Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

OBJECTIVE: We determine if Real Time Locating Systems (RTLS) paired with automated notifications have a sustained effect on perioperative efficiency in anesthesiologists over a one-year period from the time of implementation. METHODS: A retrospective chart review of all outpatient and short-stay patients, who received general anesthesia at our ambulatory surgery center between July 1st, 2017 and December 31st, 2018 was performed. Patients included were over 18 years of age who presented for non-urgent cases with ASA classification of 1, 2, and 3. Additionally, only first cases of the day for individual anesthesiologists were included.Time was used as a measure of efficiency between three comparison groups: Anesthesiologists who use RTLS prior to implementation of automated notification pairing for the period of 1 July 2017 to 31 December 2017.Anesthesiologists who use RTLS paired with automated notifications for the period of 1 January 2018 to 30 June 2018.Anesthesiologists who use RTLS paired with automated notifications for the period of 1 July 2018 to 31 December 2018.The primary outcome measure duration (DUR) was collected from patient electronic records.DUR was defined as duration of time, in minutes, from patient arrival to the Operating Room (OR) and initiation of induction by the anesthesiologist (exclusively for first cases of the day). RESULTS: During the initial six months, DUR between time of OR admission and time of induction was significantly reduced to 6.0 minutes (5.0,8.0) post-implementation of automated notification pairing with RTLS. DUR then returned to pre-intervention baseline of 7.0 minutes (5.0, 9.0) during the subsequent six-month study period. CONCLUSION: Initial results indicate that implementation of integrated RTLS technology enabled anesthesiologists at our institution to be more efficient during the perioperative period. However, this perceived benefit was not sustained over a 1-year period as our measure of efficiency DUR ultimately returned to the pre-intervention baseline.

Real-Time Locating Systems and the Effects on Efficiency of Anesthesiologists.

OBJECTIVE: To investigate the impact of Real Time Locating System (RTLS) technology on the perioperative efficiency of anesthesiologists. METHODS: A retrospective chart review was performed for all outpatient and short-stay patients who received General Anesthesia care at our institution between January 2016 and October 2017. Patients included were over 18 years and had ASA classification scores of 1, 2, and 3. Only first cases of the day for individual anesthesiologists were included. Duration between two perioperative time points was collected and used as a measure of efficiency. Two groups of anesthesiologists were compared Group 1: Anesthesiologists at Main Campus who do not use RTLSGroup 2: Anesthesiologists at Josie Robertson Surgery Center who use RTLSThe outcome measure collected from patient electronic medical records was defined as DUR: Duration from when patient is admitted to the operating room and initiation of induction only for first case of the day by attending anesthesiologist. The outcome was compared between the two groups using Wilcoxon rank sum test. RESULTS: The duration between admission to the OR and initiation of induction was significantly shorter in JRSC (with RTLS) than main campus (without RTLS); specifically, median (25th, 75th percentile) of the duration was 7.0 (5.0, 10.0) at JRSC vs. 8.0 (6.0, 11.0) at main campus (p < 0.0001, Table 1). CONCLUSION: In our initial study, we found that anesthesiologists who had access to RTLS at JRSC performed more efficiently in their preoperative evaluation of patients as well as time to induction for general anesthesia cases. Because of various confounding factors that potentially influenced the increase in efficiency of anesthesiologists with access to RTLS, this follow-up study aims to eliminate several confounding factors by assessing only time to induction of general anesthesia for all first cases of the day by anesthesiologists. We continue to find a small yet statistically significant difference in time to induction of anesthesiologists with access to RTLS. This translates directly into increased efficiency in perioperative workflow. Additional investigation and application can help elucidate the true value of RTLS on workflow efficiency in the healthcare setting.

Automated notifications improve time to anesthesia induction: Integrating health information technology systems to enhance perioperative efficiency.

OBJECTIVE: To evaluate the effects of health information technology systems integration on perioperative efficiency by investigating if automated notifications of patient arrival to the operating room leads to decreased time to induction by anesthesiologists. METHODS: We performed a retrospective chart review of all outpatient and short-stay patients who received General Anesthesia at our institution between July 1, 2017 and June 30, 2018.Time was used as a measure of efficiency between the two comparison groups.The two comparison groups were as follows:Group 1: Pre-event notification implementation (July 1, 2017-Dec 31, 2017)Group 2: Post-event notification implementation (Jan 1, 2018 - June 30, 2018)In this study, our primary outcome measure duration (DUR) was collected from patient electronic medical records:DUR: Time (duration in minutes) between anesthesia start and induction of anesthesia, exclusively for first case of the day. RESULTS: Duration of induction was significantly shorter post-event notification implementation compared to pre-event implementation (median duration, 6 min vs 7 min; p=0.001). CONCLUSION: We demonstrate that health information technology systems integration improves perioperative efficiency of anesthesiologists at our institution. Further investigation is warranted to provide data to support provider buy-in and greater uptake and implementation of these systems to enhance patient care and coordination in the healthcare setting.

Effects of Different Communication Tools on the Efficiency of Anesthesiologists in the Perioperative Setting.

OBJECTIVE: To assess if Real Time Locating Systems (RTLS) technology has an effect on the perioperative efficiency of anesthesiologists at our institution. METHODS: A retrospective chart review was performed for all outpatient and short-stay patients who received general anesthesia and monitored anesthesia care between January and June of 2016. Patients over 18 years with an ASA classification of 1, 2, and 3 were included. Time was used as a measure of efficiency between two groups of anesthesiologists.These two comparison groups were as follows: Group 1: Anesthesiologists at the academic center's main campus who do not have access to RTLSGroup 2: Anesthesiologists at Josie Robertson Ambulatory Surgical Center where RTLS is available and use of RTLS is compulsoryTwo outcome measures were collected from patient electronic records: DUR1: Duration between when patient is admitted to a presurgical bed and preoperative evaluation by the attending anesthesiologistDUR2: Duration between when patient is admitted to the operating room and initiation of induction by the attending anesthesiologist. RESULTS: Anesthesiologists who had access to RTLS technology were found to be more efficient in completing their preoperative anesthesia evaluation and initiating intraoperative induction. They took less time to complete these tasks and the difference was statistically significant to p<0.0001. CONCLUSION: Anesthesiologists at our institution, who have access to RTLS as an additional communication tool, were found to be consistently more efficient in their perioperative workflow. There are confounding factors that can account for the shorter times and more efficient perioperative workflow of anesthesiologists. With continued application and investigation over time, the utility of RTLS on workflow efficiency of healthcare providers will become more apparent.

Anesthesia for outfield procedures in cancer patients.

PURPOSE OF REVIEW: The diagnostic and therapeutic use of radiation modalities is an integral part of cancer care that is being used more frequently. Organization and planning for anesthesia out of the operating room poses many challenges that are addressed in this review. RECENT FINDINGS: Anesthesia providers are called upon to enable radiologists to accomplish a variety of procedures that are not possible without anesthesia intervention. These cases present significant challenges with regard to equipment set up, monitoring and choice of anesthesia for each patient. Recent literature focuses on guidelines for monitoring, patient safety, anesthetic choice and management. SUMMARY: Anesthesia care in the radiation suites is increasingly in demand for the diagnosis and treatment of cancer patients. Organization of all aspects of anesthetic care in radiation suites can be challenging. Planning for each type of procedure and individual patients as well as equipment set up and postoperative care is evolving.

Relationship between intraoperative fluid administration and perioperative outcome after pancreaticoduodenectomy: results of a prospective randomized trial of acute normovolemic hemodilution compared with standard intraoperative management.

BACKGROUND: Pancreaticoduodenectomy (PD) can be associated with significant blood loss and transfusion requirements, with potential adverse short- and long-term consequences. The aim of this study was to determine whether acute normovolemic hemodilution (ANH), an established blood conservation technique, reduces perioperative allogeneic transfusions in patients undergoing PD. METHODS: One hundred thirty patients undergoing PD were randomized to ANH or standard management (STDM). In the ANH group, intraoperative blood collection was performed to a target hemoglobin of 8.0 g/dL; crystalloid and colloid were used for volume replacement. Strict transfusion triggers were applied during and after operation. Perioperative complications were prospectively assessed and graded for severity. RESULTS: From July 2005 to May 2009, 209 patients were registered, 79 excluded, 65 were randomized to ANH, and 65 to STD. The groups were well matched for demographic, operative, and histopathologic variables. Patients undergoing ANH received over 2 L more fluid intraoperatively (6250 mL, range 2000-11850) compared with patients undergoing STD (3900 mL, range 2000-9000) (P < 0.001). Transfusion rates were similar (ANH = 16.9%, 30 units vs STD = 18.5%, 33 units; P = 0.82), as was overall perioperative morbidity (ANH = 49.2% vs STD = 47%, P = 0.86). There was, however, a trend toward more grade-3 complications in patients undergoing ANH (32% vs 23.1% STD, P = 0.17), and complications related to the pancreatic anastomosis (leak/fistula/abscess) were significantly higher in the ANH group (21.5% vs 7.7%, P = 0.045). The intraoperative fluid volume was higher for all patients with pancreatic anastomotic complications (n = 19), regardless of randomization arm (ANH 6000 mL, range 2800-11350 mL vs STD 5000 mL, range 2000-11850 mL, P < 0.042). CONCLUSION: In this randomized trial of patients undergoing PD, ANH did not reduce allogeneic transfusions and resulted in more pancreatic anastomotic complications, likely related to greater intraoperative fluid administration. The benefits of ANH do not necessarily extend to all procedures, and restrictive intravenous fluid management during PD may help improve postoperative outcome.