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Anesthesiology Clinics

journal
https://www.readbyqxmd.com/read/29425604/quality-improvement-and-implementation-science-different-fields-with-aligned-goals
#1
EDITORIAL
Meghan B Lane-Fall, Lee A Fleisher
No abstract text is available yet for this article.
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425603/improving-perioperative-care-what-are-the-tools-that-lead-to%C3%A2-sustainable-change
#2
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425602/rethinking-clinical-workflow
#3
REVIEW
Joseph J Schlesinger, Kendall Burdick, Sarah Baum, Melissa Bellomy, Dorothee Mueller, Alistair MacDonald, Alex Chern, Kristin Chrouser, Christie Burger
The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425601/handovers-in-perioperative-care
#4
REVIEW
Atilio Barbeito, Aalok V Agarwala, Amanda Lorinc
Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425600/developing-multicenter-registries-to-advance-quality-science
#5
REVIEW
Laura E Schleelein, Kathleen A Harris, Elizabeth M Elliott
There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425599/use-of-simulation-in-performance-improvement
#6
REVIEW
Amanda Burden, Erin White Pukenas
Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425598/emergency-manuals-how-quality-improvement-and-implementation-science-can-enable-better-perioperative-management-during-crises
#7
REVIEW
Sara N Goldhaber-Fiebert, Carl Macrae
How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425597/quality-improvement-in-anesthesiology-leveraging-data-and-analytics-to-optimize-outcomes
#8
REVIEW
Elizabeth A Valentine, Scott A Falk
Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425596/human-factors-applied-to-perioperative-process-improvement
#9
REVIEW
Joseph R Keebler, Elizabeth H Lazzara, Elizabeth Blickensderfer, Thomas D Looke
This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Finally, using the HF/E perspective on safety, high-level recommendations are provided for increasing safety within the perioperative environment...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425595/diffusing-innovation-and-best-practice-in-health-care
#10
REVIEW
Philip E Greilich, Mary Eleanor Phelps, William Daniel
Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425594/developing-capacity-to-do-improvement-science-work
#11
REVIEW
Irene McGhee, Yehoshua Gleicher
Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29425593/implementation-science-in-perioperative-care
#12
REVIEW
Meghan B Lane-Fall, Benjamin T Cobb, Crystal Wiley Cené, Rinad S Beidas
There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation...
March 2018: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101963/anesthesia-outside-the-operating-room
#13
EDITORIAL
Mark S Weiss, Wendy L Gross
No abstract text is available yet for this article.
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101962/anesthesia-outside-of-the-operating-room-the-wild-west-or-the-new-frontier
#14
EDITORIAL
Lee A Fleisher
No abstract text is available yet for this article.
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101961/value-based-care-and-strategic-priorities
#15
REVIEW
Wendy L Gross, Lebron Cooper, Steven Boggs, Barbara Gold
The anesthesia market continues to undergo disruption. Financial margins are shrinking, and buyers are demanding that anesthesia services be provided in an efficient, low-cost manner. To help anesthesiologists analyze their market, Drucker and Porter's framework of buyers, suppliers, quality, barriers to entry, substitution, and strategic priorities allows for a structured analysis. Once this analysis is completed, anesthesiologists must articulate their value to other medical professionals and to hospitals...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101960/market-evaluation-finances-bundled-payments-and-accountable-care-organizations
#16
REVIEW
Shazia Mehmood Siddique, Shivan J Mehta
To control costs and improve quality, changes in health care delivery and financing have emerged, resulting in shifting of financial risk to providers for the quality and cost of care, including emergence of accountable care organizations and bundled payment models. This article discusses health care financing and delivery models in the context of procedures and surgeries that happen outside of the operating room. It describes the history of health insurance, trends in ambulatory surgery centers, and new payment models that have emerged from the Affordable Care Act and the Medicare Access and Children's Health Insurance Program Reauthorization Act...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101959/pediatric-anesthesia-considerations-for-interventional-radiology
#17
REVIEW
Olivia Nelson, Philip D Bailey
Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101958/interventional-pulmonology
#18
REVIEW
David M DiBardino, Andrew R Haas, Richard C Month
Bronchoscopy presents a unique challenge and need for collaboration between anesthesia providers and bronchoscopists. The approach to topical anesthesia, analgesia, and sedation must be customized based on complexity, duration, and setting. The bronchoscopy team must work together in each phase of the procedure to ensure patient safety and allow completion of a quality bronchoscopy. Airway access may change depending on the type of procedure planned and must be discussed before each case. Intraprocedural difficulties with ventilation, airway pressure, and sedation may arise that must be addressed together...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101957/anesthesia-for-colonoscopy-and-lower-endoscopic-procedures
#19
REVIEW
John Michael Trummel, Vinay Chandrasekhara, Michael L Kochman
Demand for anesthesiologist-assisted sedation is expanding for gastrointestinal lower endoscopic procedures and may add to the cost of these procedures. Most lower endoscopy can be accomplished with either no, moderate, or deep sedation; general anesthesia and active airway management are rarely needed. Propofol-based sedation has advantages in terms of satisfaction and recovery over other modalities, but moderate sedation using benzodiazepines and opiates work well for low-risk patients and procedures. No sedation for routine colonoscopy works well for selected patients and eliminates sedation-related risks...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101956/anesthesia-for-routine-and-advanced-upper-gastrointestinal-endoscopic-procedures
#20
REVIEW
Christopher D Sharp, Ezekiel Tayler, Gregory G Ginsberg
This article aims to detail the breadth and depth of advanced upper gastrointestinal endoscopic procedures. It will focus on sedation and airway management concerns pertaining to this emerged and emerging class of minimally invasive interventions. The article will also cover endoscopic hemostasis, endoscopic resection, stenting and Barrett eradication therapy plus endoscopic ultrasound. It additionally will address the nuances of endoscopic retrograde cholangiopancreatography and new natural orifice transluminal endoscopic surgery procedures including endoscopic cystgastrostomy and the per-oral endoscopic myotomy procedure...
December 2017: Anesthesiology Clinics
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