Dataset Information

Problem-based learning for anesthesia resident operating room crisis management training.

ABSTRACT:

Background

Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management.

Methods

Prior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training.

Results

Post-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL.

Conclusion

Our findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.

SUBMITTER: Komasawa N

PROVIDER: S-EPMC6242352 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Problem-based learning for anesthesia resident operating room crisis management training.

Komasawa Nobuyasu N Berg Benjamin W BW Minami Toshiaki T

PloS one 20181119 11

<h4>Background</h4>Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management.<h4>Methods</h4>Prior to integrated OR emergency clinical and non-technical skil ...[more]

PMID: 30452480

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Project description:BackgroundSince operating rooms are a major bottleneck resource and an important revenue driver in hospitals, it is important to use these resources efficiently. Studies estimate that between 60 and 70% of hospital admissions are due to surgeries. Furthermore, staffing cannot be changed daily to respond to changing demands. The resulting high complexity in operating room management necessitates perpetual process evaluation and the use of decision support tools. In this study, we evaluate several management policies and their consequences for the operating theater of the University Hospital Augsburg.MethodsBased on a data set with 12,946 surgeries, we evaluate management policies such as parallel induction of anesthesia with varying levels of staff support, the use of a dedicated emergency room, extending operating room hours reserved as buffer capacity, and different elective patient sequencing policies. We develop a detailed simulation model that serves to capture the process flow in the entire operating theater: scheduling surgeries from a dynamically managed waiting list, handling various types of schedule disruptions, rescheduling and prioritizing postponed and deferred surgeries, and reallocating operating room capacity. The system performance is measured by indicators such as patient waiting time, idle time, staff overtime, and the number of deferred surgeries.ResultsWe identify significant trade-offs between expected waiting times for different patient urgency categories when operating rooms are opened longer to serve as end-of-day buffers. The introduction of parallel induction of anesthesia allows for additional patients to be scheduled and operated on during regular hours. However, this comes with a higher number of expected deferrals, which can be partially mitigated by employing additional anesthesia teams. Changes to the sequencing of elective patients according to their expected surgery duration cause expectable outcomes for a multitude of performance indicators.ConclusionsOur simulation-based approach allows operating theater managers to test a multitude of potential changes in operating room management without disrupting the ongoing workflow. The close collaboration between management and researchers in the design of the simulation framework and the data analysis has yielded immediate benefits for the scheduling policies and data collection efforts at our practice partner.

Project description:BACKGROUND:Advancements in virtual reality (VR) technology have resulted in its expansion into health care. Preliminary studies have found VR to be effective as an adjunct to anesthesia to reduce pain and anxiety for patients during upper gastrointestinal endoscopies, dental procedures and joint arthroplasties. Current standard care practice for upper extremity surgery includes a combination of regional anesthesia and intraoperative propofol sedation. Commonly, patients receive deep propofol sedation during these cases, leading to potentially avoidable risks of over-sedation, hypotension, upper airway obstruction, and apnea. The objective of this study is to evaluate the effectiveness of VR technology to promote relaxation for patients undergoing upper extremity surgery, thereby reducing intraoperative anesthetic requirements and improving the perioperative patient experience. METHODS:In this single-center, randomized controlled trial, 40 adult patients undergoing upper extremity orthopedic surgery will be randomly allocated to either intraoperative VR immersion or usual care. VR immersion is designed to provide patients with a relaxing virtual environment to alleviate intraoperative anxiety. All patients receive a peripheral nerve block prior to surgery. Patients in the intervention group will select videos or immersive environments which will be played in the VR headset during surgery. An anesthesia provider will perform their usual clinical responsibilities intraoperatively and can administer anesthetic medications if and when clinically necessary. Patients in the control arm will undergo perioperative anesthesia according to standard care practice. The primary outcome is the difference in intraoperative propofol dose between the groups. Secondary outcomes include postoperative analgesia requirements and pain scores, length of stay in the postanesthesia care unit, overall patient satisfaction and postoperative functional outcomes. DISCUSSION:It is unknown whether the use of VR during upper extremity surgery can reduce intraoperative anesthetic requirements, reduce perioperative complications, or improve the postoperative patient experience. A positive result from this clinical trial would add to the growing body of evidence that demonstrates the effectiveness of VR as an adjunct to anesthesia in reducing intraoperative pain and anxiety for multiple types of procedure. This could lead to a change in practice, with the introduction of a nonpharmacologic intervention potentially reducing the burden of over-sedation while still providing a satisfactory perioperative experience. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03614325. Registered on 9 July 2018.

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Dataset Information

Problem-based learning for anesthesia resident operating room crisis management training.

Background

Methods

Results

Conclusion

Publications

Problem-based learning for anesthesia resident operating room crisis management training.

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