Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2013
A behavioral study of daily mean turnover times and first case of the day start tardiness.
Previous research has identified 2 psychological biases in operating room (OR) decisions on the day of surgery: risk attitude of the decision-maker at the OR control desk and decisions made by OR staff to increase clinical work per unit time during the hours they are assigned. Resulting decisions are worse than random chance at reducing overutilized time. To isolate the second bias from decisions at the OR control desk, previous studies of the second bias have analyzed decisions made in non-OR locations and on nights/weekends. Another way to isolate the second bias from decisions at the OR control desk is to study facilities with negligible overutilized OR time. We examined the second bias using data from such a facility. ⋯ Previous experimental and observational studies found many clinicians maintained high clinical work per unit time during the hours to which they were assigned. We tested and confirmed a prediction of this bias as was applied during regularly scheduled OR hours among an entire surgical team. Overall, the staff worked just as quickly on days with few or many hours of cases. The OR staff did not slow down, thus filling the time. These results have important implications for the cost utility of information technologies to facilitate managerial decision-making on the day of surgery.
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Anesthesia and analgesia · Jun 2013
Color flow Doppler ultrasonography can distinguish caudal epidural injection from intrathecal injection.
Color flow Doppler ultrasonography has been used to confirm caudal epidural injection, but its ability to detect accidental intrathecal injection is unknown. We hypothesized that, when using color flow Doppler, the injection of fluid into the epidural space would result in turbulent flow which would appear as a burst of color while intrathecal injection would show an absence of a color flow Doppler signal. ⋯ In the context of this study, color flow Doppler could differentiate epidural from intrathecal injection into the caudal space of children up to 6 years of age using a 0.1 mL/kg injection volume and injection rate of 0.5 to 1.0 mL/s.
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Anesthesia and analgesia · Jun 2013
An analysis of risk factors for patient complaints about ambulatory anesthesiology care.
Anesthesiology groups continually seek data sources and evaluation metrics for ongoing professional practice evaluation, credentialing, and other quality initiatives. The analysis of patient complaints associated with physicians has been previously shown to be a marker for patient dissatisfaction and a predictor of malpractice claims. Additionally, previous studies in other specialties have revealed a nonuniform distribution of complaints among professionals. In this study, we describe the distribution of complaints among anesthesia providers and identify factors associated with complaint risk in pediatric and adult populations. ⋯ There was apparent evidence in adult patients to suggest heterogeneity in provider risk for a patient complaint. However, once patient, procedural, and provider factors were acknowledged in analyses, such evidence for heterogeneity is diminished substantially. Further study into how and why these factors are associated with greater complaint risk may reveal potential interventions to decrease complaints.