Dataset Information

Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management.

ABSTRACT: At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA).Residents completed a pre-simulation multiple-choice survey measuring their understanding and use of the DAA. Residents then managed an emergent, difficult OOOR intubation in the simulation center, where two trained reviewers assessed performance using checklists. Post-simulation, the residents completed a survey rating their behaviors during the simulation. The primary outcome was comprehension and adherence to the DAA as assessed by survey responses and behavior in the simulation.Sixty-three residents completed both surveys and the simulation. Post-survey responses indicated a shift toward decreased self-perceived familiarity with the DAA content compared to pre-survey responses. During the simulation, 22 (35%) residents were unsuccessful with intubation. Of these, 46% placed an LMA and 46% prepared for cricothyroidotomy. Nineteen residents did not attempt intubation. Of these, only 31% considered LMA placement, and 26% initiated cricothyroidotomy.Many anesthesiology residency training programs permit resident autonomy in managing emergent intubations OOOR. Residents self-reported familiarity with the content of and adherence to the DAA was higher than that observed during the simulation. Curriculum focused on comprehension of the DAA, as well as improving communication with higher-level physicians and specialists, may improve outcomes during OOORs.

SUBMITTER: Rochlen LR

PROVIDER: S-EPMC5512836 | biostudies-other | 2017 Jul

REPOSITORIES: biostudies-other

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Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management.

Rochlen Lauryn R LR Housey Michelle M Gannon Ian I Mitchell Shannon S Rooney Deborah M DM Tait Alan R AR Engoren Milo M

BMC anesthesiology 20170715 1

<h4>Background</h4>At many academic institutions, anesthesiology residents are responsible for managing emergent intubations outside of the operating room (OOOR), with complications estimated to be as high as 39%. In order to create an OOOR training curriculum, we evaluated residents' familiarity with the content and correct adherence to the American Society of Anesthesiologists' Difficult Airway Algorithm (ASA DAA).<h4>Methods</h4>Residents completed a pre-simulation multiple-choice survey meas ...[more]

PMID: 28709415

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Project description:BACKGROUND:Although the surgical pause or time-out is a required part of most hospitals' standard operating procedures, little is known about the quality of execution of the time-out in routine clinical practice. An interactive electronic time-out was implemented to increase surgical team compliance with the time-out procedure and to improve communication among team members in the operating room. We sought to identify nonroutine events that occur during the time-out procedure in the operating room, including distractions and interruptions, deviations from protocol, and the problem-solving strategies used by operating room team members to mitigate them. METHODS:Direct observations of surgical time-outs were performed on 166 nonemergent surgeries in 2016. For each time-out, the observers recorded compliance with each step, any nonroutine events that may have occurred, and whether any operating room team members were distracted. RESULTS:The time-out procedure was performed before the first incision in 100% of cases. An announcement was made to indicate the start of the time-out procedure in 163 of 166 observed surgeries. Most observed time-outs were completed in <1 minute. Most time-outs were completed without interruption (92.8%). The most common reason for an interruption was to verify patient information. Ten time-out procedures were stopped due to a safety concern. At least 1 member of the operating room team was actively distracted in 10.2% of the time-out procedures observed. CONCLUSIONS:Compliance with preincision time-outs is high at our institution, and nonroutine events are a rare occurrence. It is common for ?1 member of the operating room team to be actively distracted during time-out procedures, even though most time-outs are completed in under 1 minute. Despite distractions, there were no wrong-site or wrong-person surgeries reported at our hospital during the study period. We conclude that the simple act of performing a preprocedure checklist may be completed quickly, but that distractions are common.

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.

Dataset Information

Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management.

Publications

Assessing anesthesiology residents' out-of-the-operating-room (OOOR) emergent airway management.

Similar Datasets

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