RESUMO
PURPOSE: In this project, we sought to develop and implement pediatric anesthesia metrics into electronic health records (EHR) in a hospital setting to improve quality and safety of patient care. While there has been an upsurge in metric-driven health care, specific metrics catering to pediatric anesthesia remain lacking despite widespread use of EHR. The rapid proliferation and implementation of EHR presents opportunities to develop and implement metrics appropriate to local patient care, in this case pediatric anesthesia, with the strategic goal of enhancing quality and safety of patient care, while also delivering transparency in reporting of such metrics. CLINICAL FEATURES: Using a quasi-nominal consensus group design, we collected requirements from attending anesthesiologists using Agile methodology. Forty-five metrics addressing quality of care (e.g., induction experience, anesthesia delivery, unanticipated events, and postanesthetic care unit stay) and provider performance (e.g., bundle-compliance, collaboration, skills assurance) were developed. Implementation involved integration into the EHR followed by transition from PDF-based feedback to interactive Power BI (Microsoft Corporation, Redmond, WA, USA) dashboards. CONCLUSION: We introduced and implemented customized pediatric anesthesia metrics within an academic pediatric hospital; however, this framework is easily adaptable across multiple clinical specialties and institutions. In harnessing data-collecting and reporting properties of EHR, the metrics we describe provide insights that facilitate real-time monitoring and foster a culture of continuous learning in line with strategic goals of high-reliability organizations.
RéSUMé: OBJECTIF: Dans le cadre de ce projet, nous avons cherché à développer et à mettre en Åuvre des mesures d'anesthésie pédiatrique dans les dossiers de santé électroniques (DSE) en milieu hospitalier afin d'améliorer la qualité et la sécurité des soins aux patient·es. Bien qu'il y ait eu une recrudescence des soins de santé guidés par les procédures d'évaluation, les mesures spécifiques à l'anesthésie pédiatrique restent insuffisantes malgré l'utilisation généralisée du DSE. La prolifération et la mise en Åuvre rapides des DSE offrent des possibilités d'élaborer et de mettre en Åuvre des paramètres appropriés aux soins locaux aux patient·es, dans ce cas-ci en anesthésie pédiatrique, dans le but stratégique d'améliorer la qualité et la sécurité des soins tout en assurant la transparence des communications concernant ces paramètres. CARACTéRISTIQUES CLINIQUES: À l'aide d'un modèle de groupe consensuel quasi nominal, nous avons recueilli les exigences des anesthésiologistes traitant·es à l'aide de la méthodologie Agile. Quarante-cinq paramètres portant sur la qualité des soins (p. ex., l'expérience d'induction, l'administration de l'anesthésie, les événements imprévus et le séjour en salle de réveil) et la productivité des prestataires (p. ex., l'observance des forfaits, la collaboration, l'assurance des compétences) ont été élaborés. La mise en Åuvre a impliqué l'intégration dans le DSE, suivie de la transition des commentaires en format PDF vers les tableaux de bord interactifs Power BI (Microsoft Corporation, Redmond, WA, États-Unis). CONCLUSION: Nous avons introduit et mis en Åuvre des mesures personnalisées de l'anesthésie pédiatrique au sein d'un hôpital pédiatrique universitaire. Cependant, ce cadre est facilement adaptable à de multiples spécialités cliniques et institutions. Parce qu'elles exploitent les propriétés de collecte de données et de communications du DSE, les mesures que nous décrivons fournissent des informations qui facilitent la surveillance en temps réel et favorisent une culture d'apprentissage continu conforme aux objectifs stratégiques des organisations à haute fiabilité.
Assuntos
Anestesia , Registros Eletrônicos de Saúde , Hospitais Pediátricos , Humanos , Hospitais Pediátricos/organização & administração , Canadá , Anestesia/métodos , Anestesia/normas , Criança , Anestesiologia/normas , Qualidade da Assistência à Saúde , Anestesiologistas/organização & administração , Anestesia PediátricaRESUMO
Increasingly, both healthcare leaders and studies of healthcare outcomes recommend a medical workforce that is representative of the patient population as a method to reduce health disparities and medical costs. Anesthesiology remains a specialty with lower proportions of women and underrepresented in medicine (URiM) physicians as compared to the overall physician workforce, with 26.1% of anesthesiologists identifying as women and 31.3% of anesthesiologists as URiM. Two areas of focus are commonly identified when discussing inadequate representation in the workforce: recruitment into the specialty and retention in the profession. As medical educators, we provide a critical role in the recruitment and retention of women and URiM anesthesiologists, through implementation of processes, programs, and cultural change. Here, we will discuss the current problems of recruitment and retention of women and URiM anesthesiologists and suggest action plans for now and the future to enhance our specialty's diversity.
Assuntos
Anestesiologistas , Anestesiologia , Seleção de Pessoal , Humanos , Anestesiologistas/organização & administração , Seleção de Pessoal/métodos , Feminino , Médicas , Grupos Minoritários , Recursos HumanosRESUMO
The paediatric population is disproportionately affected during mass casualty incidents (MCIs). Several unique characteristics of children merit special attention during natural and man-made disasters because of their age, physiology, and vulnerability. Paediatric anaesthesiologists play a critical part of MCI care for this population, yet there is a deficit of publications within the anaesthesia literature addressing paediatric-specific MCI concerns. This narrative review article analyses paediatric MCI considerations and compares differing aspects between care provision in Australia, the UK, and the USA. We integrate some of the potential roles for anaesthesiologists with paediatric experience, which include preparation, command consultation, in-field care, pre-hospital transport duties, and emergency department, operating theatre, and ICU opportunities. Finally, we propose several methods by which anaesthesiologists can improve their contribution to paediatric MCI care through personal education, training, and institutional involvement.
Assuntos
Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Incidentes com Feridos em Massa , Fatores Etários , Anestesia/métodos , Anestesiologistas/organização & administração , Criança , Humanos , PediatriaRESUMO
The use of motor vehicles to initiate mass casualty incidents is increasing in frequency and such events are called intentional vehicular assaults. Perpetrators are inspired by a range of terrorist ideologies or have extremist views, criminal intent, or mental health issues. Assaults using a motor vehicle as the principal weapon of attack are easy to launch and require little to no forward planning. This makes them difficult for police and security agencies to predict, prevent, or interdict. With the increasing frequency of intentional vehicular assaults, anaesthesiologists in various settings may be involved in caring for victims and should be engaged in preparing for them. This narrative review examines the literature on vehicle assaults committed around the world and provides an overview of the unique injury patterns and considerations for the pre-hospital, perioperative, and critical care management of victims of these mass casualty events. The article discusses planning, education, and training in an attempt to reduce the mortality and morbidity of intentional vehicular assaults.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Incidentes com Feridos em Massa , Terrorismo , Anestesia/métodos , Anestesiologistas/organização & administração , Planejamento em Desastres/métodos , Humanos , Papel do Médico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapiaAssuntos
Terapias Complementares/estatística & dados numéricos , Manejo da Dor/estatística & dados numéricos , Anestesiologistas/organização & administração , Anestesiologistas/estatística & dados numéricos , Política de Saúde , Humanos , Medicina Integrativa/estatística & dados numéricos , Inquéritos e QuestionáriosAssuntos
Anestesiologia/organização & administração , COVID-19/epidemiologia , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Pandemias , SARS-CoV-2 , Anestesiologistas/organização & administração , Anestesiologia/estatística & dados numéricos , Conversão de Leitos/estatística & dados numéricos , COVID-19/terapia , Análise Custo-Benefício , Cuidados Críticos/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Admissão e Escalonamento de Pessoal , Espanha/epidemiologiaRESUMO
PURPOSE: This study evaluated the controversial role of somatostatin after pancreatoduodenectomy (PD), stratifying patients for the main risk factors using the most recent postoperative pancreatic fistula (POPF) classification and including only patients who had undergone PD with the same technique of pancreatojejunostomy. METHODS: Between November 2010 and February 2020, 218 PD procedures were carried out via personal modified pancreatojejunostomy (mPJ-PD). Somatostatin was routinely administered between 2010 and 2016, while from 2017, 97 mPJ-PD procedures without somatostatin (WS) were performed. The WS group was retrospectively compared with a control (C) group obtained with one-to-one case-control matching according to the body mass index, American Society of Anesthesiologists' score, and Fistula Risk Score (FRS). RESULTS: A total of 144 patients (72 WS group versus 72 C group) were compared. In the WS group. 6 patients (8.3%) developed clinically relevant POPF, compared with 8 patients (11.1%) in the C group (p = 0.656). In addition, on analyzing the subgroup of high-risk patients according to the FRS, we did not note any significant differences in POPF occurrence. Furthermore, no marked differences in the morbidity or mortality were found. Digestive bleeding and diabetes onset rates were higher in the WS group than in the control group, but not significantly so. CONCLUSIONS: The results of the present study confirm no benefit with the routine administration of somatostatin after PD to prevent POPF, even in high-risk patients. However, a possible role in the prevention of postoperative digestive bleeding and diabetes was observed.
Assuntos
Índice de Massa Corporal , Fístula Pancreática/classificação , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia/métodos , Pancreaticojejunostomia/métodos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/prevenção & controle , Somatostatina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Anestesiologistas/organização & administração , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/efeitos adversos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Sociedades Médicas/organização & administraçãoRESUMO
BACKGROUND: The Coronavirus infectious disease 2019 (COVID-19) brings anesthesiologists and intensive care physicians to the mainstay of clinical workload and healthcare managements' focus. There are approximately 900 anesthesiologists in Israel, working in non-private hospitals. This nationwide cross-sectional study evaluated the readiness and involvement of anesthesia departments in Israel in management of the COVID-19 pandemic. The impact on anesthesiologists' health, workload, and clinical practices were also evaluated. METHODS: An online questionnaire was distributed to all of anesthesia department chairs in Israel on April 14th. Each response was identifiable on the hospital level only. Informed consent was waived since no patient data were collected. RESULTS: Response rate was 100%. A decrease of at least 40% in operating-room activity was reported by two-thirds of the departments. Anesthesiologists are leading the treatment of COVID-19 patients in 19/28 (68%) Israeli hospitals. Israel Society of Anesthesiologists' recommendations regarding intubation of COVID-19 patients were strictly followed (intubations performed by the most experienced available physician, by rapid-sequence induction utilizing video-laryngoscopy, while minimizing the number of people in the room - about 90% compliance for each). Anesthesiologists in most departments use standard personal protective equipment when caring for COVID-19 patients, including N95 masks, face shields, and water-proof gowns. Only one anesthesiologist across Israel was diagnosed with COVID-19 (unknown source of transmission). All department chairs reported emerging opportunities that advance the anesthesia profession: implementation of new technologies and improvement in caregivers' clinical capabilities (68% each), purchase of new equipment (96%), and increase in research activity (36%). CONCLUSIONS: This nationwide cross-sectional study had a complete response rate and therefore well-represents the anesthesia practice in Israel. We found that Israeli anesthesia departments are generally highly involved in the health system efforts to cope with the COVID-19 pandemic. Anesthesia and airway management are performed in a remarkably comparable manner and with proper protection of caregivers. Ambulatory anesthesia activity has dramatically decreased, but many departments find opportunities for improvement even in these challenging times.
Assuntos
Serviço Hospitalar de Anestesia/organização & administração , Anestesiologistas/organização & administração , Anestesiologia/organização & administração , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Manuseio das Vias Aéreas/métodos , Anestesia/métodos , COVID-19 , Estudos Transversais , Humanos , Intubação Intratraqueal/métodos , Israel/epidemiologia , Salas Cirúrgicas/organização & administração , Pandemias , Inquéritos e QuestionáriosRESUMO
BACKGROUND AND PURPOSE: Prior literature suggests after-hours delay leads to poor functional outcomes in stroke patients undergoing thrombectomy. We aimed to evaluate the impact of time of presentation on mechanical thrombectomy (MT) metrics and its association with long-term functional outcome in an Interventional Radiology (IR) suite equipped operating room (OR) setting. METHODS: Retrospective review of prospectively maintained database on all stroke patients undergoing mechanical thrombectomy between January 2015 and December 2018 at our CSC. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5 PM) and after-hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Primary outcome was 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin puncture time and procedural complications. RESULTS: A total of 315 patients were included in the analyses. 209 (66.4%) received mechanical thrombectomy after hours and 106 (33.6%) during work hours. There was no difference in the shift distribution of functional outcome on the mRS at 90 days (OR: 1.14, CI: 0.72-1.78, p=0.58) and the percentage of patients achieving functional independence (mRS 0-2) at 90 days (43.1% vs. 41.3%; p=0.83) between the after hour and work hour groups respectively. Similarly, there was no difference in median door to groin times and procedural complications among both groups, with significant year on year improvement in overall time metrics. CONCLUSIONS: Our study showed that undergoing MT during off-hours had similar functional outcomes when compared to MT during working hours in an OR setting. The after-hours deleterious effect might disappear when MT is performed in a system with 24-hours in-house Anesthesia and IR tech services.
Assuntos
Plantão Médico/organização & administração , Serviço Hospitalar de Anestesia/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Salas Cirúrgicas/organização & administração , Radiografia Intervencionista , Acidente Vascular Cerebral/terapia , Trombectomia , Tempo para o Tratamento/organização & administração , Idoso , Idoso de 80 Anos ou mais , Anestesiologistas/organização & administração , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Auxiliares de Cirurgia/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Radiografia Intervencionista/efeitos adversos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Trombectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Fluxo de TrabalhoRESUMO
BACKGROUND: The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE's to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions. METHODS: Seventy-eight patients were enrolled in this prospective non-inferiority controlled trial and were randomly allocated to either group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 s was used as non-inferiority margin for the purpose of the study. We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0: Mean TTI diff ≥15 s, H A: Mean TTI diff < 15 s). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation. RESULTS: Mean TTI in group C was 42 s (CI 19.2 to 64.8) vs. 52.1 s (CI 26.1 to 78) in group BB. The difference in mean TTI was 10.1 s (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 s (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 s).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths. CONCLUSIONS: We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers. The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020.
Assuntos
Manuseio das Vias Aéreas/métodos , Anestesiologia/métodos , Infecções por Coronavirus/terapia , Intubação Intratraqueal/métodos , Pneumonia Viral/terapia , Adulto , Aerossóis , Idoso , Manuseio das Vias Aéreas/instrumentação , Anestesiologistas/organização & administração , Anestesiologia/instrumentação , COVID-19 , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Estudos Prospectivos , Respiração Artificial/métodos , Fatores de TempoAssuntos
Anestesiologia/métodos , Bloqueio do Plexo Braquial/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Aerossóis , Anestesiologistas/organização & administração , Anestesiologia/instrumentação , COVID-19 , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.
RéSUMé: La prise en charge des symptômes et les soins de fin de vie sont des compétences de base pour tous les médecins, bien qu'en temps ordinaire, de nombreux anesthésiologistes n'ont que peu d'occasions de mettre en pratique ces compétences. La pandémie actuelle de coronavirus 2019 (COVID-19) a provoqué un taux de mortalité significatif dans un court intervalle et a nécessité une augmentation des besoins en soins intensifs et en soins palliatifs. Destiné aux anesthésiologistes déployés dans les unités prenant soin de patients atteints de la COVID-19, ce compte rendu narratif offre des recommandations quant à la façon de mener les discussions à propos des objectifs de soins, du retrait des thérapies de soutien vital, et de la prise en charge de symptômes de détresse.
Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Anestesiologistas/organização & administração , Anestesiologistas/normas , COVID-19 , Competência Clínica , Infecções por Coronavirus/mortalidade , Cuidados Críticos/normas , Humanos , Cuidados Paliativos/organização & administração , Pandemias , Médicos/organização & administração , Médicos/normas , Pneumonia Viral/mortalidade , Assistência Terminal/normas , Suspensão de TratamentoRESUMO
Cardiogenic shock (CS) is a multifactorial disease process with high morbidity and mortality. When it occurs in a peri- or intraoperative setting, factors such as surgery, anesthesia, and post-surgical physiology can negatively affect patient outcomes. Since patient needs often escalate during CS-from medications to mechanical support to palliative care-this disease demands a multidisciplinary approach that encompasses all aspects of medical delivery. Preliminary studies have indicated that a multidisciplinary team approach to CS results in earlier diagnosis and treatment and improves patient outcomes. Here we discuss various management strategies for CS from an anesthesiology, surgery, and critical care perspective.
Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistência Perioperatória , Choque Cardiogênico/terapia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Anestesiologistas/organização & administração , Cardiologistas/organização & administração , Terapia Combinada , Diagnóstico Precoce , Humanos , Monitorização Intraoperatória , Período Perioperatório , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Cirurgiões/organização & administração , Resultado do TratamentoRESUMO
Unlike developed countries which have purely intensivists also called critical care physicians or intensive care physicians to manage critically ill patients like those with severe forms of COVID-19, the practice of critical care medicine in Africa is coined to anaesthesiology. Hence, anaesthesiologist-intensivist physicians are the medical specialists taking care of critically ill COVID-19 patients in Africa. Likewise, unlike intensive care units (ICUs) in high income countries, those in most African countries face the challenge of a lack of emergency drugs and resuscitation equipment, limited health infrastructure and understaffed and underfunded health care systems. The COVID-19 pandemic is an unprecedented one faced by intensivists in high-income countries and anaesthesiologist-intensivist phycisians in Africa. Infected patients with severe forms of the disease like those having grave COVID-19 complications like massive pulmonary embolism, severe cardiac arrhythmias, cardiogenic shock, septic shock, acute kidney injury or acute respiratory distress syndrome require ICU admission for better management. Both intensivists or anaesthesiologist-intensivist physicians have the peculiarity of securing the airways of critically COVID-19 patients and providing respiratory support with mechanical ventilation after laryngoscopy and endotracheal intubation when needed. In so doing, they can easily be infected from respiratory droplets or aerosols expired by the COVID-19 patients. Hence, in Africa, anaesthesiologist-intensivist phycisians have a higher risk of contracting COVID-19 compared to other health professionals. It's worth to mention that the COVID-19 pandemic struck African anaesthesiologist-intensivist phycisians and ICUs when there were neither prepared skillfully or lacked the required ICU capacity to meet the demands of thousands of severe COVID-19 African patients. These further weakened the already strained health systems in Africa. It required a lot of creativity, engineering skills and courage for these ill prepared African anaesthesiologist-intensivist physicians to provide care to these critically ill patients and improve their outcomes as the pandemic progressed. However, despites the numerous efforts made in African anaesthesiologist-Intensivist phycisians to care for critically ill COVID-19 patients, the pandemic is spreading at a rapid rate across Africa. There is an urgent need for African health authorities to anticipate on how to scale up the future high ICU capacity needs and limited ICU workforce, infrastructure and equipment to manage severe forms of COVID-19 in future. It cannot be overemphasized that these severe forms of COVID-19 are potentially fatal and are a major contributor to the death toll of the COVID-19 pandemic.
Assuntos
Anestesiologistas/organização & administração , COVID-19/terapia , Unidades de Terapia Intensiva/organização & administração , Médicos/organização & administração , África , COVID-19/complicações , COVID-19/transmissão , Cuidados Críticos/organização & administração , Estado Terminal , Atenção à Saúde/organização & administração , Países em Desenvolvimento , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional , Doenças Profissionais/epidemiologia , Doenças Profissionais/virologia , Exposição OcupacionalRESUMO
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
Assuntos
Anestésicos/administração & dosagem , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Anestesiologistas/organização & administração , Anestesiologia/métodos , HumanosRESUMO
STUDY OBJECTIVE: We consider the influence of the tardiness of first-case of the day start times on the minutes that rooms finish late for procedural suites with relatively interchangeable rooms and mean workloadsâ¯â â¯7â¯h per room, thus regularly filling 8-hour of allocated time. DESIGN: Historical cohort of Nâ¯=â¯331 workdays of data. SETTING: Gastrointestinal endoscopy suite. MAIN RESULTS: By unadjusted analyses, reductions in the number of first-cases of the day starting ≥5â¯min late were associated with less minutes that the day's cases ended beyond the allocated 8â¯h. However, there were no significant relationships in adjusted analyses, controlling for the daily total hours of cases and turnovers ("workload") or the daily caseload of elective cases. There also were no significant relationships in adjusted analyses between the minutes of cases ending beyond the allocated 8â¯h and either the count of cases starting ≥15â¯min late or the mean minutes of case tardiness. The differences between unadjusted and adjusted results were explained by slight positive associations between the count of first-cases starting ≥5â¯min late and both the daily workload and caseload. Days with less hours of cases had significantly fewer cases starting near simultaneously at the beginning of the day; the same was true for days with fewer total cases. CONCLUSIONS: For procedural suites with relatively interchangeable rooms and mean workloadsâ¯â â¯7â¯h per room, reducing tardiness of first-case of the day start times does not result in beneficial reductions in over-utilized time. The focus of improving on-time starts for the first-cases of the day should be on services with mean workloads that exceed the minimum scheduled duration of the workday.