Mobile Cricothyrotomy Simulation Cart Improves Anesthesia Providers' Confidence, Technical Skills, and Procedure Time.

Cricothyrotomy is an invasive airway used in "cannot intubate, cannot ventilate" events and can be taught using simulation. A mobile cricothyrotomy simulation for 66 anesthesia providers included an initial cricothyrotomy attempt (pretest), education, practice and feedback, and a second cricothyrotomy attempt (posttest). Provider confidence, skills, and procedure time were measured.

Standardized Perioperative Note to Improve Perioperative Management of Patients With Cardiac Implantable Electronic Devices.

Purpose: Over 3 million people have a cardiac implantable electronic device (CIED) in the United States. Without an organization-wide, standardized approach to the perioperative management of patients with CIEDs, communication errors and subsequent periods of unintentional deactivation and management can leave patients vulnerable to untreated, life-threatening arrhythmias. The purpose of this quality improvement project was to refine the standardized approach for perioperative management of patients with CIEDs at a large academic medical center.

Fast-Tracking Patients in an Academic Hospital to Increase Efficiency and Decrease Discharge Delays: A Process Improvement Plan.

Purpose: The purpose of this quality improvement project was to determine if implementing a Phase II postanesthesia care unit (PACU II) to fast-track patients following surgery in an academic hospital would decrease OR hold times and increase patient flow efficiency.

Design: An observational pre-post design was used to compare PACU bypass rates and recovery times for ambulatory surgery (AS) patients before and after implementation of a patient fast-tracking program.

Methods: A PACU II was instituted and a fast-tracking program using the White Fast-Track Scoring tool was adopted.

Implementation of contextualized, emergency management cognitive aids in a periodontics clinic.

Background: Emergencies in outpatient clinics are rare. However, potentially catastrophic events can be challenging to manage due to a variety of factors, including limited equipment and staff. The purpose of this quality improvement project was to improve the staff knowledge and familiarity with critical performance elements for emergencies encountered in the setting of a periodontics clinic.

Implementation of a Postoperative Electronic Health Record Alert for Cardiac Implantable Electronic Device Patients.

Purpose: Approximately 2% of surgical patients have an existing cardiac implantable electronic device (CIED). Perioperative device reprogramming requires postoperative care to ensure that device settings are restored. Electronic health record (EHR) alerts have been shown to improve communication between providers and decrease time to necessary interventions in other areas of medicine.

Intraoperative waste segregation initiative among anesthesia personnel to contain disposal costs.

Approximately 90% of medical waste generated in the operating room (OR) is considered to be non-infectious and non-regulated (Wyssusek, Keys & van Zundert, 2019). Frequently, this waste is inappropriately disposed of into infectious regulated medical waste containers. Due to differences in waste treatment, improper segregation can lead to the misuse or inappropriate allocation of resources, environmental pollution, and increased cost for institutions.

Optimizing Intraoperative Fluid Replacement for Patients Receiving Mannitol During Neurosurgical Procedures: A Quality Improvement Initiative.

Patients undergoing craniotomy are at increased risk of intravascular volume changes due to the use of mannitol. This quality improvement project was conducted to implement a standardized goal-directed fluid therapy (GDFT) protocol using a dynamic physiologic measure in an attempt to maintain euvolemia in patients undergoing craniotomy with mannitol administration. An evidence-based GDFT protocol was integrated into an existing neurosurgical protocol.

Perioperative Anesthetic Techniques to Reduce Surgical Morbidity After Amputation.

Anesthetic modalities to mitigate the development of phantom limb pain have not been standardized into an evidence-based, multimodal anesthesia protocol to promote improved patient outcomes. This quality improvement project involved the implementation of a lower extremity, amputation-specific anesthesia protocol. In the postimplementation group, 94 patients were anesthetized for their amputation using an Amputation Improved Recovery Enhanced Recovery After Surgery (ERAS) protocol.

Does Ultrasonographic Measurement of Gastric Content Influence Airway Management Decisions?

The presence of gastric content before induction of general anesthesia is the primary modifiable risk factor in the prevention of pulmonary aspiration. The purpose of this project was to determine if ultrasonography could be routinely used to measure gastric content and assign aspiration risk in patients undergoing general anesthesia. Preoperative gastric ultrasonography was performed in a convenience sample of 100 patients.

Nasal Ventilation Mask for Prevention of Upper Airway Obstruction in Patients With Obesity or Obstructive Sleep Apnea.

This project aimed to develop and implement a nasal ventilation mask (NVM) guideline to reduce the incidence of airway obstruction in outpatients undergoing endoscopy procedures. An observational design was used to evaluate implementation of an NVM guideline as the oxygen delivery method for this patient population. An evidence-based guideline for NVM use was developed for patients with obstructive sleep apnea (OSA) and/or an elevated body mass index (BMI) above 35 kg/m² undergoing esophagogastroduodenoscopy and/or colonoscopy procedures at an outpatient endoscopy clinic.

Use of Near-Infrared Spectroscopy to Measure Tissue Oxygen Saturation During Total Knee Arthroplasty With Use of a Tourniquet.

The primary purpose of this proof-of-concept quality improvement effort was to evaluate the practicality of using near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation (Sto) during total knee arthroplasty (TKA) with use of a tourniquet. NIRS sensors were applied to the biceps femoris (BF) and gastrocnemius (GS) muscles of both lower extremities of patients undergoing TKA procedures. For a convenience sample of 15 patients, measurement of Sto was attempted at baseline, following subarachnoid block administration, and after tourniquet inflation and deflation.

Identifying Components Necessary for an Enhanced Recovery After Surgery Pathway for Elective Intracranial Surgery: An Improvement Project Using the Quality of Recovery-15 Score.

Objective: To identify the domains of recovery, as determined by the Quality of Recovery-15 (QoR-15) score, that needed improvement to develop initial interventions for an enhanced recovery after surgery protocol for patients undergoing elective intracranial surgery under general anesthesia.

Methods: A paired-availability design was used to assess 2 groups of 41 patients undergoing elective intracranial surgery. The baseline QoR-15 score and scores 0, 6, 12, and 24 hours after arrival in the intensive care unit characterized the postoperative recovery trajectory.

Implementation of Vulnerable Elders Survey-13 Frailty Tool to Identify At-Risk Geriatric Surgical Patients.

Purpose: The primary purpose of this project was to preoperatively identify frail and vulnerable geriatric patients aged 65 or older using the Vulnerable Elders Survey (VES-13) tool, and to use those scores to assist with perioperative decision-making.

Design: This feasibility study was implemented as a quality improvement initiative with a postimplementation group only.

Methods: The VES-13 was introduced to the perioperative nursing staff and anesthesia providers and then added to the traditional preoperative assessment.

Laboratory Monitoring and Transfusion Guidelines to Influence Care in Patients Undergoing Multilevel Spinal Fusion Surgery.

Purpose: The purpose of this project was to determine whether the use of the modified Northwestern high risk spine protocol in patients undergoing multilevel spinal fusion surgery would result in improved transfusion practices.

Design: Preimplementation and postimplementation design.

Methods: A laboratory monitoring and transfusion guideline protocol was implemented in patients undergoing multilevel spinal fusions.

Implementation of an Obstructive Sleep Apnea Protocol in the Postanesthesia Care Unit for Patients Undergoing Spinal Fusion Surgery.

Purpose: The purpose of this project was to implement and evaluate the effectiveness of a postanesthesia care unit (PACU) obstructive sleep apnea (OSA) protocol in patients undergoing spinal fusion surgery.

Design: The structure of this project was a preimplementation and postimplementation design.

Methods: A convenience sample of 63 patients admitted to the PACU after spinal fusion surgery, with diagnosed or high-risk OSA, was included in protocol implementation.

Low-Dose Ketamine Infusion to Decrease Postoperative Delirium for Spinal Fusion Patients.

Purpose: The primary aim of this project was to decrease the incidence of postoperative delirium after spine surgery.

Design: A prospective preimplementation and postimplementation design was used.

Methods: A reduced dose ketamine protocol was implemented for adult patients undergoing elective spinal fusion surgery.

Implementation of Physiological Scoring to Determine Discharge Readiness for Patients Undergoing Otolaryngology Head and Neck Procedures.

Purpose: This quality improvement project examined whether the use of a validated physiological scoring protocol to determine discharge readiness for surgical procedures proximal to the airway would decrease the time at which discharge criteria were met and postanesthesia care unit (PACU) length of stay.

Design: An observational pre-post design compared preimplementation recovery times to postimplementation recovery times.

Methods: PACU nurses were trained to use two physiological scoring protocols to determine when patients met discharge criteria and to document when discharge criteria were met.

Perianesthetic Implications and Considerations for Myasthenia Gravis.

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease in which antibodies against the post-nicotinic acetylcholine receptor at the neuromuscular junction develop. Although the exact cause of MG remains unknown, the thymus is a common factor in many cases. Patients with underlying junctional disease, such as MG, have greater anesthesia-related risks because of their known predisposition toward prolonged muscle weakness.

Preprocedural Checklist for Magnetic Resonance Imaging Patients Undergoing General Anesthesia: A Process Improvement Plan to Enhance Reimbursement.

Thorough documentation is essential for hospital reimbursement from payors such as the Centers for Medicare & Medicaid Services. Inconsistencies and incomplete documentation can occur if workflow is not standardized especially in cases with interdisciplinary involvement. Documentation for patients undergoing magnetic resonance imaging (MRI) with anesthesia services was examined and revealed an opportunity for improvement to avoid financial losses.

Fast-tracking ambulatory surgery patients following anesthesia.

Purpose: The purpose of this process improvement project was to introduce and evaluate the efficacy of fast-tracking ambulatory surgical patients in a community hospital.

Design: An observational pre-post design was used, in which patient data from a reference period (pre-fast-tracking) was compared with patient data collected during an implementation period (post-fast-tracking).

Methods: Anesthesia providers were trained to use a tool to assess patients for eligibility to bypass the postanesthesia care unit (PACU).