Disruptive Innovation and the Specialty of Anesthesiology

Kain, Zeev N.; Hwang, Juliana; Warner, Mark A.

doi:10.1213/ane.0000000000000697

Cited by 31 publications

(15 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…DOSC causes are multifactorial, as are solutions, but structured preoperative screening and assessment programs have been shown to reduce DOSCs (Ferschl et al 2005 ; Knox et al 2009 ; Emanuel and Macpherseon 2013 ; Pollard et al 1996 ), as well as reduce operating room startup times, preoperative testing, postoperative complications, and workload for surgical clinic staff (van Klei et al 2006 ). In a sometimes fragmented health care system, the preoperative assessment may be one of the few opportunities to identify long-term health issues (Kain et al 2015 ) and initiate management. But while there is good evidence to support such programs, they can be expensive (Qiu et al 2006 ), and reimbursement for this process may increasingly become part of a global admission fee.…”

Section: Discussionmentioning

confidence: 99%

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit

Olson

Dhakal

2015

Perioper Med

View full text Add to dashboard Cite

BackgroundStructured preoperative assessment has been reported to improve operating room efficiency as measured by metrics such as day of surgery cancellations (DOSCs). However, not all patients require comprehensive assessment; routine full assessments can result in unnecessary duplication of tests and investigations. Selective nurse screening under the supervision of anesthesiology may provide adequate information gathering in lower risk patients. This study is undertaken to assess if DOSC rates vary with different assessment processes.MethodsAt a single academic tertiary care hospital, from Jan 2 to May 31, 2013, the consecutive patients undergoing comprehensive preoperative assessment (CPA) and nurse screening (NS), as well as the patients not assessed by the anesthesiology-supervised preoperative process, were followed for the occurrence and reason for DOSC. The operating room schedule of all elective surgery patients was analyzed to allow calculation of rates of DOSCs. Reasons for cancellations were documented as one of ten structured reasons by preoperative holding area clerical staff.ResultsOverall, there were 14,893 elective surgery patients in this time period, with 183 DOSCs, giving a rate of 1.23 % (95 % CI 1.06, 1.42). Patients who received CPA numbered 5980; 29 of them had a DOSC, giving a rate of 0.48 % (95 % CI 0.33–0.70) (P < 0.0001 vs. no assessment). Patients receiving NS numbered 1840; 11 of them had a DOSC, giving a rate of 0.60 % (95 % CI 0.30–1.10) (P < 0.0001 vs. no assessment). The most common reason for cancellation was new medical condition.ConclusionsA very low DOSC rate can be achieved with a comprehensive preoperative process where some patients are selectively telephone screened by nurses, with complete assessment deferred to the anesthesiologist on the day of surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit

Olson

Dhakal

2015

Perioper Med

View full text Add to dashboard Cite

show abstract

“…We do not believe that is the case but it is a challenge that we must overcome. In fact, as a result of the dialog and recent experiences in development of the PSH model, anesthesiologists have been at the forefront of defining ways to benefit from the changing healthcare environment [3]. We must build on this foundation and develop new collaborative approaches to patient care, patient safety [21 & ] and education of the next generation of anesthesiologists to effectively and successfully address the incredible 'health delivery experiment' that we are experiencing.…”

Section: Resultsmentioning

confidence: 99%

The future of anesthesiology

Prielipp

Cohen

2016

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…Frailty assessments can further be utilized in newer clinical patient-centered models, such as the PSH to allow for better development of patient-specific management plans. The PSH is an anesthesiologist-led, multidisciplinary team-based care model endorsed by the ASA that provides patients with perioperative continuity of care for 30 days after their surgical intervention ( 37 – 39 ). Including an initial, standardized, and categorical assessment of frailty at the outset of treatment provides a baseline for risks of perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

“…By including initial evaluations of frailty and foreseeing perioperative complications, there will be a decrease in patient risk for complication that will improve clinical outcomes, increase patient-centeredness, and decrease perioperative costs ( 37 , 39 – 41 ). Patient-centeredness and patient-specific needs are addressed by the Edmonton Frailty Scale; the EFS encompasses “mood, functional independence, medication use, social support, nutrition, health attitudes, continence, burden of medical illness and quality of life” thereby creating a plan that addresses a patient’s specific needs and instilling a sense of ownership of a recovery plan ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

Stoicea

Baddigam

Wajahn

et al. 2016

Front. Public Health

View full text Add to dashboard Cite

The elderly population in the United States is increasing exponentially in tandem with risk for frailty. Frailty is described by a clinically significant state where a patient is at risk for developing complications requiring increased assistance in daily activities. Frailty syndrome studied in geriatric patients is responsible for an increased risk for falls, and increased mortality. In efforts to prepare for and to intervene in perioperative complications and general frailty, a universal scale to measure frailty is necessary. Many methods for determining frailty have been developed, yet there remains a need to define clinical frailty and, therefore, the most effective way to measure it. This article reviews six popular scales for measuring frailty and evaluates their clinical effectiveness demonstrated in previous studies. By identifying the most time-efficient, criteria comprehensive, and clinically effective scale, a universal scale can be implemented into standard of care and reduce complications from frailty in both non-surgical and surgical settings, especially applied to the perioperative surgical home model. We suggest further evaluation of the Edmonton Frailty Scale for inclusion in patient care.

show abstract

Disruptive Innovation and the Specialty of Anesthesiology

Cited by 31 publications

References 10 publications

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit

Day of surgery cancellation rate after preoperative telephone nurse screening or comprehensive optimization visit

The future of anesthesiology

The Gap Between Clinical Research and Standard of Care: A Review of Frailty Assessment Scales in Perioperative Surgical Settings

Contact Info

Product

Resources

About