Improving Compliance With Institutional Performance on Train of Four Monitoring.

Background: We performed a multistep quality improvement project related to neuromuscular blockade and monitoring to evaluate the effectiveness of a comprehensive quality improvement program based upon the Multi-institutional Perioperative Outcomes Group (MPOG) Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) metrics targeted specifically at improving train of four (TOF) monitoring rates.

Methods: We adapted the plan-do-study-act (PDSA) framework and implemented 2 PDSA cycles between January 2021 and December 2021. PDSA Cycle 1 (Phase I) and PDSA Cycle 2 (Phase II) included a multipart program consisting of (1) a departmental survey assessing attitudes toward intended results, outcomes, and barriers for TOF monitoring, (2) personalized MPOG ASPIRE quality performance reports displaying provider performance, (3) a dashboard access to help providers complete a case-by-case review, and (4) a web-based app spaced education module concerning TOF monitoring and residual neuromuscular blockade.

Sustained Value of Implementation of a Flexibility-Based Compensation Structure for Nurse Anesthetists in a Large Multihospital Healthcare System.

Nurse anesthetists can use their creative problem-solving abilities to benefit both their employers and themselves. In an era when healthcare dollars are in short supply and patients who require anesthesia care are living longer (and requiring more procedures with anesthesia), innovative strategies are needed to achieve value and access to anesthesiology services. Leveraging the professional interests of Certified Registered Nurse Anesthetists (CRNAs), the implementation of a flexibility-based compensation structure can optimize overall staffing requirements to meet patient care demands, particularly in the face of recruitment challenges.