American journal of medical quality : the official journal of the American College of Medical Quality
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Anesthetic practice utilization and related characteristics of total knee arthroplasties (TKAs) are understudied. The research team sought to characterize anesthesia practice patterns by utilizing National Anesthesia Clinical Outcomes Registry data of the Anesthesia Quality Institute. The proportions of primary TKAs performed between January 2010 and June 2013 using general anesthesia (GA), neuraxial anesthesia (NA), and regional anesthesia (RA) were determined. ⋯ Patients receiving RA had higher median age and higher frequency of American Society of Anesthesiology score ≥3 compared with those receiving other anesthesia types under study. Relative to GA (45.0%), when NA or RA were used, the anesthesiologist was more frequently board certified (75.5% and 62.1%, respectively; P < .0001). Anesthetic technique differences for TKAs exist, with variability associated with patient and provider characteristics.
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Face-to-face handoff: improving transfer to the pediatric intensive care unit after cardiac surgery.
The goal was to develop and implement a comprehensive, primarily face-to-face handoff process that begins in the operating room and concludes at the bedside in the intensive care unit (ICU) for pediatric patients undergoing congenital heart surgery. Involving all stakeholders in the planning phase, the framework of the handoff system encompassed a combination of a formalized handoff tool, focused process steps that occurred prior to patient arrival in the ICU, and an emphasis on face-to-face communication at the conclusion of the handoff. The final process was evaluated by the use of observer checklists to examine quality metrics and timing for all patients admitted to the ICU following cardiac surgery. The process was found to improve how various providers view the efficiency of handoff, the ease of asking questions at each step, and the overall capability to improve patient care regardless of overall surgical complexity.
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This study evaluates how emergency department (ED) and medical intensive care unit (MICU) providers interact in the setting of a quality improvement project designed to enhance transport/care for patients from the ED to the MICU. Focus groups were conducted with nurses, residents, physician assistants, and physicians from the ED and MICU at baseline and 6 months regarding their thoughts on and perspectives of the intervention and working with colleagues from another department. ⋯ Analysis also showed, however, that variances in departmental culture play a significant role in the willingness and ability of providers to practice interdepartmental team-based care. It is argued that anticipating and acknowledging these differences and designing systems to address them prior to launch will be essential to the development and implementation of effective interdepartmental quality improvement interventions.