A Ready Force: The U.S. Army Certified Registered Nurse Anesthetist Readiness Model.

The U.S. was at war for nearly two decades, supporting unprecedented survival on the battlefield. As the nation pivots to a relative peace, it is critical that U.S. Army certified registered nurse anesthetist (CRNA) leaders mitigate the loss of lessons learned and prepare future Army CRNAs for war. This article describes the U.S. Army CRNA Readiness Model that incorporates the knowledge, skills, and abilities required to sustain readiness. This model will provide U.S. Army nursing leaders with the framework to implement and evaluate solider readiness to provide anesthesia in operational environments.

Obstructive Sleep Apnea Screening in Preoperative Patients.

Patients with the medical diagnosis of obstructive sleep apnea (OSA) and those with undiagnosed OSA have greater chances for adverse events during surgical procedures related to their medical condition. Early identification of at-risk OSA patients can help mitigate associated adverse events. The purpose of this project was to implement a preoperative process to provide early identification of at-risk OSA patients in the preadmission unit, at a large military level I trauma center in central Texas. The Population, Intervention, Comparison, Outcome, Time (PICOT) question for this project is: "In the adult surgical population, how does the routine use of the STOP-Bang Questionnaire compared to non-standardized assessment influence the identification of OSA during the preadmission processing in a military health care treatment facility?" Following the implementation of the standardized use of the STOP-Bang Questionnaire, the identification of early at-risk OSA patients increased from 23% (based on a medical diagnosis of OSA) to 54% with an intermediate and high-risk OSA. Early identification of OSA has an impact on the decisions made to augment and enhance the patient-specific tailored care for each at-risk OSA surgical patient. Potential adverse events may be diminished or eliminated with the early identification of OSA patients. Preoperative policies that support the utilization of preoperative screening for OSA will improve the overall quality and safety of care provided to surgical patients.

Service Block Time Allocation in the US Army Medical Command.

Service block time allocation is a critical requirement for the optimization of patient throughput and access to care in the Surgical Services Service Line of the US Army Medical Command. The procedure complexity, volume, and diversity across 25 facilities create significant variation in service block time. This variation requires the involvement of both the informatics and leadership teams for block time allocation to be effective. This article describes our use of the Army's Surgery Scheduling System, which includes service block time as an embedded function, to develop a standardized process that helps ensure service block time is optimized. We also present guidelines for block time allocation and offer case studies that demonstrate the application of these guidelines.