A Monte Carlo Simulation to Estimate the Additional Cost Associated With Adverse Medication Events Leading to Intraoperative Hypotension and/or Hypertension in the United States.

OBJECTIVES: Intraoperative hypertension and hypotension are common and often related to adverse medication events (AMEs). The study objective is to estimate the annual additional fully allocated costs to the U.S. healthcare system related to AMEs associated with clinically significant intraoperative hypertension and hypotension. METHODS: Using anesthesia-trained observers in randomly selected operating rooms, we estimated the rates of clinically significant intraoperative hypotension and hypertension. We conducted systematic literature reviews to estimate incidence and additional costs of acute kidney injury (AKI), acute myocardial injury, and stroke after intraoperative hypotension and hypertension. We used Monte Carlo simulation to estimate annual costs to the U.S. healthcare system. RESULTS: Intraoperative hypotension (mean arterial pressure <55 mm Hg for >6 minutes) occurred in 11 of 277 operations (3.97%), hypotension (>30% drop from baseline mean arterial pressure in patients with coronary artery disease) in 9 operations (3.25%) and hypertension in 14 operations (5.05%). After hypotension, incremental incidence of AKI was 1.46% (additional cost $17,289/case), acute myocardial injury was 0.75% ($21,340/case), and stroke was 0.05% ($19,903/case). After hypertension, incremental stroke incidence was 4.76% ($28,320/case). Annually in the United States, we estimated 11,513 cases of AKI, 5914 of acute myocardial injury, 345 of stroke after intraoperative hypotension, and 47,774 cases of stroke after intraoperative hypertension, costing the U.S. $1.7 billion (90% confidence interval, $1.4-$2.0 billion), of which $923 million (90% confidence interval, $763-$1101 million) is preventable. CONCLUSIONS: Adverse medication events related to blood pressure are frequent, costly, and can cause considerable patient harm. Cost estimates for these events may provide a means of prioritizing safety improvements to reduce cost of care and improve patient outcomes.

Residency Education Reform Program in Department of Anesthesiology and Critical Care: An Academic Reform Model.

BACKGROUND: Reform in medical education is a basic process in every academic department, especially in residency programs. OBJECTIVES: This study was designed to assess the indices of education and research as part of the Medical Education Reform program (MERP) in the Department of Anesthesiology and Critical Care (DACC), Shahid Beheshti University of Medical Sciences (SBMU) for four years. METHODS: MERP in DACC, SBMU was designed and implemented as a modern academic reform model; different outcome measures in education and research were assessed to demonstrate the effects of the reform plan in academic improvements. RESULTS: there were significant improvements regarding education indices (i.e., teaching methods, passing comprehensive exams, mentorship, assessment methods, faculty development, professionalism in medical education, integration in education, and crisis management) and research indices (targeted research activities, innovation in research approaches, increasing the impact of research). CONCLUSIONS: Based on the experiences of DACC, SBMU regarding clinical anesthesiology residency, reform could be achieved using painstaking plans and continuous efforts with tangible documented outcomes. Often, the management period is not durable, and these reforms require meticulous care to sustain.

Attitudes of Anesthesiology Residents Toward a Small Group Blended Learning Class.

BACKGROUND: Accreditation Council for Graduate Medical Education (ACGME) has been used to evaluate the residents' competency; however, the thriving of residents needs especial training methods and techniques. Small group learning has been used for this propose. OBJECTIVES: This study assessed the attitudes of CA-1 to CA-3 anesthesiology residents toward level-specific small-group blended learning. METHODS: Anesthesiology residents from Department of Anesthesiology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran participated in this cross-sectional attitude assessment descriptive-analytical study throughout the 2nd academic semester (May-October 2019). They took part in a level-specific small-group blended learning program and filled out an attitude assessment questionnaire. The questionnaire included eight closed questions and was filled out anonymously. RESULTS: The residents believed that this program made important contributions to their theory training and clinical skills of anesthesia; while created a greater sense of solidarity. In addition, nearly the majority of the respondents did not believe that participating in the classes made interference in their clinical duties or was a difficult task. Instead, the majority of residents believed that these classes were in favor of reducing their burnout. The reliability of the questionnaire based on Cronbach's Alpha was 0.885. CONCLUSIONS: Anesthesiology residents are in favor of small-group learning, especially when considering their clinical setting and the degree of burnout they tolerate.