Anesthesiologist staffing considerations consequent to the temporal distribution of hypoxemic episodes in the Postanesthesia care unit

Anesthesia and Analgesia

Volumn 119, Issue 6, 2014, Pages 1322-1333

  Epstein, Richard H ^a   Dexter, Franklin ^b   Lopez, Marcos G ^c   Ehrenfeld, Jesse M ^c  

^a THOMAS JEFFERSON UNIVERSITY   (United States)

^b UNIVERSITY OF IOWA   (United States)

^c VANDERBILT UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

OXYGEN;

ANESTHESIST; ARTICLE; ENDOTRACHEAL INTUBATION; HOSPITAL PERSONNEL MANAGEMENT; HUMAN; HYPOXEMIA; OPERATING ROOM; OXYGEN SATURATION; RECOVERY ROOM; ANESTHESIOLOGY; ANESTHETIC RECOVERY; ANOXIA; HEALTH SERVICE; HOSPITAL DEPARTMENT; MANPOWER; NEEDS ASSESSMENT; OXIMETRY; PERSONNEL MANAGEMENT; PREDICTIVE VALUE; TIME; UNIVERSITY HOSPITAL; WORKLOAD;

ACADEMIC MEDICAL CENTERS; ANESTHESIA DEPARTMENT, HOSPITAL; ANESTHESIA RECOVERY PERIOD; ANESTHESIOLOGY; ANOXIA; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; INTUBATION, INTRATRACHEAL; NEEDS ASSESSMENT; OXIMETRY; PERSONNEL STAFFING AND SCHEDULING; PREDICTIVE VALUE OF TESTS; TIME FACTORS; WORKLOAD;

EID: 84914162011     PISSN: 00032999     EISSN: 15267598     Source Type: Journal    
DOI: 10.1213/ANE.0000000000000410     Document Type: Article

References (34)

1. Aukburg SJ, Ketikidis PH, Kitz DS, Mavrides TG, Matschinsky BB. Automation of physiologic data presentation and alarms in the post anesthesia care unit. Proc Annu Symp Comput Appl Med Care 1989;8580-2
2. Moller JT, Wittrup M, Johansen SH. Hypoxemia in the postanesthesia care unit: an observer study. Anesthesiology 1990;73:890-5
3. Daley MD, Norman PH, Colmenares ME, Sandler AN. Hypoxaemia in adults in the post-anaesthesia care unit. Can J Anaesth 1991;38:740-6
4. Russell GB, Graybeal JM. Hypoxemic episodes of patients in a postanesthesia care unit. Chest 1993;104:899-903
5. Mathew JP, Rosenbaum SH, OConnor T, Barash PG. Emergency tracheal intubation in the postanesthesia care unit: physician error or patient disease? Anesth Analg 1990;71:691-7
6. Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP. Critical respiratory events in the postanesthesia care unit. Patient, surgical, and anesthetic factors. Anesthesiology 1994;81:410-8
7. Lee PJ, MacLennan A, Naughton NN, OReilly M. An analysis of reintubations from a quality assurance database of 152,000 cases. J Clin Anesth 2003;15:575-81
8. Dexter F, Epstein RH, Penning DH. Statistical analysis of postanesthesia care unit staffing at a surgical suite with frequent delays in admission from the operating room-a case study. Anesth Analg 2001;92:947-9
9. Epstein RH, Dexter F, Traub RD. Statistical power analysis to estimate how many months of data are required to identify post anesthesia care unit staffing to minimize delays in admission from operating rooms. J Perinesth Nurs 2001;17:84-8
10. Dexter F, Epstein RH, Marcon E, de Matta R. Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms. J Perianesth Nurs 2005;20:92-102
11. Dexter F, Wachtel RE, Epstein RH. Impact of average patient acuity on staffing of the phase I PACU. J Perianesth Nurs 2006;21:303-10
12. Kapur PA. Leading into the future: the 50th annual Rovenstine lecture. Anesthesiology 2012;116:758-67
13. Kapur PA. Designing the future: insights from current supervisory models. Anesth Analg 2013;116:749-51
14. Epstein RH, Dexter F. Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics. Anesthesiology 2012;116:683-91
15. Paoletti X, Marty J. Consequences of running more operating theatres than anaesthetists to staff them: a stochastic simulation study. Br J Anaesth 2007;98:462-9
16. Dexter F, Epstein RH. Sensitivity of tests of hypotheses about supervision ratios and first-case starts to definitions and durations of critical portions of cases. Anesthesiology 2012;117:438-41
17. Smallman B, Dexter F, Masursky D, Li F, Gorji R, George D, Epstein RH. Role of communication systems in coordinating supervising anesthesiologists activities outside of operating rooms. Anesth Analg 2013;116:898-903
18. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107:130-7
19. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, Nisman M. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology 2008;109:389-98
20. Cammu GV, Smet V, De Jongh K, Vandeput D. A prospective, observational study comparing postoperative residual curarisation and early adverse respiratory events in patients reversed with neostigmine or sugammadex or after apparent spontaneous recovery. Anaesth Intensive Care 2012;40:999-1006
21. Dexter F, Epstein RH, Marcon E, Ledolter J. Estimating the incidence of prolonged turnover times and delays by time of day. Anesthesiology 2005;102:1242-8
22. Epstein RH, Dexter F. Implications of resolved hypoxemia on the utility of desaturation alerts sent from an anesthesia decision support system to supervising anesthesiologists. Anesth Analg 2012;115:929-33
23. Ehrenfeld JM, Funk LM, Van Schalkwyk J, Merry AF, Sandberg WS, Gawande A. The incidence of hypoxemia during surgery: evidence from two institutions. Can J Anaesth 2010;57:888-97
24. Dexter F, Epstein RH, Marsh HM. Costs and risks of weekend anesthesia staffing at 6 independently managed surgical suites. AANA J 2002;70:377-81
25. Dexter F, Epstein RH. Holiday and weekend operating room on-call staffing requirements. Anesth Analg 2006;103:1494-8
26. van Oostrum JM, Van Houdenhoven M, Vrielink MM, Klein J, Hans EW, Klimek M, Wullink G, Steyerberg EW, Kazemier G. A simulation model for determining the optimal size of emergency teams on call in the operating room at night. Anesth Analg 2008;107:1655-62
27. Ledolter J, Dexter F, Epstein RH. Analysis of variance of communication latencies in anesthesia: comparing means of multiple log-normal distributions. Anesth Analg 2011; 113:888-96
28. Law AM, Kelton WD. Simulation Modeling and Analysis. 2nd ed. New York, NY: McGraw-Hill, Inc., 1991:551-3
29. Dexter F, Marcon E, Epstein RH, Ledolter J. Validation of statistical methods to compare cancellation rates on the day of surgery. Anesth Analg 2005;101:465-73
30. Clopper CJ, Pearson ES. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika 1934; 26:404-13
31. Hahn GJ, Meeker WQ. Statistical Intervals. A Guide for Practitioners. New York, NY: Wiley, 1991:82-4, 100-5
32. Ehrenfeld JM, Dexter F, Rothman BS, Minton BS, Johnson D, Sandberg WS, Epstein RH. Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit. Anesth Analg 2013;117:1444-52
33. Weingarten TN, Abenstein JP, Dutton CH, Kohn MA, Lee EA, Mullenbach TE, Narr BJ, Schroeder DR, Sprung J. Characteristics of emergency pages using a computer-based anesthesiology paging system in children and adults undergoing procedures at a tertiary care medical center. Anesth Analg 2013; 116:904-10
34. Epstein RH, Dexter F. Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data. Anaesth Intensive Care 2012;40:803-12