Operating Room Anesthesia Subspecialization Is Not Associated With Significantly Greater Quality of Supervision of Anesthesia Residents and Nurse Anesthetists

Dexter, Franklin; Ledolter, Johannes; Epstein, Richard H.; Hindman, Bradley J.

doi:10.1213/ane.0000000000001671

Cited by 18 publications

(6 citation statements)

References 33 publications

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“…Relying on the rater’s judgement to determine the degree of the interaction is important and necessary because availability and physical presence are integral components of supervision [ 12 , 16 ]. However, this cannot change our results and their implications, specifically previous reports, of the supervision scale being reliable and valid in the operating room setting when applied daily should be considered limited to the precise process that was used, with invitations to evaluate anesthesiologists sent only with documentation of the joint workload in the electronic health record [ 3 , 5 , 6 , 12 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 92%

“…Previously, anesthesia residents’ evaluations of anesthesiologists were studied in the operating room environment [ 4 , 17 , 18 ]. Requests for residents’ evaluations of anesthesiologists’ quality of supervision were sent only if they worked together that day for at least one hour [ 3 - 5 ]. Our study suggests that this rater selection method, which the investigators had considered as a means to reduce the inconvenience to potential raters, probably was an integral process requirement for the scale’s success in the operating room, necessary for psychometric reliability [ 3 - 6 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, our department has used the scale for daily evaluations of operating room anesthesiologists by resident physicians and fellows (i.e., raters), and weekly evaluations of the critical care anesthesiologists. However, unlike for operating room evaluations wherein email requests were sent daily only to raters who had worked for at least an hour with the anesthesiologist the preceding day, each potential rater was requested to evaluate all (e.g., three) critical care anesthesiologists scheduled in intensive care units during that week [ 3 - 5 ]. Raters chose whom to evaluate, selecting “insufficient” contact for the other anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Insufficient Interaction on the Evaluation of Anesthesiologists’ Quality of Clinical Supervision by Anesthesiology Residents and Fellows

Hadler¹,

Dexter²,

Hindman³

2022

Cureus

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Introduction In this study, we tested whether raters’ (residents and fellows) decisions to evaluate (or not) critical care anesthesiologists were significantly associated with clinical interactions documented from electronic health record progress notes and whether that influenced the reliability of supervision scores. We used the de Oliveira Filho clinical supervision scale for the evaluation of faculty anesthesiologists. Email requests were sent to raters who worked one hour or longer with the anesthesiologist the preceding day in an operating room. In contrast, potential raters were requested to evaluate all critical care anesthesiologists scheduled in intensive care units during the preceding week. Methods Over 7.6 years, raters (N=172) received a total of 7764 requests to evaluate 21 critical care anesthesiologists. Each rater received a median/mode of three evaluation requests, one per anesthesiologist on service that week. In this retrospective cohort study, we related responses (2970 selections of “insufficient interaction” to evaluate the faculty, and 3127 completed supervision scores) to progress notes (N=25,469) electronically co-signed by the rater and anesthesiologist combination during that week. Results Raters with few jointly signed notes were more likely to select insufficient interaction for evaluation (P < 0.0001): 62% when no joint notes versus 1% with at least 20 joint notes during the week. Still, rater-anesthesiologist combinations with no co-authored notes accounted not only for most (78%) of the evaluation requests but also most (56%) of the completed evaluations (both P < 0.0001). Among rater and anesthesiologist combinations with each anesthesiologist receiving evaluations from multiple (at least nine) raters and each rater evaluating multiple anesthesiologists, most (72%) rater-anesthesiologist combinations were among raters who had no co-authored notes with the anesthesiologist (P < 0.0001). Conclusions Regular use of the supervision scale should be practiced with raters who were selected not only from their scheduled clinical site but also using electronic health record data verifying joint workload with the anesthesiologist.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Insufficient Interaction on the Evaluation of Anesthesiologists’ Quality of Clinical Supervision by Anesthesiology Residents and Fellows

Hadler¹,

Dexter²,

Hindman³

2022

Cureus

Self Cite

View full text Add to dashboard Cite

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“…Alternatively, the physicians could be partitioned into groups based on specialty and the model could then be applied to each group separately. However, the value added by subspecialties as perceived by physicians is mixed [9,22].…”

Section: Discussionmentioning

confidence: 99%

Hospital physicians can’t get no long-term satisfaction – an indicator for fairness in preference fulfillment on duty schedules

Gross

Brunner

Blobner

2018

Health Care Manag Sci

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Physicians are a scarce resource in hospitals. In order to minimize physician attrition, schedulers incorporate individual physician preferences when creating the physicians' duty roster. The manual creation of a roster is very time-consuming and often produces suboptimal results. Many schedulers therefore use model-based software to assist in planning. The planning horizon for duty schedules is usually a single month. Many models optimize the plan for the current planning horizon, without taking into account data on preference fulfillment and work load distribution from previous months. It is therefore possible that, when looking at a longer time horizon, some physicians are disadvantaged in terms of preference fulfillment more often than their peers, simply because this generates better results for the individual months. This may be perceived as unfair by the disadvantaged physicians. In order to eliminate this imbalance, we introduce a satisfaction indicator for preference fulfillment in physician scheduling. This indicator is computed for each physician on each monthly plan and is then used to inform decisions regarding preference fulfillment on the current and future plans. As a result, a more equal distribution of preference fulfillment among physicians is achieved. We run a computational study with three different update strategies for our satisfaction indicator. Our study uses 24 months of data from a German university hospital and derives additional generated data from it. Results indicate that our satisfaction indicator, combined with the right update strategy, can achieve an equal distribution of satisfaction over all physicians within a peer group, as well as stable satisfaction levels for each individual physician over a longer time horizon. As our main contribution, we identify that our satisfaction indicator is more effective in creating equal distribution of long-term satisfaction the higher the rate of conflicting preferences is.

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“…The studied anesthesia department has obtained daily evaluations for several years [21][22][23][24][25][26][27]. With tens of thousands of rater-ratee days, associations can be examined between the evaluation scores and characteristics of the cases and the patients.…”

Section: Introductionmentioning

confidence: 99%

Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists’ Clinical Supervision and Nurse Anesthetists’ Work Habits

Dexter,

Hindman,

Bayman

et al. 2024

Cureus

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Introduction: Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists’ quality of clinical supervision and nurse anesthetists’ work habits, and patient and operational factors were examined. Methods: Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day. Results: There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen’s d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day’s count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important. Conclusions: When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision quality and work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians’ non-technical performance.

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Operating Room Anesthesia Subspecialization Is Not Associated With Significantly Greater Quality of Supervision of Anesthesia Residents and Nurse Anesthetists

Abstract: Greater clinical specialization of faculty anesthesiologists was not associated with meaningful improvements in quality of clinical supervision.

Cited by 18 publications

References 33 publications

Effect of Insufficient Interaction on the Evaluation of Anesthesiologists’ Quality of Clinical Supervision by Anesthesiology Residents and Fellows

Effect of Insufficient Interaction on the Evaluation of Anesthesiologists’ Quality of Clinical Supervision by Anesthesiology Residents and Fellows

Hospital physicians can’t get no long-term satisfaction – an indicator for fairness in preference fulfillment on duty schedules

Patient and Operational Factors Do Not Substantively Affect the Annual Departmental Quality of Anesthesiologists’ Clinical Supervision and Nurse Anesthetists’ Work Habits

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