Journal of clinical anesthesia
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Comparative Study
ASA physical status assignment by non-anesthesia providers: Do surgeons consistently downgrade the ASA score preoperatively?
The American Society of Anesthesiologists physical status (ASA-PS) is associated with increased morbidity and mortality in the perioperative period. When surgeries are scheduled by surgeons and their staff at our large institution a presumed ASA-PS is chosen. This is because our institution (and, anecdotally, others in our hospital system and elsewhere), recognizing the relationship between higher ASA-PS and poorer postoperative outcomes, requires all patients with higher ASA-PS levels (≥3) to undergo enhanced preoperative workup. The patients may not, however, necessarily be seen in the anesthesia clinic prior to surgery. As a result, patients are assigned a presumed ASA-PS by a non-anesthesia provider (e.g., surgeons and physician extenders) that may not reflect the ASA-PS chosen by the anesthesiologist on the day of surgery. Errors in the accuracy of the ASA-PS prior to surgery lead to unnecessary and costly preoperative testing, delays in operative procedures, and potential case cancellations. Our study aimed to determine whether there are significant differences in the assignment of ASA-PS by non-anesthesia providers when compared to anesthesia providers. ⋯ Non-anesthesia providers assign ASA-PS with significantly less accuracy than do anesthesia providers, even when adjusted for multiple comparisons. Surgical and procedural departments were found to consistently under-rate the ASA-PS of patients in our clinical vignettes.
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Comparative Study Observational Study
Anesthesiologists' perceptions of minimum acceptable work habits of nurse anesthetists.
Work habits are non-technical skills that are an important part of job performance. Although non-technical skills are usually evaluated on a relative basis (i.e., "grading on a curve"), validity of evaluation on an absolute basis (i.e., "minimum passing score") needs to be determined. ⋯ Our results suggest that routinely evaluated work habits of nurse anesthetists within departments should not be compared with an appropriate minimum score (i.e., of 3.69). Instead, work habits scores should be analyzed based on relative reporting among anesthetists.
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Comparative Study Clinical Trial
Non-invasive cardiac output monitor validation study in pediatric cardiac surgery patients.
To validate a non-invasive cardiac output monitor in pediatric cardiac surgery patients. ⋯ There is a strong correlation between the cardiac output values derived from the Fick equation and the Aesculon non-invasive cardiac output monitor.