Physician Anesthesiologists Research Articles

Abstract 110: Introduction of a Mechanical Chest Compression Device for In-hospital Cardiac Arrest During the Covid-19 Pandemic

Introduction: Cardiopulmonary resuscitation (CPR) for hospitalized patients during the COVID-19 pandemic presents unique challenges to resuscitation teams, including a potentially increased risk from virus aerosolization. As such, the American Heart Association has published guidance, which includes a suggested use of mechanical chest compression devices if available. We herein describe the experience at a tertiary care hospital with a high COVID-19 case load, where mechanical compression devices were rapidly deployed early in the pandemic. Methods: In April 2020, two LUCAS® chest compression systems were deployed and staff trained in their use. In June 2020, an electronic survey was developed that explored experiences of resuscitation providers who responded to in-hospital cardiac arrests (IHCA) during the pandemic. The survey was sent to the physician code leaders, anesthesiologists, and intensive care nurses who had responded to IHCAs. Results: Forty-four (58%) of 76 surveys were returned. There were 21 IHCAs during the study period. Of the respondents, 15 (34%) were nurses and 14 (31.8%) were medical trainees. Thirty-two (73%) respondents had been involved in an IHCA where the LUCAS® was deployed. Ten (31.3%) respondents agreed/strongly agreed that transferring to the LUCAS® backboard was difficult, and that it was difficult to latch the LUCAS® to the backboard. Twelve (37.5%) respondents believed that the LUCAS resulted in delays in care. Twenty-two (68.8%) respondents thought that LUCAS® resulted in a more controlled resuscitation experience, 20 (62.5%) felt the LUCAS® improved the quality of chest compressions, and 23 (71.9%) reported that the LUCAS® allowed for fewer people in the room. Those who responded to arrests where the LUCAS® was not deployed, reported patient size and difficulty attaching the device as common obstacles. Conclusions: Rapid deployment of mechanical chest compression devices during the COVID-19 pandemic is feasible. Although there are substantial technical challenges, most report a more controlled resuscitation experience, better compression quality, and fewer individuals in the room. Additional staff training may be necessary to achieve optimal results.

The Science Behind the Term ‘Physician Anesthesiologist’ and ASA's New Awareness Campaign

The Science Behind the Term ‘Physician Anesthesiologist’ and ASA's New Awareness Campaign

Anaesthetic practices in the gynaecology and obstetric department in the principal health facilities of Butembo city, Eastern of the Democratic Republic of the Congo

Background: The practice of anaesthesia should be team work involving Obstetrician and Anesthesiologist to determine the anaesthetic and surgical needs of the patient in order to have a successful plan for the baby and mother. The aim of this survey was to evaluate the practice of anesthesia in obstetric and gynaecology department in the principal health facilities of Butembo city. Methods: A prospective and observational descriptive study was done in four health facilities of Butembo city, from January 1st, 2015 to December 31st, 2019. Results: 64.86% of obstetrical and gynaecological procedures were done under spinal anaesthesia. General anaesthesia with an endotracheal tube was performed in 2.97% of the cases, the laryngeal mask in 0.10% and intra venous anaesthesia without any airway support in 96.93% of the cases. 100% of the cases had benefited from a pre-anaesthetic consultation; 77.75% anaesthesia was administered by anaesthetic officers. 53,27% of the patients were classified as ASA I and 77.25% of cases were electives. Caesareans accounted for 87.83% of emergency cases and 70.73% of elective cases. The pre-medication consisted of atropine and diazepam in 31,02%. Bupivacaine was used for spine anaesthesia in 66.87%. Maintenance during general anaesthesia with ketamine was done in 98.72%. Pethidine was the analgesic used in intraoperative in 48.00%. Tramadol was the most used drugs for pain management in post operative period. Adverse events were recorded in 2.94% of the patients; hypotension was noted in 39,27%. 24 maternal deaths were recorded. Fifteen among them died due to complication related to anaesthesia. There is a dependency between the accidents and complications and qualification of anaesthetists. Conclusion: Anaesthesia is commonly used in the gynaecology and obstetric department. It is important to promote continuous training of Non Physician Anaesthetists as well as Consultants Anaesthesiologists in order to practice safe anaesthesia for the well being of our patients. Spinal anaesthesia was the common used predominantly with few adverse events to the mother and foetus.

Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report

BackgroundRegional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SourcesHospital records and interviews with individuals familiar with the case. FindingsAn otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. ConclusionSpinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.

Anesthesiologists in Spotlight During Pandemic

ASA News| July 2020 Anesthesiologists in Spotlight During Pandemic ASA Monitor July 2020, Vol. 84, 35. https://doi.org/10.1097/01.M99.0000688748.96876.29 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 Anesthesiologists in Spotlight During Pandemic. ASA Monitor 2020; 84:35 doi: https://doi.org/10.1097/01.M99.0000688748.96876.29 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 As the world faced unprecedented times and a global health care pandemic, physician anesthesiologists have taken their experience into a critical care setting to lead care for the sickest of COVID-19 patients. The specialty's expertise and leadership was hailed by ABC News, calling physician anesthesiologists “special heroes in the fight against coronavirus” and have been consistently featured in media coverage and on social channels. Outreach efforts to highlight the critical role of physician anesthesiologists during the pandemic first began in February with the promotion of ASA's recommendations for providers on caring for patients with COVID-19 and continued throughout March and April as ASA issued statements, news releases and alerts to highlight critical issues and information such as addressing the shortage of personal protective equipment (PPE), increasing access to ventilators by repurposing anesthesia gas machines, discussing the potential dangers of sharing ventilators, addressing drug shortages, advocating for economic support of the... You do not currently have access to this content.

Barriers to Effective Transfusion Practices in Limited-Resource Settings: From Infrastructure to Cultural Beliefs.

BackgroundSurgery and anesthesia are indivisible parts of health care, but safe and timely care requires more than operating rooms and skilled providers. One vital component of a functional surgical system is reliable blood transfusion. While almost half of all blood is donated in high-income countries (HICs), over eighty percent of the global population lives outside of these countries. High-income countries have on average 30 donations per 1000 people, and the average age of transfusion recipient is over 65. Most low-income countries (LICs) have fewer than five donations per 1000 people, where maternal hemorrhage and childhood anemia are the most common indications for transfusion. In LICs, greater than 50% of blood is administered to children under 5 years of age. This study aims to snapshot, by survey, available resources for transfusion and then discusses the infrastructure and cultural barriers to optimal transfusion practice.MethodsIn January 2019, a 10-question survey was sent electronically to physician anesthesiologists working in low- and middle-income countries to examine resources and practice patterns for blood transfusion. Subsequent discussions illustrate obstacles contributing to low availability of blood products and illuminate infrastructure and cultural barriers preventing optimal transfusion practices.Survey ResultsAcquiring whole blood takes hours. Clinicians wait days to receive packed red blood cells or platelets. Fresh frozen plasma is available but untimely. For many, protocols for massive transfusion are rare, and for transfusion, ratios are nonexistent. Complete blood counts take hours, and coagulation profiles are severely delayed.Discussion of Infrastructure and Cultural BarriersWith few voluntary, unpaid, donors and inconsistent supply of testing kits, donated blood is unsafe. Donors are seasonal for farming communities, endemic malaria areas, and student donors recruited through schools. Cultural beliefs fuel distrust. Transfusion specialists, concentrated in urban areas, see rural patients presenting late. Inadequate triaging and supervision jeopardize patients to shock. Inadequate blood storage leads to waste. Modeling systems from HICs fail to overcome hurdles faced by clinicians working with distinctive belief systems and unique patient populations.

Anesthesia Care and Anesthesia Care Providers: Ambiguities in Terminologies

The designated titles for various levels of anesthesia care providers have been evolving. Enormous confusions regarding these titles exist due to ever-changing delivery of anesthesia care and other factors such as conflicting political and financial interests. Confusions exist between the terms of 'Anesthesiology care' and 'Anesthesia care', Anesthesiologist and Certified Registered Nurse Anesthetist (CRNA), CRNA and Certified Anesthesiologist Assistant (CAA), 'Anesthesia clinician' and 'Anesthesia provider', and Anesthesiologist and Physician anesthesiologist. Studies comparing the difference between anesthesia care delivered by physician anesthesiologist and CRNA showed conflicting results. The likely changes in anesthesia care have also been discussed in the article.

Regional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre–post evaluations

Background and objectivesEducational initiatives are a sustainable means to address provider shortages in resource-limited settings (RLS), yet few regional anesthesia curricula for RLS have been described. We sought to design...

Economic Shocks From the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices.

Economic Shocks From the Novel COVID-19 Pandemic for Anesthesiologists and Their Practices.

Operating Room Leadership and Perioperative Practice Management, 2nd ed

Operating Room Leadership and Perioperative Practice Management is a revised second-edition textbook, intended to be an up-to-date resource for all aspects of operating room management. This edition has 11 new chapters and there has been a substantial revision to the 27 chapters that were retained from the first edition. The book is organized into 5 sections: (1) leadership and strategy; (2) economic considerations, efficiency, and design; (3) surgical and anesthesia practice management; (4) nursing; and (5) safety, standards, and information technology. The contributors to the book are experts in their fields and the majority of the 71 authors are department chairs, medical center chief executive officers, executive directors, or directors of coding or compliance. One of the strengths of this book is the clarity of writing. Each chapter is approximately 10–15 pages in length. The chapters deconstruct complex topics, provide clear definitions for commonly used terms, and, most importantly, provide concrete anesthesia-specific examples. Figures and tables supplement almost every chapter and highlight key learning points. The section on leadership and strategy is perhaps one of the best-written sections of the book, as many of the principles commonly used in the business world are not familiar to many practicing anesthesiologists, yet the reader is given a sufficient primer to have a functional understanding of the relevant tenets. The chapter on The Joint Commission, Center for Medicare and Medicaid Services, and other standards, in particular, is an excellent summary of the history of the modern health care system and the evolution of standards and accreditation over the past century. As the legislative landscape has changed significantly in a relatively short period of time, the authors provide a concise summary of key concepts affecting all anesthesiologists. Another strength of the book is the comprehensive discussion of all aspects of operating room management, from conception of operating room design to staffing and personnel relationships. The authors recognize that the operating room environment is complicated, with its own culture. Successful leaders must understand this complex environment and work collaboratively to effectively manage the operating room. While this overview works well for most chapters, some of the chapters do seem slightly superficial, in particular Chapters 5 (Implications of Emotional Intelligence and Collaboration for Operating Room Leadership and Management), 16 (Efficiency and Scheduling), and 27 (Operating Room Metrics). These chapters have a cursory discussion of 3 very complex topics, leave the reader wanting more information, and do not give the reader the necessary tools to act on the information presented. This might limit the usefulness of the book for someone without existing leadership experience. A further limitation is that the book is intended for use by a multidisciplinary audience, thus some of the information presented, particularly in the preoperative evaluation and management chapter, may seem basic to the established anesthesiologist. Finally, the title of Section 4, “Nursing,” is a bit misleading. While all 3 chapters in this section have nursing implications, the section delves into broader topics, such as staffing and throughput, which are relevant to a broader audience. Ultimately, successful operating room management involves not only administrative efficiency but also knowledge of the legislative landscape and development of high-performing teams who deliver patient care. This book is an excellent primer for physician anesthesiologists who would like to ascend to perioperative leadership roles. While the contents of this book are likely to be a review for experts or established leaders, it is useful for resident trainees, those stepping into leadership positions, or even anesthesiologists who are not in leadership but who would like to better understand the mechanics of operating room management. Nicole Higgins, MDDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisPaloma Toledo, MD, MPHDepartment of AnesthesiologyNorthwestern University Feinberg School of MedicineChicago, IllinoisCenter for Healthcare StudiesNorthwestern University Feinberg School of MedicineChicago, Illinois[email protected]

Adherence to recommended practices for perioperative anesthesia care for older adults among US anesthesiologists: results from the ASA Committee on Geriatric Anesthesia-Perioperative Brain Health Initiative ASA member survey

BackgroundWhile specific practices for perioperative care of older adults have been recommended, little is known regarding adherence by US physician anesthesiologists to such practices. To address this gap in knowledge, the ASA Committee on Geriatric Anesthesia and the ASA Perioperative Brain Health Initiative undertook a survey of ASA members to characterize current practices related to perioperative care of older adults.MethodsWe administered a web-based questionnaire with items assessing the proportion of practice focused on delivery of care to older adults, adherence to recommended practices for older surgical patients, resource needs to improve care, and practice characteristics.ResultsResponses were collected between May 24, 2018, and June 29, 2018. A total of 25,587 ASA members were invited to participate, and 1737 answered at least one item (6.8%). 96.4% of respondents reported that they had cared for a patient aged 65 or older within the last year. 47.1% of respondents (95% confidence interval, 44.6%, 49.7%) reported using multimodal analgesia among patients aged 65 and older at least 90% of the time, and 25.5% (95% CI, 23.3%, 27.7%) provided preoperative information regarding postoperative cognitive changes at least 90% of the time. Over 80% of respondents reported that preoperative screening for frailty or dementia, postoperative screening for delirium, and preoperative geriatric consultation occurred in fewer than 10% of cases. Development of practice guidelines for geriatric anesthesia care and expansion of web-based resources were most frequently prioritized by respondents as initiatives to improve care in this domain.DiscussionMost survey respondents reported providing anesthesia care to older adults, but adherence to recommended practices varied across the six items assessed. Reported rates of screening for common geriatric syndromes, such as frailty, delirium, and dementia, were low among survey respondents. Respondents identified multiple opportunities for ASA initiatives to support efforts to improve care for older surgical patients.

Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

With the prospect of an increasing number of COVID-19 cases and with the city of Sao Paulo being the epicenter of the COVID-19 pandemic in Brazil, Hospital das Clinicas of the Faculdade de Medicina of the Universidade de Sao Paulo (HCFMUSP) initiated an action plan to designate the largest of its eight institutes to the treatment of the disease. With the progressive increase in the number of attended cases, at the end of March 2020, the 900 beds of HCFMUSP [...]

Erratum for: Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

Erratum for: Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis

Anesthesia Provider Training and Practice Models: A Survey of Africa.

In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts.

Establishing a sustainable anaesthetic education programme at Jimma University Medical Centre, Ethiopia.

Lack of continuing education and physician anaesthetist support are commonly cited problems amongst Ethiopian anaesthetic providers. Whilst operating at Jimma University Medical Centre (JUMC), Operation Smile volunteers identified a clear need for improvement in anaesthetic care delivery at JUMC. JUMC is a 450-bed university teaching hospital 350 km southwest of Addis Ababa. At the start of this programme it had two physician anaesthetists, with the majority of anaesthesia historically having been provided by non-physician anaesthesia providers. A visiting lecturer programme was established at JUMC in 2012 following collaboration between two consultant anaesthetists, working for Operation Smile and JUMC respectively. UK trainee anaesthetists in their final years of anaesthetic training volunteered at JUMC for periods of two to six months, providing sustainable education and consistent physician anaesthetist presence to support service provision and training. Over its six-year history, nine visiting lecturers have volunteered at JUMC. They have helped establish a postgraduate training programme in anaesthesia, assisting in the provision of a future physician anaesthetist workforce. Four different training courses designed for low- and middle-income countries (LMICs) have been delivered and visiting lecturers have trained local anaesthetists in subsequent course delivery. Patient safety and quality improvement projects have included introducing the World Health Organization Surgical Safety Checklist, Lifebox pulse oximeters, obstetric spinal anaesthesia packs, improving critical care delivery and establishing two post-anaesthetic care units. Development of partnerships on local, national and global platforms were key to the effective delivery of relevant sustainable education and support. Instilling local ownership proved fundamental to implementing change in the local safety culture at JUMC. Sound mentorship from anaesthetic consultant supervisors both in the UK and in Jimma was crucial to support the UK trainee anaesthetists working in a challenging global setting. This model of sustainable capacity building in an LMIC with a significant deficit in its physician workforce could be replicated in a similar LMIC setting.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Human Factors Evaluation of the Universal Anaesthesia Machine: Assessing Equipment with High-Fidelity Simulation Prior to Deployment in a Resource-Constrained Environment

BackgroundAnesthesia providers in low- and middle-income countries face many challenges, including poor availability of functioning equipment designed to meet their environmental, organizational, and resource constraints. These are serious global health disparities which threaten access to care and patient safety for those who receive surgical care. In this study, we conducted a simulation-based human factors analysis of the Universal Anaesthesia Machine (UAM®), a device designed to support anesthesia providers in austere medical settings. Our team anticipated the introduction of the UAM® to the two major referral hospitals in Freetown, Sierra Leone. A prior observational study had identified these two hospitals as having environmental conditions consistent with an austere environment: an unstable electrical grid, as well as limited access to compressed oxygen, biomedical support, and consumables. Although the Baltimore simulation environment cannot reproduce all of the challenges present in a resource-constrained environment such as Sierra Leone, the major impediments to standard anesthesia machine functionality and human factors-associated use can be reproduced with the use of high-fidelity simulation. Using anesthesia care providers who have limited UAM® familiarity, this study allowed for the examination of machine-user issues in a controlled environment in preparation for further field studies concerning equipment introduction, training and device deployment in Sierra Leone.The goals of this study were: 1. to assess the usability of the UAM® (machine-user interface, simulated patient use, symbology, etc.) across different provider user groups during simulation of use in scenarios depicting routine use in healthy patients, use in clinically challenging patients and use in environmentally-challenging scenarios in a controlled setting devoid of patient risk, and 2. To gather feedback on available UAM manuals and cognitive aides and UAM usability issues in order to guide development of curricula for training providers on use of the UAM® in the intended austere clinical environments. MethodsResidents, fellows, attending physician anesthesiologists, student nurse anesthetists, and nurse anesthetists participated in a variety of simulations involving the Universal Anaesthesia Machine® at the Johns Hopkins Medicine Simulation Center between September 2012 and July 2013. Data collected included participant demographics, performance during simulation scenarios captured with critical action checklists, workload ratings captured with the National Aeronautics and Space Administration Task Load Index (NASA TLX), and participant reactions to UAM® use captured through a post-session survey and semi-structured usability debriefing. The scenarios were: 1. normal use (machine check, induction, and maintenance of an uneventful case), 2. use in a challenging clinical condition (acute onset of bronchospasm) and 3.use in an adverse environmental event (power failure). Critical action checklists and workload ratings were analyzed by Analysis of Covariance (ANCOVA) to control for participant demographics. Usability debriefings were analyzed qualitatively. ResultsThirty-five anesthesia providers participated in the study. Overall participant ratings, observations of performance in simulation scenarios, and usability debriefings indicated a high level of usability for the UAM®. Mean participant ratings were high for ease of use (5.4 ± 0.96) and clarity of instruction (6.2 ± 0.87) on a 7-point scale in which higher ratings indicate more positive perceptions. After adjusting for clinical experience, workload ratings were significantly higher in the bronchospasm scenario than in the normal/routine use (P = 0.046; 95% CI, 0.33–34.7) or power failure scenarios (P = 0.012; 95% CI, 5.24–37.9). Thirty-two specific usability issues were identified and grouped into five themes: device design and labeling, machine use during simulation scenarios, user-anticipated errors or hazards, curriculum issues, and overall impressions of the UAM®. ConclusionsThe UAM® design addresses many of the key challenges facing anesthesia providers in resource-constrained settings. The simulation-based human factors evaluation described here successfully identified opportunities for continued refinement of the initial device design as well as issues to be addressed in future curricula and cognitive aides.

Impact d'une formation sur la prise en charge de l'hémorragie du post-partum

ObjectiveThe aim of the study was to assess the impact of the introduction of training workshops on the quality of prevention and management of Post-Partum Hemorrhage (PPH) in a type III university center. MethodsA clinical audit was carried out in our type III university center before and after the introduction of training workshops on the prevention and management of PPH, in two periods between January 1st to December 31st 2011 and March 1st and August 1st, 2015. Training workshops were according to the recommendations for clinical practice of the National College of Gynecologists-Obstetricians French published in 2014, and included a theoretical portion and a simulation of low fidelity manikin. Data on the management of patients presenting with PPH after vaginal birth of a singleton were retrospectively collected consecutively from medical records. Data were collected using a standardized analytical grid. Between the two data collections, some improvement actions were implemented. ResultsAfter implementation of training workshops, the proportion of patients with active management of the third stage of labor (prophylactic uterotonic after delivery) has significantly improved (72% before, vs. 92% after, P=0.001); time to PPH diagnosis has been significantly higher notified (40% before, vs. 94% after, P<0.001), as well as the quantification of bleeding at diagnosis (46% before, vs. 72% after, P<0.003) and total bleeding (68% before, vs. 92%, P<0.001). PPH-specific monitoring sheet was found to be used significantly more frequently (3 before, vs. 30 after, P=0.00015). Additionally, the Physician Anesthesiologist has been contacted significantly more often (34% before, vs. 53% after, P=0.002). ConclusionOur study highlights a significant improvement in professional practices between 2011 and 2015 on PPH prevention and management in our type III university center.

Training non-physician anaesthetists in sub-Saharan Africa: a qualitative investigation of providers’ perspectives

ObjectivesTo explore the views of non-physician anaesthesia providers (NPAPs) and their colleagues regarding the effectiveness of NPAP training programmes in three contrasting sub-Saharan African countries.DesignThis was a qualitative exploratory descriptive...

Evaluation of Knowledge Acquisition with a Practice Management Course for Anesthesiology Residents: A Pilot Study

Senior anesthesiology residents (Clinical Anesthesia-3) at The George Washington University were eligible to participate in a 1-month Ambulatory Anesthesiology-Practice Management Rotation focusing on the acquisition of nontechnical skills and knowledge applicable to becoming an effective clinical leader. The rotation included 1-week service as operating room manager, completion of an online module, assigned readings with follow-up discussions, and completion of a billing and reimbursement exercise. The interventions, in aggregate, were measured with a preknowledge and a postknowledge test. Twelve residents out of 14 (86%) completed the preknowledge and postknowledge tests. Residents scored significantly higher on the postcourse exam (61.49%, SD 18.65%) than the pretest (42.7%, SD 12.7%) (P < .004). A curriculum designed to develop the practice management skills required of a physician anesthesiologist is feasible and effective at improving knowledge within a 1-month, senior resident rotation.