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OBJECTIVE: This study evaluated how surgical and anesthesiology departments adapted their resources in response to the coronavirus disease 2019 (COVID-19) pandemic. DESIGN: This scoping review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol, with Covidence as a screening tool. An initial search of PubMed, Embase, Web of Science, Global Index Medicus, and Cochrane Systematic Reviews returned 6,131 results in October 2021. After exclusion of duplicates and abstract screening, 415 articles were included. After full-text screening, 108 articles remained. RESULTS: Most commonly, studies were retrospective in nature (47.22 percent), with data from a single institution (60.19 percent). Nearly all studies occurred in high-income countries (HICs), 78.70 percent, with no articles from low-income countries. The reported responses to the COVID-19 pandemic involving surgical departments were grouped into seven categories, with multiple responses reported in some articles for a total of 192 responses. The most frequently reported responses were changes to surgical department staffing (29.17 percent) and task-shifting or task-sharing of personnel (25.52 percent). CONCLUSION: Our review reflects the mechanisms by which hospital surgical systems responded to the initial stress of the COVID-19 pandemic and reinforced the many changes to hospital policy that occurred in the pandemic. Healthcare systems with robust surgical systems were better able to cope with the initial stress of the COVID-19 pandemic. The well-resourced health systems of HICs reported rapid and dynamic changes by providers to assist in and ultimately improve the care of patients during the pandemic. Surgical system strengthening will allow health systems to be more resilient and prepared for the next disaster.
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COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Servicio de Cirugía en Hospital/organización & administración , Planificación en Desastres/organización & administración , Servicio de Anestesia en Hospital/organización & administración , PandemiasRESUMEN
BACKGROUND: Most anesthesia providers experience an adverse event during their training or career. Limited evidence suggests skilled peer support programs (SPSPs) reduce initial distress and support adaptive functioning and coping. This study evaluated second victim perceptions of a voluntary SPSP. METHODS: An SPSP was developed and implemented for all clinical and administrative personnel in the Department of Anesthesiology and Perioperative Medicine in three hospitals and six outpatient surgery centers in December 2017. The program incorporated the Scott Three-Tiered Interventional Model of Second Victim Support. Surveys were offered to clinicians in the department prior to implementation of the SPSP and again 18 months after implementation. Among the subset of respondents who experienced a serious adverse patient event, the authors used multiple logistic regression models that adjusted for role and number of night shifts per month to examine differences in perceived resource availability and post-event support received following implementation of the program. RESULTS: There were 94 surveys (83 complete; 11 partially complete) collected prior to implementation and 84 surveys (67 complete; 17 partially complete) collected after implementation. A total of 25 individuals took the survey at both pre and post (19 complete). After implementation, 62.5% of respondents indicated that institutional support had improved since the occurrence of their serious adverse patient event. Statistical models identified a significant improvement in the probability that a clinician agreed with the statement "I think that the organization learned from the event and took appropriate steps to reduce the chance of it happening again" at post vs. pre (adjusted odds ratio [aOR] 3.9, 95% confidence interval [CI] 1.01-15.1. A statistically significant increase from pre to post in the perceived availability of formal emotional support was identified (aOR 5.2, 95% CI 1.9-22.5). CONCLUSION: Implementation of a skilled peer support program within a large department of anesthesiology can improve institutional-based emotional support.
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Grupo Paritario , Humanos , Femenino , Masculino , Anestesiología , Apoyo Social , Adulto , Encuestas y Cuestionarios , Servicio de Anestesia en Hospital/organización & administraciónRESUMEN
BACKGROUND: As the United States moves toward value-based care metrics, it will become essential for anesthesia groups nationwide to understand the costs of their services. Time-driven activity-based costing (TDABC) estimates the amount of time it takes to perform a clinical activity by dividing complex tasks into process steps and mapping each step and has historically been used to estimate the costs of various health care services. TDABC is a tool that can be adapted for variable staffing models and the volume of service provided. Anesthesia departments often provide staffing for airway response teams (ART). The economic implications of staffing ART have not been well described. We present a TDABC model for ART activation in a tertiary-care center to estimate the cost incurred by an anesthesiology department to staff an ART. METHODS: Pages received by the Brigham and Women's Hospital ART over a 24-month time period (January 2019 to December 2020) were analyzed and categorized. The local administrative database was queried for the Current Procedural Terminology (CPT) code used to bill for emergency airway placements. Sessions were held by multiple members of the ART to create process maps for the different types of ART activations. We estimated the staffing costs using the estimated time it took for each type of ART activation as well as the data collected for local ART activations. RESULTS: From the paging records, we analyzed 3368 activations of the ART. During the study period, 1044 airways were billed for with emergency airway CPT code. The average revenue collected per airway was $198.45 (95% CI, $190-$207). For STAT/Emergency airway team activations, process maps and non-STAT airway team activations were created, and third subprocess map was created for performing endotracheal intubation. Using the TDABC, the total staffing costs are estimated to be $218,601 for the 2-year study period. The ART generated $207,181 in revenue during the study period. CONCLUSIONS: Our analysis of ART-activation pages suggests that while the revenue generated may cover the cost of staffing the team during ART activations, it does not cover consumable equipment costs. Additionally, the current fee-for-service model relies on the team being able to perform other clinical duties in addition to covering the airway pager and would be impossible to capture using traditional top-down costing methods. By using TDABC, anesthesia groups can demonstrate how certain services, such as ART, are not fully covered by current reimbursement models and how to negotiate for subsidy agreements.As the transition from traditional fee-for-service payments to value-based care models continues in the United States, improving the understanding and communication of medical care costs will be essential. In the United States, it is common for anesthesia groups to receive direct revenue from hospitals to preserve financial viability, and therefore, knowledge of true cost is essential regardless of payer model.1 With traditional payment models, what is billable and nonbillable may not reflect either the need for or the cost of providing the service. As anesthesia departments navigate the transition of care from volume to value, actual costs will be essential to understand for negotiations with hospitals for support when services are nonbillable, when revenue from payers does not cover anesthesia costs, and when calculating the appropriate share for anesthesia departments when bundled payments are distributed.
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Manejo de la Vía Aérea/economía , Costos de la Atención en Salud , Equipo Hospitalario de Respuesta Rápida/economía , Servicio de Anestesia en Hospital/economía , Servicio de Anestesia en Hospital/organización & administración , Servicios Médicos de Urgencia , Humanos , Intubación Intratraqueal/economía , Personal de Hospital/economía , Sistema de Pago Prospectivo , Centros de Atención Terciaria , Estados UnidosRESUMEN
BACKGROUND: The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures-with the exception of urgent/emergent ones-between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars-CoV-2 in every case. METHODS: Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT-PCR testing outcomes, and comparison to same period surgeries in 2019. RESULTS: An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43-2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi-squared P-value < .001). Sars-CoV-2-positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. CONCLUSION: We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.
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Servicio de Anestesia en Hospital/organización & administración , Citas y Horarios , Prueba de Ácido Nucleico para COVID-19 , COVID-19/epidemiología , Hospitales Pediátricos/organización & administración , Hospitales Universitarios/organización & administración , Pandemias , SARS-CoV-2 , Servicio de Cirugía en Hospital/organización & administración , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Centros de Atención Terciaria/organización & administración , Adolescente , Prueba de Ácido Nucleico para COVID-19/estadística & datos numéricos , Cuidadores , Niño , Preescolar , Estudios de Cohortes , Grupos Diagnósticos Relacionados , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas/epidemiología , Femenino , Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Hospitales Urbanos/organización & administración , Hospitales Urbanos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Italia/epidemiología , Masculino , Nasofaringe/virología , Pacientes , SARS-CoV-2/aislamiento & purificación , Evaluación de Síntomas , Centros de Atención Terciaria/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training. METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training. CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.
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Servicio de Anestesia en Hospital/organización & administración , Anestesia Obstétrica , COVID-19/prevención & control , Lista de Verificación , Atención a la Salud/organización & administración , Control de Infecciones/organización & administración , Flujo de Trabajo , COVID-19/transmisión , Vías Clínicas/organización & administración , Femenino , Humanos , Embarazo , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/organización & administraciónRESUMEN
PURPOSE OF REVIEW: The COVID-19 pandemic has driven transformation in every aspect of the healthcare delivery system. The unpredictable onset and magnitude of COVID-19 infections resulted in wide gaps in preparedness for healthcare systems. The development of protocols to address both scarcity of resources and staff protection continues to be essential for risk mitigation. RECENT FINDINGS: The northeast region of the United States had a rapid early surge of COVID-19 infections leading to the exhaustion of critical care capacity. In addition, northeastern hospitals experienced decrease in elective surgical interventions, including organ transplantation. Limited availability of COVID-19 testing and personal protective equipment further fueled the pandemic. This commentary highlights a comprehensive innovative approach to addressing the operating room and hospital demands, as well as the shortages in resources and staffing during the pandemic. SUMMARY: The VCU Department of Anesthesiology operated at 40% of its regular operating room volume throughout the COVID-19 pandemic because of the increased demand from emergency cases. The delay in the peak surge allowed Virginia Commonwealth University, Department of Anesthesiology to develop a comprehensive infrastructure resulting in resulting is maximal workforce risk mitigation.
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Servicio de Anestesia en Hospital/organización & administración , COVID-19/prevención & control , Prueba de COVID-19/estadística & datos numéricos , Hospitales Universitarios/organización & administración , Humanos , Exposición Profesional/prevención & control , Pandemias , Equipo de Protección Personal/provisión & distribución , Estados UnidosRESUMEN
BACKGROUND: All anesthetists are at risk of mental ill health and pediatric anesthetists face additional stressors that may impact upon well-being, particularly after an adverse outcome. The SARS COV-2 pandemic has resulted in a plethora of resources to support the well-being of frontline workers. Developing a well-being system for an anesthesia department using these resources may be complex to implement. AIMS: In this article we outline how an anesthesia department can design and implement a framework for wellbeing, regardless of resources and financial constraints. We use the example of a free online toolkit developed in Australia for anesthetists. METHODS: The "Long lives, Healthy Workplaces toolkit" is a framework which has been specifically developed by mental health experts for anesthetists, and does not require departments to pay for external experts.1 Departments can design a long-term model of evidence-based mental health strategies to meet their unique needs using five steps outlined in the toolkit and detailed in this article. The framework uses cycles of assessment and review to create an adaptable approach to incorporate emerging evidence. We explain how culture can impact the implementation of a well-being framework and we outline how departments can set goals and priorities. CONCLUSION: Departments have different constraints which will alter how they approach supporting anaesthetists' wellbeing. Regardless of location or funding all departments should explicitly address anesthetists well-being. Long term sustainable well-being programs require a strategic and coordinated approach.
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Servicio de Anestesia en Hospital/organización & administración , Anestesistas/organización & administración , Anestesistas/psicología , COVID-19/psicología , Hospitales Pediátricos/organización & administración , Lugar de Trabajo/organización & administración , Lugar de Trabajo/psicología , Australia/epidemiología , COVID-19/epidemiología , Humanos , Salud Mental , PandemiasRESUMEN
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.
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Servicio de Anestesia en Hospital/organización & administración , Anestesiólogos/organización & administración , Anestesiología/organización & administración , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Manejo de la Vía Aérea/métodos , Anestesia/métodos , COVID-19 , Estudios Transversales , Humanos , Intubación Intratraqueal/métodos , Israel/epidemiología , Quirófanos/organización & administración , Pandemias , Encuestas y CuestionariosRESUMEN
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.
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Atención Posterior/organización & administración , Servicio de Anestesia en Hospital/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Quirófanos/organización & administración , Radiografía Intervencional , Accidente Cerebrovascular/terapia , Trombectomía , Tiempo de Tratamiento/organización & administración , Anciano , Anciano de 80 o más Años , Anestesiólogos/organización & administración , Bases de Datos Factuales , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Auxiliares de Cirugía/organización & administración , Grupo de Atención al Paciente/organización & administración , Radiografía Intervencional/efectos adversos , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Trombectomía/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Flujo de TrabajoRESUMEN
INTRODUCTION: The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic. METHODS AND ANALYSIS: This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children's Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact. TRIAL REGISTRATION NUMBER: ISRCTN10666798.
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Infecciones por Coronavirus/terapia , Cuerpo Médico de Hospitales/psicología , Neumonía Viral/terapia , Estrés Psicológico/epidemiología , Servicio de Anestesia en Hospital/organización & administración , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Servicio de Urgencia en Hospital/organización & administración , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/estadística & datos numéricos , Unidades de Cuidados Intensivos/organización & administración , Irlanda/epidemiología , Estudios Longitudinales , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Prevalencia , Proyectos de Investigación , SARS-CoV-2 , Autoinforme , Encuestas y Cuestionarios , Reino Unido/epidemiologíaAsunto(s)
Anestesia , Anestésicos/provisión & distribución , Cuidados Críticos/organización & administración , Servicio de Farmacia en Hospital/organización & administración , Servicio de Anestesia en Hospital/organización & administración , Francia , Humanos , Unidades de Cuidados Intensivos/organización & administración , Preparaciones Farmacéuticas/provisión & distribuciónRESUMEN
The provision of safe obstetric anaesthesia services is essential during the COVID-19 global outbreak. The identification of the 'high-infection risk' parturient can be challenging especially with the rapidly changing risk criteria for COVID-19 'cases'. A multidisciplinary taskforce is required to review the infection control protocols and workflows for managing the parturient for labour analgesia and for caesarean section in order to minimize infection risk to healthcare staff and other parturients. A constant review of such processes is needed to enhance efficiency and to optimise use of finite resources. Good communication between health officials, institutional leadership and ground staff is essential for the dissemination of information.
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Servicio de Anestesia en Hospital/organización & administración , Anestesia Obstétrica , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , COVID-19 , Cesárea , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades , Femenino , Recursos en Salud , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Embarazo , SARS-CoV-2 , Singapur/epidemiologíaRESUMEN
In response to the rapidly evolving coronavirus disease 2019 (COVID-19) pandemic and the potential need for physicians to provide critical care services, the American Society of Anesthesiologists (ASA) has collaborated with the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF) to develop the COVID-Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) Intensive Care Unit (ICU) workgroup. CAESAR-ICU is designed and written for the practicing general anesthesiologist and should serve as a primer to enable an anesthesiologist to provide limited bedside critical care services.
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Servicio de Anestesia en Hospital/organización & administración , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/terapia , Prestación Integrada de Atención de Salud/organización & administración , Servicios Médicos de Urgencia/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Neumonía Viral/terapia , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Guías de Práctica Clínica como Asunto , SARS-CoV-2Asunto(s)
Servicio de Anestesia en Hospital/organización & administración , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Neumonía Viral/transmisión , Servicio de Cirugía en Hospital/organización & administración , África del Sur del Sahara/epidemiología , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/terapia , Humanos , Cuerpo Médico de Hospitales , Pandemias , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/terapia , SARS-CoV-2RESUMEN
Robotic-assisted surgery (RAS) presents unique teamwork challenges for perioperative team members, including anesthesia professionals. The purpose of this study was to explore anesthesiologists' and nurse anesthetists' teamwork experiences during RAS using an exploratory qualitative study design involving individual semistructured interviews. Study participants expressed that teamwork during RAS is both positive and challenging, and the start-up phase is the most demanding phase of RAS in terms of teamwork. Anesthesia professionals believe that both technical and nontechnical skills are necessary to provide excellent patient care and maintain patient safety during RAS. Furthermore, they believe that a more concentrated focus on nontechnical skills than is traditional is an essential component of teamwork.
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Servicio de Anestesia en Hospital/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Percepción , Procedimientos Quirúrgicos Robotizados/psicología , Servicio de Anestesia en Hospital/organización & administración , Competencia Clínica/normas , Competencia Clínica/estadística & datos numéricos , Humanos , Noruega , Grupo de Atención al Paciente/estadística & datos numéricos , Investigación Cualitativa , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricosRESUMEN
BACKGROUND: Monitoring improvements in nationwide anesthesia capacity over time is critical to ensuring that population anesthesia needs are being met and identifying areas for targeted health systems interventions. Anesthesia resources in Bangladesh were previously measured using a cross-sectional nationwide hospital-based survey in 2012. No follow-up studies have been conducted since then. METHODS: A follow-up cross-sectional study was performed in 16 public hospitals; 8 of which are public district hospitals, and 8 are medical college (tertiary) hospitals in Bangladesh. A survey tool assessing hospital anesthesia capacity, developed by Vanderbilt University Medical Center, was utilized. Nationwide data were obtained from the Ministry of Health and Family Welfare and from the Bangladesh Society of Anaesthesiologists. Institutional Review Board approvals were obtained in the United States and Bangladesh, and informed consent was waived. RESULTS: Bangladesh has 952 anesthesiologists (0.58 anesthesiologists per 100,000 people), which represents a modest increase from 850 anesthesiologists in 2012. Significant improvements in electricity and clean water availability have occurred since the 2012 survey. Severe deficiencies in patient safety and monitoring equipment (eg, pulse oximetry, electrocardiography, blood pressure, anesthesia machines, and intubation materials) were noted, primarily at the district hospital level. CONCLUSIONS: Despite modest improvements in certain anesthesia metrics over the past several years, the public health care system in Bangladesh still suffers from substantial deficiencies in anesthesia care.
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Servicio de Anestesia en Hospital/organización & administración , Anestesiólogos/provisión & distribución , Anestesiología/organización & administración , Atención a la Salud/organización & administración , Países en Desarrollo , Hospitales Públicos/organización & administración , Bangladesh , Estudios Transversales , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud/organización & administración , Hospitales de Distrito/organización & administración , Humanos , Evaluación de Necesidades/organización & administración , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud/organización & administración , Centros de Atención Terciaria/organización & administración , Factores de TiempoRESUMEN
Anesthesia of curettage of uterine cavity (CUC) at postoperative period causes additional expenses. Preventive intraoperative anesthesia makes it possible to reduce these expenses and provide significant positive economic effect on state budget. The objective of this research is determination of influence of different methods of anesthesia of CUC on cash value of anesthetic maintenance of CUC and the possibility of saving of budgetary funds. 128 women took part in the research. They underwent the procedure of CUC. Anesthetic maintenance was performed using different medicamental combinations and their dosages. Mathematical calculation of the cost of each CUC stage was done considering the cost of consumables, medical preparations and value of labor of medical staff. In the course of this research, it was proven that a combination of additional use of dexketoprofen (at the stage of premedication of CUC) and performing preventive intraoperative applicational anesthesia with bupivacaine solution can save 130 452,26UAH of wage fund per year and general budget savings within the confines of a state can each 9 954 617,67UAH per year.
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Servicio de Anestesia en Hospital/economía , Anestesia/economía , Bupivacaína/economía , Legrado/métodos , Útero/cirugía , Servicio de Anestesia en Hospital/organización & administración , Bupivacaína/administración & dosificación , Ahorro de Costo , Legrado/economía , Femenino , Humanos , Periodo PosoperatorioRESUMEN
Benchmarking and comparing group productivity is an essential activity of data-driven management. For clinical anesthesiology, accomplishing this task is a daunting effort if meaningful conclusions are to be made. For anesthesiology groups, productivity must be done at the facility level in order to reduce some of the confounding factors. When industry or external comparisons are done, then the use of total ASA units per anesthetizing sites allows for overall productivity comparisons. Additional productivity components (total ASA units/h, h/case, h/operating room/d) allow for leaders to develop productivity dashboards. With the emergence of large groups that provide care in multiple facilities, these large groups can choose to invest more effort in collecting data and comparing facility productivity internally with group-defined measurements including total ASA units per full time equivalent.