Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Aug 2022
ReviewPreventing patient positioning injuries in the nonoperating room setting.
Postprocedural positioning injuries are an under-appreciated source of morbidity for patients. These injuries may not present until days after anesthesia and may be missed for multiple reasons including the distracting injury of the procedural site, illness of the patient, lack of follow-up, and insufficient awareness of this type of injury. Risks for these adverse events are exacerbated in the nonoperating room anesthesia (NORA) population for several reasons. These patients tend to be older and sicker than patients presenting to the operating room, increasing the risk of an injury. Proceduralists and anesthesia providers are usually consultants, not the primary care team, so may have limited patient follow-up. This review will discuss the risk factors for position-related injuries and how to prevent them with proper positioning and padding. ⋯ http://links.lww.com/COAN/A87.
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Curr Opin Anaesthesiol · Aug 2022
ReviewFrameworks for value-based care in the nonoperating room setting.
Nonoperating room anesthesia (NORA) presents a unique opportunity for the application of value-based care (VBC) principles to procedures performed in the office-based and nonoperating room inpatient settings. The purpose of this article is to review how value is defined in NORA and enabling principles by which anesthesiologists can maximize value in NORA. ⋯ Value in NORA can be defined as clinical outcomes, quality, patient-reported outcomes, and efficiency divided by the direct and indirect costs for achieving those outcomes. We present a novel framework adapting current VBC practices in operating room anesthesia to the NORA environment.
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Curr Opin Anaesthesiol · Jun 2022
ReviewLimited English proficiency in the labor and delivery unit.
Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately. ⋯ The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.