Adverse Outcomes Associated With Intraoperative Anesthesia Handovers: A Systematic Review and Meta-analysis.

PURPOSE: Whether intraoperative handover of anesthesia care increases the risk of adverse outcomes in patients undergoing surgery remains unclear. This systematic review aimed to synthesize the evidence on the association of intraoperative anesthesia handover with delivery of patient care and patient outcomes. DESIGN: This is a systematic review and meta-analysis. METHODS: A comprehensive search was conducted to identify the eligible studies examining the association between intraoperative anesthesia handover and adverse outcomes in patients receiving surgery. The cohort studies and case-control studies were included. The methodological quality of each included study was assessed using the Newcastle-Ottawa Scale. The meta-analysis across the studies was performed using Review Manager. Adjusted odds ratio (aOR) with 95% confidence intervals were used for dichotomous variables. Sensitivity analysis was conducted by removing one study each time and re-estimating the overall effect size. FINDINGS: Seven retrospective cohort studies with 680,155 patients were finally included. Among these participants, 139,362 patients (20.49%) had anesthesia handovers during their surgeries. In pooled analysis, the statistically significant relationship between intraoperative anesthesia handover and composite morbidity was observed (aOR 1.20 and 95% CI 1.12-1.28). However, the number of handovers was not significantly associated with composite of mortality and morbidity (aOR 1.12, 95% CI 1.00-1.25) and in-hospital mortality (aOR 1.26, 95% CI 0.96-1.67). CONCLUSIONS: The findings suggested that each additional intraoperative anesthesia handover increased the odds of composite morbidity. It is important to improve the handover quality and avoid handovers when anesthesia providers have high-risk care events, patients having unstable status, or inadequate handover time.

Building an International Partnership to Develop Advanced Practice Nurses in Anesthesia Settings: Using a Theory-Driven Approach.

The International Federation of Nurse Anesthetists is calling for international collaboration to develop advanced nursing practice in anesthesia settings globally. However, international collaboration is challenging. Limited information is available about what process and factors specifically lead to a successful international collaboration partnership. This article aimed to describe a theoretical and empirical base that can be used to build and maintain long-term international partnerships. The Theoretical Framework of Developing International Partnerships was developed, which comprises seven interrelated concepts including partnerships, collaborations, environment, structure, process for collaborating, outcomes, and sustainability. It was used to guide an equitable horizontal collaboration partnership to develop anesthesia nursing care in local culture and context. Five major challenges were identified during the collaboration process. Sixty-six strategies were developed to facilitate collaboration using the theoretical framework. This work can inform others in establishing an international collaboration and partnership in advancing nursing knowledge and culturally congruent health care delivery.

IFNA approved Chinese Anaesthesia Nurse Education Program: A Delphi method.

BACKGROUND: Numerous nurses work in operating rooms and recovery rooms or participate in the performance of anaesthesia in China. However, the scope of practice and the education for Chinese Anaesthesia Nurses is not standardized, varying from one geographic location to another. Furthermore, most nurses are not trained sufficiently to provide anaesthesia care. OBJECTIVES: This study aimed to develop the first Anaesthesia Nurse Education Program in Mainland China based on the Educational Standards of the International Federation of Nurse Anaesthetists. METHODS: The Delphi technique was applied to develop the scope of practice, competencies for Chinese Anaesthesia Nurses and education program. In 2014 the Anaesthesia Nurse Education Program established by the hospital applied for recognition by the International Federation of Nurse Anaesthetists. The Program's curriculum was evaluated against the IFNA Standards and recognition was awarded in 2015. RESULTS: The four-category, 50-item practice scope, and the three-domain, 45-item competency list were identified for Chinese Anaesthesia Nurses. The education program, which was established based on the International Federation of Nurse Anaesthetists educational standards and Chinese context, included nine curriculum modules. In March 2015, 13 candidates received and passed the 21-month education program. The Anaesthesia Nurse Education Program became the first program approved by the International Federation of Nurse Anaesthetists in China. CONCLUSIONS: Policy makers and hospital leaders can be confident that anaesthesia nurses graduating from this Chinese program will be prepared to demonstrate high level patient care as reflected in the recognition by IFNA of their adoption of international nurse anaesthesia education standards.

Recertifying the professional nurse anesthetist: a call for national dialogue.

In 2011 the National Board of Certification and Recertification for Nurse Anesthetists initiated a Continued Professional Certification program that strongly suggests the search for alternatives. This article presents a thoughtful critique of the proposed professional competency program as well as alternatives that could be considered in a revision of the current program. Options discussed include a Continuous Professional Development program, a Simulation-Based Model, and a Practice-Based Model.

Predictors of situation awareness in student registered nurse anesthetists.

Situation awareness (SA) is defined as one's perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. The concept of SA is well known in the aviation industry, which is characterized by complexity and dynamism. The discipline of anesthesia shares these same environmental characteristics, yet the study of SA in this setting is in its infancy. Guided by Endsley's theory of SA, the purpose of this study was to provide educators with a best-evidence predictor model of SA in student registered nurse anesthetists (SRNAs). Seventy-one SRNAs were randomly selected from 3 US universities. A nonexperimental, correlational design and multiple regression analysis were used to measure the relationship between memory, cognition, and automaticity and SA. Findings from this study reveal cognition as the best predictor of SA in graduate SRNAs, with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the admission, education, and training of SRNAs. This study contributes evidence for further research examining the use of high-fidelity simulation in promoting SA in SRNAs.

Perceived deprivation in active duty military nurse anesthetists.

There is a shortage of military Certified Registered Nurse Anesthetists (CRNAs). Relative deprivation is a perception of unfairness due to discrepancies between what one has and what one could or should have that is dependent on feelings (subjective data) and facts (objective data). Feelings of relative deprivation could contribute to the military CRNA shortage. The purposes of this study were to measure relative deprivation in active-duty military CRNAs and explore variables that correlate with relative deprivation. The descriptive, correlational study was conducted using a self-administered survey sent to 435 active-duty Army, Navy, and Air Force CRNAs. Surveys were distributed to subjects by mail and could be answered by mail or by secured website. Data were analyzed using descriptive and inferential statistics. Analysis of the data revealed a calculated response rate of 57.7%. There was no significant correlation (P < .05) between years as a CRNA, military pay, promotion opportunity, or scope of practice/autonomy and relative deprivation. Correlations of the psychological factors "wanting" and "deserving" with relative deprivation were significant (P < .001). Further research is indicated to identify definitive factors that can be modified to improve feelings of deprivation as they relate to retention and recruitment of military CRNAs.

Distribution of US anesthesia providers and services.

This study describes the correlation between anesthesia providers by type (Certified Registered Nurse Anesthetist [CRNA] or anesthesiologist) and their respective rural or urban distributions across America. Analyses are based on county level data contained in several distinct databases with a given assumption that most providers practice and reside in the same rural or urban designation category. Data reveal that 91.6% (28,569) of active practicing anesthesiologists reside in metropolitan counties and that 8.4% (2,625) reside in nonmetropolitan counties. Of the 26,658 active practicing CRNAs, 81.4% (21,701), reside in metropolitan counties as opposed to 18.6% (4,957) in nonmetropolitan counties. Overall, analyses indicate that out of a total of 3,140 counties, there are 843 counties in the United States where neither anesthesiologists nor CRNAs reside. Ninety-seven percent (816) of these counties are nonmetropolitan.

Preadmission characteristics of advanced practice nursing students.

PURPOSE: To determine the nature of prerequisite experiences of applicants to nurse practitioner (NP) and certified registered nurse anesthetist (CRNA) programs that faculty believe are necessary for success in graduate nursing programs. DATA SOURCES: An exploratory descriptive study based on findings from four focus groups of faculty from four different universities and a written survey mailed to program or admissions directors of a random sample of 50% of the 295 credentialed NP or CRNA programs in the United States. CONCLUSIONS: Themes from the focus groups revealed 20 personal characteristics, 14 professional characteristics, and 9 clinical skills, all of which were used to create a survey instrument. A 33% response rate was achieved (n = 48). Personal characteristics were considered most important, professional characteristics and clinical skills moderately important, and kinds of clinical experience of lesser importance. Length of desired experience ranged from 0 to 5 years, most often 2 years. The most important characteristic under personal was "ethical;" under professional, "clinically competent;" under clinical, "interpersonal communication;" and under clinical experience, "to work in a setting with MD-RN interaction." IMPLICATIONS FOR PRACTICE: Information from this study may be useful for examining admissions policies of advanced practice graduate programs. Faculty were able to articulate the characteristics, proficiencies, and experiences that are likely to produce success in NP and CRNA programs. These desired characteristics need to be translated into meaningful criteria for admission.

Daedalus revisited: a call for redesign of the bougie esophageal dilator.

We report a case of a patient undergoing gastric bypass in which an improperly introduced bougie dilator resulted in esophageal perforation and we examine the matter using a human-factors approach. The Institute of Medicine's widely distributed 1999 report estimated that up to 98,000 Americans die each year as a result of preventable errors with the operating room being a particularly error-prone environment. The report suggests that the majority of errors are not the result of poor provider performance but instead are the result of inherent systems-based problems. Perforation can be associated with significant negative outcome; modifying factors include experience, appreciating anatomical details, and cognizance of mechanisms of perforation. Human-factors research reveals that 1) humans are prone to err and 2) the majority of errors are not the result of personal inadequacy but instead are the product of defects in the design of health care environmental systems in which that work occurs. Here during a highly complex surgical procedure a simple preventable human error occurred, one often associated with significant negative outcome. We suggest a simple solution in line with a human-factors approach that might prevent future occurrences.