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Lane, Sophia; Gross, Marketa; Arzola, Cristian; Malavade, Archana; Szadkowski, Leah; Huszti, Ella; Friedman, Zeev
doi: 10.1007/s12630-022-02238-9pmid: 35314994
PurposeIntraoperative handovers are common in anesthesia practice and are associated with increased patient morbidity and mortality. Checklists may improve transfer of information during handovers. This before-and-after study sought to examine the effect of a checklist on intraoperative handover. We hypothesized that introducing a handover checklist would improve our primary outcome of completeness of data transfer.MethodsFrom February to August 2016, anesthesia providers (residents, fellows, and consultants) at a single tertiary academic center participated in a handover study. Baseline handovers between anesthesia care providers were videotaped, analyzed, and compared with anesthetic records. An intraoperative handover checklist was then introduced, and handovers completed with it were videotaped. The completeness of handovers was compared between the baseline routine and checklist groups. The primary outcome was completeness of information transfer.ResultsSixty-seven anesthesia providers participated in the study. Use of the intraoperative handover checklist improved completeness of handover by 6% (95% confidence interval [CI], 2 to 10; P < 0.01). There was no relationship observed between the provider (consultants/fellows vs resident) of the handovers and the degree of completeness (95% CI, 3 to 8; P = 0.33). Complexity had a significant impact on the handover completeness with low or high complexity cases more completely handed over than those of medium complexity both before and after the intervention—a 6% increase for low complexity (95% CI, 1 to 11; P = 0.02) and a 9% increase for high complexity (95% CI, 3 to 14; P < 0.01).ConclusionUse of a checklist during intraoperative handovers improved completeness of data transfer. Handover checklists should be considered to improve handover completeness.
Cho, Jenny Sue Hyun; McCarthy, Kristian; Schiavo, Simone; Jacob, Binu; Engelsakis, Marina; Zywiel, Michael; Karkouti, Keyvan; McCluskey, Stuart; Clarke, Hance; Wong, Jean
Cordovani, Ligia; Cordovani, Daniel; Wong, Anne
doi: 10.1007/s12630-022-02234-zpmid: 35314995
PurposeLearning needs are influenced by the stage of learning and medical specialty. We sought to investigate the characteristics of a good clinical teacher in anesthesiology from the medical students’ perspective.MethodsWe conducted a qualitative descriptive study to analyze written comments of medical students about their clinical teachers’ performances. Our analysis strategy was the inductive content analysis method. The results are reported as a descriptive summary with major themes as the final product.ResultsOur study identified four themes. The first theme, teachers’ individual characteristics, includes characteristics that are usually more related to students’ subjective experiences and feelings. The second theme, teachers’ characteristics that advance student learning, seems to be one of the most important contributions to learning because it increases the practice of procedural skills. The third theme, teachers’ characteristics that prepare students for success, shows characteristics that facilitate students’ learning by promoting a healthy and safe environment. Lastly, the fourth theme, characteristics related to teaching approaches, includes characteristics that can guide clinical teachers more objectively.ConclusionOur analysis of the written comments of medical students identified many characteristics of a good clinical teacher that were organized in four different themes. These themes contribute to expand on existing understandings of clinical teaching in the anesthesiology clerkship environment, and add new interpretations that can be reflected upon and explored by other clinical educators.
Dassieu, Lise; Choinière, Manon; Saint-Jean, Laurence; Webster, Fiona; Peng, Philip; Buckley, Norm; Gilron, Ian; Williamson, Owen; Finley, G. Allen; Baerg, Krista; Janelle-Montcalm, Audrée; Hudspith, Maria; Boulanger, Aline; Di Renna, Tania; Intrater, Howard;
Liu, Laura; McCluskey, Stuart A.; Law, Michael; Abrahamyan, Lusine; Peer, Miki; Tait, Gordon; Rao, Vivek; Wijeysundera, Duminda N.; Scales, Damon C.; Callum, Jeannie; Karkouti, Keyvan; Bartoszko, Justyna
Showing 1 to 10 of 11 Articles
PurposeHip fractures are debilitating in older adults because of their impact on quality of life. Opioids are associated with adverse effects in this population, so oral acetaminophen is commonly prescribed to minimize opioid use. Intravenous (iv) acetaminophen has been reported to have superior efficacy and bioavailability than oral acetaminophen. Nevertheless, its effect on postoperative outcomes in emergency hip fractures is unclear. This systematic review assessed the effect of iv acetaminophen on postoperative outcomes in older hip fracture patients.SourceWe searched multiple databases from inception to June 2021 for studies on adults > 50 yr of age undergoing emergency hip fracture surgery who received iv acetaminophen (or paracetamol) and that reported postoperative outcomes. Relevant titles, abstracts, and full texts were screened based on the eligibility criteria. The Newcastle-Ottawa scale was used to assess the quality of the selected papers.Principal findingsOf 3,510 initial studies, four met the inclusion criteria. One was a prospective cohort study and three were retrospective cohort studies. All four studies used historical control groups. Three studies reported a significantly lower mean opioid dose with iv acetaminophen than with oral acetaminophen. Three studies also reported a significantly shorter hospital stay. One study each reported a significant decrease in the number of missed physical therapy sessions, the need for one-to-one supervision, and episodes of delirium.ConclusionThere is very limited low-level evidence that iv acetaminophen improves preoperative and postoperative analgesia and shortens hospital stay in older hip fracture patients. Nevertheless, our results should be interpreted with caution since there are no prospective randomized trials investigating whether iv acetaminophen improves postoperative outcomes in this patient population.Study registrationPROSPERO (CRD42021198174); registered 15 August 2021.
doi: 10.1007/s12630-022-02241-0pmid: 35304693
PurposeA multidisciplinary approach is recommended for patients with complex chronic pain (CP). Many multidisciplinary pain treatment facilities (MTPFs) use patient exclusion criteria but little is known about their characteristics. The objective of this study was to describe the frequency and characteristics of exclusion criteria in public Canadian MTPFs.MethodsWe conducted a cross-sectional study in which we defined an MPTF as a clinic staffed with professionals from three disciplines or more (including at least one medical specialty) and whose services were integrated within the facility. We disseminated a web-based questionnaire in 2017–2018 to the administrative leads of MPTFs across the country. They were invited to complete the questionnaire about the characteristics of their facilities. Data were analyzed using descriptive statistics and correlation measures.ResultsA total of 87 MTPFs were included in the analyses. Half of them (52%) reported using three exclusion criteria or more. There was no significant association between the number of exclusion criteria and wait time for a first appointment or number of new consultations in the past year. Fibromyalgia and migraine were the most frequently excluded pain syndromes (10% and 7% of MPTFs, respectively). More than one MPTF out of four excluded patients with mental health disorders (30%) and/or substance use disorders (29%), including MPTFs with specialists in their staff.ConclusionsMultidisciplinary pain treatment facility exclusion criteria are most likely to affect CP patients living with complex pain issues and psychosocial vulnerabilities. Policy efforts are needed to support Canadian MPTFs in contributing to equitable access to pain management.
doi: 10.1007/s12630-022-02237-wpmid: 35378686
PurposeTo evaluate the perceptions and practices of Canadian cardiovascular anesthesiologists and intensivists towards intravenous albumin as a resuscitation fluid in patients undergoing cardiac surgery.MethodsWe conducted a cross-sectional survey of cardiac anesthesiologists and intensivists involved in the care of cardiac surgical patients. The 22-item survey included seven open-ended questions and assessed practice patterns and attitudes towards albumin. Descriptive statistics were analyzed using counts and proportions. Qualitative data were analyzed to identify themes describing albumin use patterns in Canada.ResultsA total of 133 respondents from seven provinces participated, with 83 (62%) using albumin perioperatively. The majority of respondents (77%) felt a low fluid balance in cardiac surgical patients was important, and that supplementing crystalloids with albumin was helpful for this objective (67%). There was poor agreement among survey respondents regarding the role of albumin for faster vasopressor weaning or intensive care discharge, and ≥ 90% did not feel albumin reduced mortality, renal injury, or coagulopathy. Nevertheless, cardiac surgical patients were identified as a distinct population where albumin may help to minimize fluid balance. There was an acknowledged paucity of formal evidence supporting possible benefits. Fewer than 10% of respondents could identify institutional or national guidelines for albumin use. A lack of evidence supporting albumin use in cardiac surgical patients, especially those at highest risk of complications, was a frequently identified concern.ConclusionsThe majority of Canadian anesthesiologists and intensivists (62%) use albumin in cardiac surgical patients. There is clinical equipoise regarding its utility, and an acknowledged need for higher quality evidence to guide practice.