Content analysis of resident evaluations of faculty anesthesiologists: supervision encompasses some attributes of the professionalism core competency.

Background: Anesthesiology departments need an instrument with which to assess practicing anesthesiologists' professionalism. The purpose of this retrospective analysis of the content of a cohort of resident evaluations of faculty anesthesiologists was to investigate the relationship between a clinical supervision scale and the multiple attributes of professionalism.

Methods: From July 1, 2013 to the present, our department has utilized the de Oliveira Filho unidimensional nine-item supervision scale to assess the quality of clinical supervision of residents provided by our anesthesiologists.

"Opt Out" and Access to Anesthesia Care for Elective and Urgent Surgeries among U.S. Medicare Beneficiaries.

Background: In 2001, the Centers for Medicare and Medicaid Services issued a rule allowing U.S. states to "opt out" of the regulations requiring physician supervision of nurse anesthetists in an effort to increase access to anesthesia care.

Operating Room Anesthesia Subspecialization Is Not Associated With Significantly Greater Quality of Supervision of Anesthesia Residents and Nurse Anesthetists.

Background: Supervision of anesthesia residents and nurse anesthetists is a major responsibility of faculty anesthesiologists. The quality of their supervision can be assessed quantitatively by the anesthesia residents and nurse anesthetists. Supervision scores are an independent measure of the contribution of the anesthesiologist to patient care.

US National Anesthesia Workload on Saturday and Sunday Mornings.

Background: In order to provide guidance to organizations considering elective weekend surgical case scheduling, we analyzed data from the American Society of Anesthesiologist's Anesthesia Quality Institute. We determined the US anesthesia workload on Saturdays and Sundays.

Methods: The American Society of Anesthesiologist's Anesthesia Quality Institute data were from all US anesthesia groups that submitted cases to the National Anesthesia Clinical Outcomes Registry for 2013.

Narrative Review of Statistical Reporting Checklists, Mandatory Statistical Editing, and Rectifying Common Problems in the Reporting of Scientific Articles.

Considerable attention has been drawn to poor reproducibility in the biomedical literature. One explanation is inadequate reporting of statistical methods by authors and inadequate assessment of statistical reporting and methods during peer review. In this narrative review, we examine scientific studies of several well-publicized efforts to improve statistical reporting.

Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 1 Efficacy: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations.

The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the US Food and Drug Administration, convened a meeting of sedation experts from a variety of clinical specialties and research backgrounds with the objective of developing recommendations for procedural sedation research. Four core outcome domains were recommended for consideration in sedation clinical trials: (1) safety, (2) efficacy, (3) patient-centered and/or family-centered outcomes, and (4) efficiency. This meeting identified core outcome measures within the efficacy and patient-centered and/or family-centered domains.

Diversity and Similarity of Anesthesia Procedures in the United States During and Among Regular Work Hours, Evenings, and Weekends.

Background: Anesthesiologists providing care during off hours (ie, weekends or holidays, or cases started during the evening or late afternoon) are more likely to care for patients at greater risk of sustaining major adverse events than when they work during regular hours (eg, Monday through Friday, from 7:00 AM to 2:59 PM). We consider the logical inconsistency of using subspecialty teams during regular hours but not during weekends or evenings.

Methods: We analyzed data from the Anesthesia Quality Institute's National Anesthesia Clinical Outcomes Registry (NACOR).

Growth in an Anesthesiologist- and Nurse Anesthetist-Supervised Sedation Nurse Program Using Propofol and Dexmedetomidine.

In 2007, the Department of Anesthesia at the University of Iowa established an anesthesiologist-supervised nurse-managed sedation program. In 2008, the use of propofol and dexmedetomidine by nurses was approved in Iowa. We reviewed 11,038 elective sedation cases done between January 1, 2007, and June 30, 2014.

Written Comments Made by Anesthesia Residents When Providing Below Average Scores for the Supervision Provided by the Faculty Anesthesiologist.

Background: Anesthesia residents in our department evaluate the supervision provided by the faculty anesthesiologist with whom they worked the previous day. What advice managers can best provide to the faculty who receive below-average supervision scores is unknown.

Methods: The residents provided numerical answers (1 "never," 2 "rarely," 3 "frequently," or 4 "always") to each of the 9 supervision questions, resulting in a total supervision score.

The Effect of "Opt-Out" Regulation on Access to Surgical Care for Urgent Cases in the United States: Evidence from the National Inpatient Sample.

Background: In 2001, the Center for Medicare and Medicaid Services issued a rule permitting states to "opt-out" of federal regulations requiring physician supervision of nurse anesthetists. We examined the extent to which this rule increased access to anesthesia care for urgent cases.

Methods: Using data from a national sample of inpatient discharges, we examined whether opt-out was associated with an increase in the percentage of patients receiving a therapeutic procedure among patients admitted for appendicitis, bowel obstruction, choledocholithiasis, or hip fracture.

The Risks to Patient Privacy from Publishing Data from Clinical Anesthesia Studies.

In this article, we consider the privacy implications of posting data from small, randomized trials, observational studies, or case series in anesthesia from a few (e.g., 1-3) hospitals.

Influence of Data and Formulas on Trust in Information from Journal Articles in an Operating Room Management Course.

To make good decisions, operating room (OR) managers often act autocratically after obtaining expert advice. When such advice is provided by e-mail, attachments of research articles can be included. We performed a quasi-experimental study using an evaluation of 4 articles used in a 50-hour OR management course to assess how their content influences trust in the article's content, including its quality, usefulness, and reliability.

Controlled Substance Reconciliation Accuracy Improvement Using Near Real-Time Drug Transaction Capture from Automated Dispensing Cabinets.

Background: Accurate accounting of controlled drug transactions by inpatient hospital pharmacies is a requirement in the United States under the Controlled Substances Act. At many hospitals, manual distribution of controlled substances from pharmacies is being replaced by automated dispensing cabinets (ADCs) at the point of care. Despite the promise of improved accountability, a high prevalence (15%) of controlled substance discrepancies between ADC records and anesthesia information management systems (AIMS) has been published, with a similar incidence (15.

Work Habits Are Valid Components of Evaluations of Anesthesia Residents Based on Faculty Anesthesiologists' Daily Written Comments About Residents.

Background: In our department, faculty anesthesiologists routinely evaluate the resident physicians with whom they worked in an operative setting the day before, providing numerical scores to questions. The faculty can also enter a written comment if so desired. Because residents' work habits are important to anesthesiology program directors, and work habits can improve with feedback, we hypothesized that faculty comments would include the theme of the anesthesia resident's work habits.

Decreasing the Hours That Anesthesiologists and Nurse Anesthetists Work Late by Making Decisions to Reduce the Hours of Over-Utilized Operating Room Time.

In this special article, we evaluate how to reduce the number of hours that anesthesiologists and nurse anesthetists work beyond the end of their scheduled shifts. We limit consideration to surgical suites where the hours of cases in each operating room (OR) average 8 hours or more per day. Let "allocated hours" refer to the hours into which cases are scheduled, calculated months in advance for each combination of service and day of the week.

Amnesia of the Operating Room in the B-Unaware and BAG-RECALL Clinical Trials.

Background: Patient memories of the operating room (OR) may serve as the informational basis for assessing satisfaction with individual anesthesiologists. Furthermore, the provision of clinically important information may assume that perioperative memories are retained. Studies assessing the extent of perioperative amnesia and factors associated with perioperative amnesia are sparse.

Comparing Policies for Case Scheduling Within 1 Day of Surgery by Markov Chain Models.

Background: In previous studies, hospitals' operating room (OR) schedules were influenced markedly by decisions made within a few days of surgery. At an academic hospital, 46% of ORs had their last case scheduled or changed within 1 working day of surgery, and a private hospital had 64%. Many of these changes were for patients who were admitted before surgery (i.

Economic and Environmental Considerations During Low Fresh Gas Flow Volatile Agent Administration After Change to a Nonreactive Carbon Dioxide Absorbent.

Background: Reducing fresh gas flow (FGF) during general anesthesia reduces costs by decreasing the consumption of volatile anesthetics and attenuates their contribution to greenhouse gas pollution of the environment. The sevoflurane FGF recommendations in the Food and Drug Administration package insert relate to concern over potential toxicity from accumulation in the breathing circuit of compound A, a by-product of the reaction of the volatile agent with legacy carbon dioxide absorbents containing strong alkali such as sodium or potassium hydroxide. Newer, nonreactive absorbents do not produce compound A, making such restrictions moot.

Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc.