Emergency Pages Using a Computer-Based Anesthesiology Paging System in Ambulatory Surgical Centers

Abstract

Background The nature of pages associated with periprocedural emergency events in ambulatory centers has never being examined. Our institution has a proprietary anesthesiology paging system with hierarchal paging capabilities (emergency versus routine) and maintains a log of all events. Here we describe emergency pages in our ambulatory surgery centers. Methods We identified all emergency page activations between June 1, 2008, and December 31, 2012 in our ambulatory surgical centers. Electronic medical records were reviewed for rates and characteristics of pages such as primary cause, interventions performed, and outcomes. Results During the study time frame, 120,618 procedures were performed and 93 emergency pages were recorded (7.7 per 10,000 cases, 95% CI, 6.2 – 9.4), of which 51 originated in the procedure room and 42 outside the procedure room (16 before and 26 after the procedure). Among those 14/93 were associated with serious events (1.2 per 10,000 cases). Among emergency pages for bradyarrhythmias (N=35, 2.9 per 10,000 cases), 15 occurred during intravenous line placement in the preprocedural area, 11 during postprocedural recovery, and 9 during the procedure. Bradyarrhythmias accounted for 60.4% of pages outside the procedural room. In contrast, respiratory and airway events (N=31, 2.6 per 10,000 cases) typically occurred in the procedural room (28 vs. 9, P = 0.0006). Only one patient sustained permanent injury, myocardial infarction and death 4 months later. Another patient died after 8 days from unrelated causes. Conclusion The rates of emergency page activations, especially those representing critical events, in our surgical ambulatory center are rare. Many emergency pages originated outside the procedural room, therefore providers within these areas should be trained to promptly recognize and treat these events.

Feasibility of Anesthesiologists Giving Nurse Anesthetists 30-Minute Lunch Breaks and 15-Minute Morning Breaks at a University’s Facilities

“…Most emergency pages are from outside the operating rooms (e.g., bradyarrhythmia during intravenous line placement) [ 22 ]. Most episodes of hypoxemia in the phase I post-anesthesia care unit occur after the anesthesia provider has left the patient [ 23 ]. Operating room control desks at hospitals average more than or equal to one inpatient cancelation or add-on case scheduled per hour during regular workdays [ 24 ].…”

Content analysis of resident evaluations of faculty anesthesiologists: supervision encompasses some attributes of the professionalism core competency

“…When the anesthesiologist is supervising an OR, depending on other responsibilities -such as in another OR and/or a post-anesthesia care unit -it can be challenging to be present at critical portions of every anesthetic delivery and still contribute fully to each patient's care. 5,[7][8][9] Thus, our department monitors the quality of anesthesiologists' supervision and provides them with periodic feedback. 5,10 Individual faculty anesthesiologists can be reliably and dependably assessed using the de Oliveira Filho nine-item clinical supervision scale (Table 1).…”

Safety of Sedation for Patients Undergoing Bone Marrow Biopsy and Aspiration While Febrile

“…Despite the long track record of safety of this practice, 2 patients presenting for BMBx under propofol sedation who are acutely febrile pose a clinical conundrum. Many of these febrile patients often have no discernable signs or symptoms to suggest the source of their fevers.…”

“…Our institution has long used deep sedation with propofol to perform ambulatory bone marrow biopsy and aspiration procedures (BMBx). 1 Despite the long track record of safety of this practice, 2 patients presenting for BMBx under propofol sedation who are acutely febrile pose a clinical conundrum. Many of these febrile patients often have no discernable signs or symptoms to suggest the source of their fevers.…”