A Mobile Post Anesthesia Care Unit Order Reminder System Improves Timely Order Entry.

Transition to the postanesthesia care unit (PACU) requires timely order placement by anesthesia providers. Computerized ordering enables automated order reminder systems, but their value is not fully understood. We performed a single-center, retrospective cohort study to estimate the association between automated PACU order reminders and primary outcomes (1) on-time order placement and (2) the degree of delay in placement.

The impact of a medically directed student registered nurse anesthesia staffing model on Postprocedural patient outcomes.

Study Objective: In 2018, the American Society of Anesthesiologists stated that student registered nurse anesthetists (SRNAs) "are not yet fully qualified anesthesia personnel." It remains unclear, however, whether postprocedural outcomes are affected by SRNAs providing anesthesia care under the medical direction of anesthesiologists, as compared with medically directed anesthesiology fellows or residents, or certified registered nurse anesthetists (CRNAs). We therefore aimed to examine whether medically directed SRNAs serving as in-room anesthesia providers impact surgical outcomes.

Automated feedback modestly improves perioperative treatment adherence of postoperative nausea and vomiting.

Study Objective: Extensive evidence demonstrates that medical record modernization and a vast amount of available data have not overcome the gap between recommended and delivered care. This study aimed to evaluate the use of clinical decision support (CDS) in conjunction with feedback (post-hoc reporting) to improve PONV medication administration compliance and postoperative nausea and vomiting (PONV) outcomes.

Design: Single center, prospective observational study between January 1, 2015, and June 30, 2017.

Understanding the Accuracy of Clinician Provided Estimated Discharge Dates.

Discharge planning is a vital tool in managing hospital capacity, which is essential for maintaining hospital throughput for surgical postoperative admissions. Early discharge planning has been effective in reducing length of stay and hospital readmissions. Between 2014 and 2017, Vanderbilt University Medical Center (VUMC) implemented a tool in the electronic health record (EHR) requiring providers to input the patient's estimated discharge date on each hospital day.

The effect of adding goal-directed hemodynamic management for elective patients in an established enhanced recovery program for colorectal surgery: results of quasi-experimental pragmatic trial.

Background: Recent literature has demonstrated that hemodynamic instability in the intraoperative period places patients at risk of poor outcomes. Furthermore, recent studies have reported that stroke volume optimization and protocolized hemodynamic management may improve perioperative outcomes, especially surgical site infection (SSI), in certain high-risk populations. However, the optimal strategy for intraoperative management of all elective patients within an enhanced recovery program remains to be elucidated.

Transition from Private to Academic Anesthesia Provision Changes Process and Patient Centered Outcomes in an Ambulatory Surgery Center.

A recurring concern in the discussion of performance of anesthesia practices is that academic practitioners are slower, less efficient, or produce poorer operational outcomes than their private practice counterparts. A simple overnight 'swap' of a private anesthesia practice with an academic anesthesia practice took place in an outpatient surgery center where the case volume, case mix, surgeons, and staff remained the same. Operational and quality measures were analyzed for comparison between the practices over the span of two years.

Patient satisfaction survey scores are not an appropriate metric to differentiate performance among anesthesiologists.

Study Objective: With the focus of patient-centered care in healthcare organizations, patient satisfaction plays an increasingly important role in healthcare quality measurement. We sought to determine whether an automated patient satisfaction survey could be effectively used to identify outlying anesthesiologists.

Design: Retrospective Observational Study.

Pediatric Perioperative Mortality in Kenya: A Prospective Cohort Study from 24 Hospitals.

Background: The global surgery access imbalance will have a dramatic impact on the growing population of the world's children. In regions of the world with pediatric surgery and anesthesia manpower deficits and pediatric surgery-specific infrastructure and supply chain gaps, this expanding population will present new challenges. Perioperative mortality rate is an established indicator of the quality and safety of surgical care.

CYP2D6 Genotype-guided Metoprolol Therapy in Cardiac Surgery Patients: Rationale and Design of the Pharmacogenetic-guided Metoprolol Management for Postoperative Atrial Fibrillation in Cardiac Surgery (PREEMPTIVE) Pilot Study.

Objectives: The Preemptive Pharmacogenetic-guided Metoprolol Management for Atrial Fibrillation in Cardiac Surgery (PREEMPTIVE) pilot trial aims to use existing institutional resources to develop a process for integrating CYP2D6 pharmacogenetic test results into the patient electronic health record, to develop an evidence-based clinical decision support tool to facilitate CYP2D6 genotype-guided metoprolol administration in the cardiac surgery setting, and to determine the impact of implementing this CYP2D6 genotype-guided integrated approach on the incidence of postoperative atrial fibrillation (AF), provider, and cost outcomes.

Design: One-arm Bayesian adaptive design clinical trial.

Setting: Single center, university hospital.

A retrospective evaluation of the risk of bias in perioperative temperature metrics.

The prevention and treatment of hypothermia is an important part of routine anesthesia care. Avoidance of perioperative hypothermia was introduced as a quality metric in 2010. We sought to assess the integrity of the perioperative hypothermia metric in routine care at a single large center.

An enhanced recovery program in colorectal surgery is associated with decreased organ level rates of complications: a difference-in-differences analysis.

Background: Perioperative care has lacked coordination and standardization. Enhanced recovery programs (ERPs) have been shown to decrease aggregate complications across surgical specialties. We hypothesize that the sustained implementation of an ERP will be associated with a decrease in a broad range of complications at the organ system level.

Implementation of Acceleromyography to Increase Use of Quantitative Neuromuscular Blockade Monitoring: A Quality Improvement Project.

Residual neuromuscular blockade creates excess perioperative morbidity. Quantitative neuromuscular monitoring devices may help ensure full recovery from neuromuscular blocking agents and have been demonstrated to reduce complications associated with residual neuromuscular blockade. We studied the effectiveness of educational efforts to introduce quantitative monitoring at a large academic medical center, with predefined main outcome measures of self-reported familiarity with use of the device and actual device uptake.

An enhanced recovery program for bariatric surgical patients significantly reduces perioperative opioid consumption and postoperative nausea.

Background: Patients frequently remain in the hospital after bariatric surgery due to pain, nausea, and inability to tolerate oral intake. Enhanced recovery after surgery (ERAS) concepts address these perioperative complications and therefore improve length of stay for bariatric surgery patients.

Objectives: To determine if ERAS concepts increase the proportion of patients discharged on postoperative day 1.

Sources of Variation in Anesthetic Drug Costs.

Background: Increasing attention has been focused on health care expenditures, which include anesthetic-related drug costs. Using data from 2 large academic medical centers, we sought to identify significant contributors to anesthetic drug cost variation.

Methods: Using anesthesia information management systems, we calculated volatile and intravenous drug costs for 8 types of inpatient surgical procedures performed from July 1, 2009, to December 31, 2011.

Implementation and Evaluation of the Z-Score System for Normalizing Residency Evaluations.

Background: Assessment of clinical competence is essential for residency programs and should be guided by valid, reliable measurements. We implemented Baker's Z-score system, which produces measures of traditional core competency assessments and clinical performance summative scores. Our goal was to validate use of summative scores and estimate the number of evaluations needed for reliable measures.

Monitoring Anesthesia Care Delivery and Perioperative Mortality in Kenya Utilizing a Provider-driven Novel Data Collection Tool.

Background: Perioperative mortality rate is regarded as a credible quality and safety indicator of perioperative care, but its documentation in low- and middle-income countries is poor. We developed and tested an electronic, provider report-driven method in an East African country.

Methods: We deployed a data collection tool in a Kenyan tertiary referral hospital that collects case-specific perioperative data, with asynchronous automatic transmission to central servers.

A Perioperative Systems Design to Improve Intraoperative Glucose Monitoring Is Associated with a Reduction in Surgical Site Infections in a Diabetic Patient Population.

Background: Diabetic patients receiving insulin should have periodic intraoperative glucose measurement. The authors conducted a care redesign effort to improve intraoperative glucose monitoring.

Methods: With approval from Vanderbilt University Human Research Protection Program (Nashville, Tennessee), the authors created an automatic system to identify diabetic patients, detect insulin administration, check for recent glucose measurement, and remind clinicians to check intraoperative glucose.

Prolonged patient emergence time among clinical anesthesia resident trainees.

Background And Aims: Emergence time, or the duration between incision closure and extubation, is costly nonoperative time. Efforts to improve operating room efficiency and identify trainee progress make such time intervals of interest. We sought to calculate the incidence of prolonged emergence (i.