Perianesthetic dental injuries: analysis of incident reports.

STUDY OBJECTIVE: To conduct a retrospective analysis of incident reports concerning dental injury, the most common cause for litigation against anesthesiologists, to determine specific risk factors that will help in formulating a risk reduction strategy for this clinical problem. DESIGN: Retrospective chart review of a large professional liability insurer. INTERVENTIONS: Of 40 hospitals that report to the MRM Co. as part of the professional liability insurance, during the years 1992-1999, 18 hospitals reported dental injury. A Maxillofacial surgeon (GN) and an anesthesiologist (ES), using a structured form, reviewed the reports. Evaluation of the cost of injury was determined from the patient's claims or from an evaluation of rehabilitation plan constructed by the maxillofacial surgery consultants to the company. MEASUREMENTS AND MAIN RESULTS: There were 203 incidents due to dental injury. The patients were most commonly in their 5(th) to 7(th) decade. Eighty six percent of the injured teeth were the upper incisors. Lower incisors were more likely to be injured during an urgent intubation, or due to airway manipulation other than intubation. (i.e., oral airway insertion) In only 38 (18.6%) cases was there a previous assessment of an expected difficult intubation. Dentition was judged to be pathological in 32% of the patients. CONCLUSIONS: In elective intubation, the teeth most likely to be injured are the upper incisors, in patients aged 50-70 years. In most cases dental injury is not associated with a pre-event prediction of difficult intubation.

[Requirements for the successful installation of an data management system]. / Voraussetzungen für das Gelingen einer Installation von Daten-Management-Systemen.

Due to increasing requirements on medical documentation, especially with reference to the German Social Law binding towards quality management and introducing a new billing system (DRGs), an increasing number of departments consider to implement a patient data management system (PDMS). The installation should be professionally planned as a project in order to insure and complete a successful installation. The following aspects are essential: composition of the project group, definition of goals, finance, networking, space considerations, hardware, software, configuration, education and support. Project and finance planning must be prepared before beginning the project and the project process must be constantly evaluated. In selecting the software, certain characteristics should be considered: use of standards, configurability, intercommunicability and modularity. Our experience has taught us that vaguely defined goals, insufficient project planning and the existing management culture are responsible for the failure of PDMS installations. The software used tends to play a less important role.

Medicare and Medicaid programs; hospital Conditions of Participation: anesthesia services. Final rule.

This final rule amends the Anesthesia Services Condition of Participation (CoP) for hospitals, the Surgical Services Condition of Participation for Critical Access Hospitals (CAH), and the Surgical Services Condition of Coverage for Ambulatory Surgical Centers (ASCs), and, with its publication, withdraws the January 18, 2001 final rule (66 FR 4674).This final rule maintains the current physician supervision requirement for certified registered nurse anesthetists(CRNAs), unless the Governor of a State, in consultation with the State's Boards of Medicine and Nursing, exercises the option of exemption from this requirement consistent with State law.

[Economic aspects of anesthesia. I. Health care reform in the German Republic]. / Okonomische Aspekte in der Anästhesie. Teil I: Rahmenbedingungen in der Bundesrepublik Deutschland.

Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.

Miscellaneous operational issues in the operating room.

As physicians in the OR suite, anesthesiologists' interests extend beyond the technical issues of rendering anesthesia care, and a number of topics germane to problems in the OR and anesthesia department have been covered. More and more anesthesiology practices are locating outside the "safety" zone of the hospital; thus, it becomes encumbent on the physicians working in those environments to be aware of the regulations, safety standards, and hazards in order to provide a safe environment for their patients and to run a well-managed OR suite.