Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2016
A Systematic Approach to Creation of a Perioperative Data Warehouse.
Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc.), which contain all of the data required for reporting on various metrics. ⋯ In creating the database, the authors were able to significantly reduce the number of required table identifiers from >10 to 3, as well as to correct errors in linkages affecting up to 18.4% of cases. In addition, the data mart greatly simplified the code required to extract data, making the data accessible to individuals who lacked a strong coding background. Overall, this infrastructure represents a scalable way to successfully report on perioperative EPIC data while standardizing the definitions and improving access for end users.
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Anesthesia and analgesia · Jun 2016
Written Comments Made by Anesthesia Residents When Providing Below Average Scores for the Supervision Provided by the Faculty Anesthesiologist.
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. ⋯ A faculty who has insufficient presence cannot be providing good teaching. Furthermore, there was negligible correlation between supervision scores and faculty clinical assignments. Thus, insufficient faculty presence accounted for a small proportion of below-average supervision scores and low-quality supervision. Furthermore, scores ≥3 have a predictive value for the absence of disrespectful behavior ≅99%. Approximately 94% of the faculty supervision scores that were below average were still ≥3. Consequently, for the vast majority of the faculty-resident-days, quality of teaching distinguished between below- versus above-average supervision scores. This result is consistent with our prior finding of a strong correlation between 6-month supervision scores and assessments of teaching effectiveness. Taken together, when individual faculty anesthesiologists are counseled about their clinical supervision scores, the attribute to emphasize is quality of clinical teaching.
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Anesthesia and analgesia · Jun 2016
The Effect of "Opt-Out" Regulation on Access to Surgical Care for Urgent Cases in the United States: Evidence from the National Inpatient Sample.
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. ⋯ Based on 2 measures of access, opt-out does not appear to have significantly increased access to anesthesia for urgent inpatient conditions.
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Anesthesia and analgesia · Jun 2016
Observational StudyCosts Associated with Anesthesia-Related Adverse Events During Labor and Delivery in New York State, 2010.
The safety of anesthetic care provided during childbirth has improved during the past 2 decades in the United States, with a marked decrease in the rate of anesthesia-related adverse events (ARAEs). To date, there is little research on the costs of ARAEs in obstetrics. This study aims to assess the excess cost and cost per admission associated with ARAEs during labor and delivery. ⋯ ARAEs during labor and delivery are associated with significant excess cost. However, the excess cost per admission for ARAEs is significantly less compared with the excess cost per admission for preeclampsia/eclampsia and postpartum hemorrhage.