Operating Room Management at the Edge of Order and Chaos.

The operating room (OR) management literature tends to view management problems as having finite solutions and assumes that equilibrium exists in the intricate encounters that occur every day. In this article, we review complexity theory and assess its applicability to the strategic, tactical, and operational issues facing OR managers. By building on complexity theory and its assumptions, we also show that as complex systems, ORs resemble high-reliability organizations more than they resemble ultra-safe organizations.

Potential Association Between Physician Burnout Rates and Operating Margins: Specialty-Specific Analysis.

Physician burnout rates have increased across most specialties betweer 2011 and 2014, and there may be an association with financial metrics. WE examined the ordinal ranking of operating margins for each physician spe. cialty from the University of Vermont Medical Center and the correspond.

Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis.

Background: Although previous publications suggest an increasing demand and volume of nonoperating room anesthesia (NORA) cases in the United States, there is little factual information on either volume or characteristics of NORA cases at a national level. Our goal was to assess the available data using the National Anesthesia Clinical Outcomes Registry (NACOR).

Methods: We performed a retrospective analysis of NORA volume and case characteristics using NACOR data for the period 2010-2014.

Electronic Cigarette Use and Respiratory Symptoms in Adolescents.

Rationale: Rates of adolescent electronic (e-) cigarette use are increasing, but there has been little study of the chronic effects of use. Components of e-cigarette aerosol have known pulmonary toxicity.

Objectives: To investigate the associations of e-cigarette use with chronic bronchitis symptoms and wheeze in an adolescent population.

Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia: a retrospective analysis of 23,073 patients.

Total shoulder arthroplasty (TSA) is typically performed in the beach-chair position. Maintenance of adequate mean arterial pressure is required to provide appropriate cerebral perfusion pressure and prevent cerebral ischemia. Placement of an arterial line to facilitate invasive monitoring is discretionary, based on clinical judgment.

Novel drug development for neuromuscular blockade.

Pharmacological advances in anesthesia in recent decades have resulted in safer practice and better outcomes. These advances include improvement in anesthesia drugs with regard to efficacy and safety profiles. Although neuromuscular blockers were first introduced over a half century ago, few new neuromuscular blockers and reversal agents have come to market and even fewer have remained as common clinically employed medications.

Role of ketamine for analgesia in adults and children.

Ketamine an N-methyl-D-aspartate (NMDA) receptor blocking agent and a dissociative anesthetic with neurostimulatory side effects. In recent years, multiple research trials as well as systematic reviews and meta-analyses suggest the usefulness of ketamine as a strong analgesic used in subanesthetic intravenous doses, and also as a sedative. In addition, ketamine was noted to possess properties of anti-tolerance, anti-hyperalgesia and anti-allodynia most likely secondary to inhibition of the NMDA receptors.

Introduction of a new electronic medical record system has mixed effects on first surgical case efficiency metrics.

To evaluate the effect of deploying a new electronic medical record (EMR) system on first case starts in the operating room. Data on first case start times were collected after implementation of a new EMR (Epic) from June 2015 to May 2016, which replaced a legacy system of both paper and electronic records. These were compared to data from the same months in the three proceeding years.

Unplanned Reintubation Following Cardiac Surgery: Incidence, Timing, Risk Factors, and Outcomes.

Objectives: To determine the incidence, timing, risk factors for, and outcomes after unplanned reintubation following cardiac surgery in adults.

Design: Retrospective analysis of admission data from the American College of Surgeons National Surgical Quality Improvement Project Database, 2007-2013, inclusive. Univariate and multivariate analyses of risk factors and outcomes.

Creating a Standardized Operating Room Management Curriculum for Anesthesia Trainees.

As the healthcare environment evolves, physicians are taking on new roles and responsibilities. In addition to clinical care, physicians must now be knowledgeable about administrative concepts and understand healthcare finances. However, these nonclinical subjects usually are not taught during residency training.

Epidemiologic data and trends concerning the use of regional anaesthesia for shoulder arthroscopy in the United States of America.

Background: Despite a growing body of literature illustrating the benefits of regional anaesthesia in shoulder arthroscopy, data on actual use of the technique in the United States is lacking. This study analyses epidemiologic data to describe current trends in anaesthetic practice for these procedures in the United States and highlights key associations with patient and provider demographic variables that may provide further insight.

Methods: We analysed the large database from the National Anesthesia Clinical Outcomes Registry of the Anesthesia Quality Institute.

The Need for Accreditation of Office-Based Interventional Vascular Centers.

The rise in office-based interventional vascular laboratories in recent years was prompted in part by expedient ambulatory patient experience and favorable outpatient procedural reimbursement. While studies have shown that clinical safety and treatment efficacy can be achieved in office-based vascular facilities, critics have raised various concerns due to inconsistent patient care standards and lack of organizational oversight to ensure optimal patient outcome. Available literature showed widely varied clinical outcomes which were partly attributable to nonuniform standards in reporting clinical efficacy and adverse events.

The Patterns of Utilization of Interscalene Nerve Blocks for Total Shoulder Arthroplasty.

The interscalene block (ISB) is a common adjunct to general anesthesia for total shoulder arthroplasty (TSA). The aim of the study was to report the current national demographics of the patients who are receiving ISB for TSAs. We performed a retrospective analysis of data from the National Anesthesia Clinical Outcomes Registry from 2010 to 2015.

Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

Background: Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature.

Remimazolam: Pharmacologic Considerations and Clinical Role in Anesthesiology.

Midazolam, fentanyl, and propofol are commonly used for sedation in modern anesthesia practice. These agents possess characteristics that have afforded various anesthetics to be delivered and produce relatively safe and effective outcomes. However, each agent has certain drawbacks in clinical practice.

E-cigarettes, Cigarettes, and the Prevalence of Adolescent Tobacco Use.

Background: Adolescent e-cigarette use has increased rapidly in recent years, but it is unclear whether e-cigarettes are merely substituting for cigarettes or whether e-cigarettes are being used by those who would not otherwise have smoked. To understand the role of e-cigarettes in overall tobacco product use, we examine prevalence rates from Southern California adolescents over 2 decades.

Methods: The Children's Health Study is a longitudinal study of cohorts reaching 12th grade in 1995, 1998, 2001, 2004, and 2014.

Use of Historical Surgical Times to Predict Duration of Primary Total Knee Arthroplasty.

Background: Primary total knee arthroplasty (TKA) is one of the most commonly performed procedures at US hospitals. Surgeons are typically asked to estimate surgical control time (SCT) needed for the procedure. Here, we compare the performance of a surgeon's prediction against a potentially more accurate method of using historical averages over the last 3, 5, 10, and 20 cases.

An Agenda for Improving Perioperative Code Status Discussion.

Code status discussions (CSDs) clarify patient preferences for cardiopulmonary resuscitation in the event of cardiac or respiratory arrest. CSDs are a key component of perioperative care, particularly at the end of life, and must be both patient-centered and shared. Physicians at all levels of training are insufficiently trained in and inappropriately perform CSD; this may be particularly true of perioperative physicians.

E-Cigarettes and Future Cigarette Use.

Background: There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal.

Methods: The Children's Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.

The emerging therapeutic roles of κ-opioid agonists.

The current practice of μ-opioid receptor agonists such as morphine as the primary means of acute and chronic pain relief has several dangerous consequences that limit their effectiveness, including respiratory depression, gastrointestinal motility inhibition, addiction, tolerance, and abuse. Several other opioid receptors, notably the μ-opioid (KOP) receptor, have long been known to play a role in pain relief. Recent discoveries and advancements in laboratory techniques have allowed significant developments of KOP agonists as potential novel therapies for pain relief and other pathological processes.

National incidences and predictors of inefficiencies in perioperative care.

Study Objective: The operating room suite can be one of the most costly units within the hospital. Some of these costs stem from postoperative unplanned admissions, case cancellations, case delays, and extended recovery room times. The objective is to determine the clinical predictors of these operating room inefficiencies.

Incidence and risk factors for early postoperative reintubations.

Study Objective: Reintubations are associated with significantly increased morbidity and mortality, increased hospital length of stay, and increased cost. Our aim was to assess the national incidence and associated risk factors for unanticipated early postoperative reintubations.

Design: Using the National Anesthesia Clinical Outcomes Registry (NACOR) from 2010 to 2014, multivariate logistic regression was fitted to determine if various patient, surgical, intraoperative, or provider data were associated with unanticipated early postoperative reintubations.

The E-cigarette Social Environment, E-cigarette Use, and Susceptibility to Cigarette Smoking.

Purpose: One concern regarding the recent increase in adolescent e-cigarette use is the possibility that electronic (e-) cigarettes may be used by those who might not otherwise have used cigarettes, and that dual use, or transition to cigarette use alone, may follow.

Methods: Questionnaire data were obtained in 2014 from 11th/12th grade students attending schools in 12 communities included in the Southern California Children's Health Study. We evaluated the cross-sectional association between e-cigarette use, the social environment (family and friends' use and approval of e-cigarettes and cigarettes), and susceptibility to future cigarette use among never cigarette smokers (N = 1,694), using previously validated measures based on reported absence of a definitive commitment not to smoke.

Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012.

Importance: Childhood bronchitic symptoms are significant public and clinical health problems that produce a substantial burden of disease. Ambient air pollutants are important determinants of bronchitis occurrence.

Objective: To determine whether improvements in ambient air quality in Southern California were associated with reductions in bronchitic symptoms in children.