Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Dec 2015
ReviewOrganizational aspects to optimize patient's ambulatory pathway.
Successful ambulatory care implementation should combine both medical and organizational features. These two components are closely interrelated. Only optimal organization, part of a quality management program, will allow us to perform safe medical procedures and provide good patient satisfaction. This review is intended to update organizational concepts that could improve ambulatory surgery center efficiency. ⋯ Organizational feature in ambulatory surgery center is a major determinant of patient flow, activity, resource utilization, safety, and patient satisfaction. Most of these basic principles may contribute to improve the quality of care that can also be of benefit to conventional surgical activity.
-
More surgical procedures are performed on an ambulatory basis and the advantages are apparent, but outpatient surgery presents challenges because of the expectation of a fast recovery soon after termination of anaesthesia. Ambulatory surgery is a well tolerated regimen with few serious adverse outcomes, hence difficult to obtain sound scientific evidence for avoiding complications. ⋯ The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation, sleep deprivation, unfamiliar surroundings, and medication errors. Enhanced recovery programmes (fast-track regimens) may allow earlier discharge which is probably beneficial for the elderly. Frailty is becoming an increasingly important concept that needs to be clinically considered in elderly patients, as well as in future studies.
-
Electronic medical devices are an integral part of patient care. As new devices are introduced, the number of alarms to which a healthcare professional may be exposed may be as high as 1000 alarms per shift. The US Food and Drug Administration has reported over 500 alarm-related patient deaths in five years. The Joint Commission, recognizing the clinical significance of alarm fatigue, has made clinical alarm management a National Patient Safety Goal. ⋯ Alarm fatigue can jeopardize safety, but some clinical solutions such as setting appropriate thresholds and avoiding overmonitoring are available.
-
Curr Opin Anaesthesiol · Dec 2015
ReviewWrong-site regional anesthesia: review and recommendations for prevention?
Wrong-site regional anesthetic procedures are considered never events. The purpose of this review is to describe the phenomenon of wrong-site regional anesthetic blocks and identify preventive strategies. ⋯ Preoperative site verification and surgical site marking are mandatory. A time-out should occur immediately before any invasive procedure. Confirming the correct patient and block site with a time-out should occur immediately before all regional anesthetic procedures. If more than one block is performed on one patient, it is recommended that time-out be repeated each time the patient position is changed or separated in time or performed by a different team. The anesthetic team should uniformly implement robust guidelines and checklists to reduce the occurrence of wrong-site regional anesthetic procedures.
-
There is an increasing interest in the application of near-infrared spectroscopy (NIRS) as a monitoring tool in noncardiac surgery. This review summarizes the latest developments and current evidence for the use of NIRS in the noncardiac intraoperative setting. ⋯ NIRS offers noninvasive monitoring of cerebral and overall organ oxygenation in a wide range of clinical scenarios. There is an increasing evidence that the optimized cerebral oxygenation is associated with improved outcomes in both neurologic and major organ morbidity in a variety of surgical settings.