Anesthesia Residents Preferentially Request Operating Room Case Assignments with Complex Cases

Abstract

Self-directed learning is associated with knowledge and performance improvements, increased identification and amelioration of knowledge gaps, and heightened critical appraisal of available evidence. We developed and implemented a decision support system that could support self-directed learning for anesthesia residents by soliciting resident input in case selection. We hypothesized that residents would utilize this system to request complex cases, and that more advanced residents would request more complex cases. Prospective, observational study involving 101 anesthesiology residents. We used a web-based interface, RHINOS [Residents Helping in Navigating Operating Room (OR) Scheduling], which allowed residents to share their rank-ordered preferences for OR assignment. Number of cases per OR, anesthesia base units, time units, and proportion of inpatient cases were used as proxies for case complexity. Data were analyzed using a mixed linear model. Residents requested rooms with fewer cases [F(3,22,350) = 194.0; p < 0.001], more base units [F(3,19,158) = 291.4; p < 0.001], more time units [F(3,19,744) = 186.4; p < 0.001], and a greater proportion of cases requiring inpatient preoperative evaluation [F(3,51,929) = 11.3; p < 0.001]. In most cases, these differences were greater for more advanced residents. As hypothesized, residents requested ORs with higher case complexity, and these cases more often required inpatient preoperative evaluation. More advanced residents exhibited a stronger preference for more educational cases than junior residents.

A Quality Improvement Study Designed to Optimize Scheduling Geographic/Site Preferences Among Anesthesia Professionals Utilizing Decision Support Tool Assistance

“…Past studies have used electronic decision support to optimize work schedules, surgical team composition, and clinical assignments [ 4 , 5 , 10 ]. A prospective observational study utilized an electronic decision support tool to enhance OR case preferences among 101 anesthesia residents [ 4 ].…”

“…Past studies have used electronic decision support to optimize work schedules, surgical team composition, and clinical assignments [ 4 , 5 , 10 ]. A prospective observational study utilized an electronic decision support tool to enhance OR case preferences among 101 anesthesia residents [ 4 ]. A case study of a New Jersey emergency department implemented an information systems decision support tool that used past patient census electronic data patterns to provide improvements in nursing scheduling practices [ 5 ].…”

“…Therefore, dynamic location preference tracking could facilitate identification of quality improvement opportunities in a hospital system. Past studies have used electronic decision support to optimize work schedules, surgical team composition, and clinical assignments [4,5,10]. A prospective observational study utilized an electronic decision support tool to enhance OR case preferences among 101 anesthesia residents [4].…”

“…Past literature has established an association between scheduling practices and healthcare provider job satisfaction [1][2][3]. In recent years, electronic decision support tools have emerged as a method for scheduling advancement in healthcare management to provide an efficient tool to place providers in the appropriate clinical environment [4,5]. In addition, previous studies have also found success in applying electronic decision support tools to determine fair end of shift relief among anesthesiologists [6,7].…”

Perioperative Information Systems: Opportunities to Improve Delivery of Care and Clinical Outcomes in Cardiac and Vascular Surgery

“…51–55 Additionally, these systems have been used in academic centers to assist trainee education and case selection. 56 Finally, a number of AIMS have functionality that can support quality improvement efforts through their ability to capture and display large amounts of data at the provider level, allowing for targeted feedback and practice improvement. 32,57,58…”