an estimated physician anesthesiologist density of 0.8/100,000 population. Only 10% of district hospitals reported having an anesthesia provider continuously present intraoperatively during general or neuraxial anesthesia cases. No hospitals reported assessing pain in the immediate postoperative period. While the availability of some medications such as benzodiazepines and local anesthetics was robust (100% availability across all hospitals), not all hospitals had essential medications such as ketamine, epinephrine, or atropine. There were deficiencies in the availability of essential equipment and basic intraoperative monitors, such as end-tidal carbon dioxide detectors (17% availability across all hospitals). Postoperative care and access to resuscitative equipment, such as defibrillators, were also lacking. This first countrywide, MSPAS-led assessment of anesthesia capacity at public facilities in Guatemala revealed a lack of essential materials and personnel to provide safe anesthesia and surgery. Hospitals surveyed often did not have resources regardless of hospital size or level, which may suggest multiple factors preventing availability and use. Local and national policy initiatives are needed to address these deficiencies.