Change in staff anesthesiologists' opinions of an Anesthesia Information Management System (AIMS).

Following introduction of an Anesthesia Information Management System (AIMS) at a tertiary care, academic health sciences centre, a quality assurance initiative was conducted to assess staff opinions of the AIMS using a previously published, anonymous survey tool at 1 and 5 years following AIMS introduction. At 5 years compared to 1 year after implementation of AIMS, the majority (18 of 24, 75%) of responses to the survey questions had a statistically significant change (P < 0.05) in the proportion of respondents favoring AIMS compared to the 1 year survey. Domains noted to be more favorable 5 years compared to 1 year after AIMS introduction included patient safety in the Operating Rooms and Post-Anesthesia Care Unit, quality of handover and overall documentation, and communication amongst healthcare workers. The ideal time period at which to assess AIMS after introduction is not clear.

Preparing anesthesiology faculty for competency-based medical education.

PURPOSE: Competency-based medical education (CBME) is quickly becoming the dominant organizing principle for medical residency programs. As CBME requires changes in the way medical education is delivered, faculty will need to acquire new skills in teaching and assessment in order to navigate the transition. In this paper, we examine the evidence supporting best practices in faculty development, propose strategies for faculty development for CBME-based residency programs, and discuss the results of faculty development initiatives at the pioneering anesthesia CBME residency program at the University of Ottawa. SOURCE: Review of the current literature and information from the University of Ottawa anesthesia residency program. PRINCIPAL FINDINGS: Faculty development is critical to the success of CBME programs. Attention must be paid to the competence of faculty to teach and assess all of the CanMEDS roles. At the University of Ottawa, some faculty development initiatives were very successful, while others were hindered by factors both internal and external to the residency program. Many faculty development activities had low attendance rates. CONCLUSIONS: Faculty development must be considered in the rollout of any new educational initiative. Experts suggest that faculty development for CBME should incorporate educational activities using multiple teaching and delivery methods, and should be offered longitudinally through the planning, development, and implementation phases of curriculum change. Additionally, these educational activities must continue until all faculty have demonstrated an acceptable level of competence. Faculty buy-in is paramount to the successful delivery of any faculty development program that is not mandatory in nature.

Unplanned admission after day surgery: a historical cohort study in patients with obstructive sleep apnea.

PURPOSE: Practice guidelines suggest that patients with obstructive sleep apnea (OSA) should be monitored postoperatively to reduce adverse events. This study evaluated outcomes following ambulatory surgery in patients who had previously undergone polysomnography (PSG), and compared unplanned admissions in patients diagnosed with OSA with those in patients without OSA. METHODS: A historical cohort study (July 2003 to March 2009) was conducted using administrative data and supplemented by selective chart review. Patients undergoing ambulatory surgery at the Ottawa Hospital who had a previously documented PSG were identified. The PSG reports were reviewed, and the presence and severity of OSA was determined. Unplanned admissions to hospital within seven days of surgery were identified using administrative data. Using a nested case-control design, three charts were randomly selected for each patient admitted for a focussed health records review. Event rates in patients with OSA and treated with continuous airway pressure were compared with event rates in patients without OSA. An exploratory multivariable analysis was conducted to identify predictors of admission. RESULTS: There were 77,809 ambulatory surgical procedures in the period studied. A PSG test could be analyzed in 1,547 patients, and OSA was diagnosed in 674 (44%) of those analyzed. The rate of unplanned admission was 7.0% (95% confidence interval [CI] 5.1 to 8.9) in OSA patients compared with 5.6% (95% CI 4.1 to 7.1) in patients without OSA (odds ratio 1.26; 95% CI 0.83 to 1.91; P = 0.246). Median [interquartile range; IQR] hospital length of stay was 7 hr [IQR 5, 8] with OSA and 6 hr [IQR 5, 8] without OSA (P = 0.058). Severity of OSA was not associated with unplanned admission. CONCLUSIONS: We did not identify a clinically important increased rate of unplanned admission associated with a prior diagnosis of OSA.