What information do anaesthetists provide for patients?
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BACKGROUND: Information on anaesthesia interventions, plans and risks is needed by patients and carers alike and is a key component of the Good Practice In Consent initiative. Existing information materials may under-represent what patients are able to contribute. METHOD: UK anaesthetic departments were surveyed on provision of written patient information. The response rate was 66% (177/267). RESULTS: Fifty-five per cent of respondents reported providing patient information materials for planned surgical admission, mainly on general anaesthesia, regional analgesia and pain. A minority provided information for children and for critical care patients. Few (32%) had sought feedback from patients, and few used existing sources of guidance. Most (85%) wanted improvements, with a four-to-one majority favouring central resources developed by The Royal College of Anaesthetists. CONCLUSIONS: Working in parallel does not give our hospitals excellent, effective patient information materials. Demand exists for The Royal College of Anaesthetists to lead in this area. Working in partnership with patients and taking into account existing written guidance is important but has often been overlooked. (+info)
Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study.
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BACKGROUND: Anesthesia simulators can generate reproducible, standardized clinical scenarios for instruction and evaluation purposes. Valid and reliable simulated scenarios and grading systems must be developed to use simulation for evaluation of anesthesia residents. METHODS: After obtaining Human Subjects approval at each of the 10 participating institutions, 99 anesthesia residents consented to be videotaped during their management of four simulated scenarios on MedSim or METI mannequin-based anesthesia simulators. Using two different grading forms, two evaluators at each department independently reviewed the videotapes of the subjects from their institution to score the residents' performance. A third evaluator, at an outside institution, reviewed the videotape again. Statistical analysis was performed for construct- and criterion-related validity, internal consistency, interrater reliability, and intersimulator reliability. A single evaluator reviewed all videotapes a fourth time to determine the frequency of certain management errors. RESULTS: Even advanced anesthesia residents nearing completion of their training made numerous management errors; however, construct-related validity of mannequin-based simulator assessment was supported by an overall improvement in simulator scores from CB and CA-1 to CA-2 and CA-3 levels of training. Subjects rated the simulator scenarios as realistic (3.47 out of possible 4), further supporting construct-related validity. Criterion-related validity was supported by moderate correlation of simulator scores with departmental faculty evaluations (0.37-0.41, P < 0.01), ABA written in-training scores (0.44-0.49, < 0.01), and departmental mock oral board scores (0.44-0.47, P < 0.01). Reliability of the simulator assessment was demonstrated by very good internal consistency (alpha = 0.71-0.76) and excellent interrater reliability (correlation = 0.94-0.96; P < 0.01; kappa = 0.81-0.90). There was no significant difference in METI versus MedSim scores for residents in the same year of training. CONCLUSIONS: Numerous management errors were identified in this study of anesthesia residents from 10 institutions. Further attention to these problems may benefit residency training since advanced residents continued to make these errors. Evaluation of anesthesia residents using mannequin-based simulators shows promise, adding a new dimension to current assessment methods. Further improvements are necessary in the simulation scenarios and grading criteria before mannequin-based simulation is used for accreditation purposes. (+info)
Evaluation of high fidelity patient simulator in assessment of performance of anaesthetists.
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BACKGROUND: There is increasing emphasis on performance-based assessment of clinical competence. The High Fidelity Patient Simulator (HPS) may be useful for assessment of clinical practice in anaesthesia, but needs formal evaluation of validity, reliability, feasibility and effect on learning. We set out to assess the reliability of a global rating scale for scoring simulator performance in crisis management. METHODS: Using a global rating scale, three judges independently rated videotapes of anaesthetists in simulated crises in the operating theatre. Five anaesthetists then independently rated subsets of these videotapes. RESULTS: There was good agreement between raters for medical management, behavioural attributes and overall performance. Agreement was high for both the initial judges and the five additional raters. CONCLUSIONS: Using a global scale to assess simulator performance, we found good inter-rater reliability for scoring performance in a crisis. We estimate that two judges should provide a reliable assessment. High fidelity simulation should be studied further for assessing clinical performance. (+info)
Anesthesia in Italy in 2000: sciences and working practice.
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BACKGROUND: To survey current anaesthesiology practice in Italy. METHODS: We submitted to 1260 Italian anaesthesiologists in 12 different regional places a structured form aimed at surveying their common work practice. Our sample consisted of anaesthesiologists, age 26-63, with 1-35 years of professional practice. We believe that our sample represents about 7-10% of Italian anaesthesiologists, reflecting a global number of 600,000 procedures performed during 2000. The results have been analyzed by an Excel spreadsheet and they are reported as mean of the percentage of use declared in the case of drugs, and as percentage of the responses in the case of procedure and monitoring systems used. Furthermore we divided our sample population according to two criteria: principal place of work (general operating rooms (OR), subspecialty ORs, ICU) and years of anaesthesiology practice (<5>). The results have been crossmatched within and between the subgroups. RESULTS: The survey showed a composite state of anaesthesia practice in Italy. The main differences are between the youngest and the oldest anaesthesiologists and between the anaesthesiologists working mainly in the ICU and in the ORs. CONCLUSIONS: Italian anaesthesia practice is still a very composite reality. (+info)
Laryngoscopic intubation: learning and performance.
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BACKGROUND: Many healthcare professionals are trained in direct laryngoscopic tracheal intubation (LEI), which is a potentially lifesaving procedure. This study attempts to determine the number of successful LEI exposures required during training to assure competent performance, with special emphasis on defining competence itself. METHODS: Analyses were based on a longitudinal study of novices under training conditions in the operating room. The progress of 438 LEIs performed by the 20 nonanesthesia trainees was monitored by observation and videotape analysis. Eighteen additional LEIs were performed by experienced anesthesiologists to define the standard. A generalized linear, mixed-modelling approach was used to identify key aspects of effective training and performance. The number of tracheal intubations that the trainees were required to perform before acquiring expertise in LEI was estimated. RESULTS: Subjects performed between 18 and 35 laryngoscopic intubations. However, statistical modeling indicates that a 90% probability of a "good intubation" required 47 attempts. Proper insertion and lifting of the laryngoscope were crucial to "good" or "competent" performance of LEI. Traditional features, such as proper head and neck positions, were found to be less important under the study conditions. CONCLUSIONS: This study determined that traditional LEI teaching for nonanesthesia personnel using manikin alone is inadequate. A reevaluation of current standards in LEI teaching for nonanesthesia is required. (+info)
Occupational stress and burnout in anaesthesia.
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BACKGROUND: Formal studies on stress in anaesthetists have usually measured stress through mental or physiological indicators. When using this approach, one must be careful not to confuse the effects of stress or outcome variables and the sources of stress or antecedent variables. To date, it seems from the literature that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress. Furthermore, work characteristics such as job satisfaction, job control and job support may moderate the effects of stress. METHODS: We measured the effects of stress together with the sources of stress and job characteristics, using self-reported questionnaires rather than physiological indicators in order to better diagnose stress in anaesthetists. RESULTS: The mean stress level in anaesthetists was 50.6 which is no higher than we found in other working populations. The three main sources of stress reported were a lack of control over time management, work planning and risks. Anaesthetists reported high empowerment, high work commitment, high job challenge and high satisfaction. However, 40.4% of the group were suffering from high emotional exhaustion (burnout); the highest rate was in young trainees under 30 years of age. CONCLUSIONS: Remedial actions are discussed at the end of the paper. (+info)
How much are anesthesiologists exposed to electromagnetic fields in operating rooms?
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Numerous electronic devices have been introduced into the operating room. Although little is known about the relationship between exposure to electromagnetic fields (EMF) and health hazards, some authors reported its association with cancer or other diseases. We measured the amount of EMF exposure that an anesthesiologist gets in the operating room. The density of the magnetic field was checked by an extremely low frequency (ELF) field strength measurement system in the 19 operating rooms of our hospital. We measured the magnetic field intensity at a distance of 30 cm, 50 cm, and at the place where the anesthesiologist usually stands from the center of the main monitor. The average exposure quantities of magnetic fields in 19 operating rooms were 2.22 +/- 1.13 mG at 30 cm, 1.29 +/- 0.84 mG at 50 cm and 1.00 +/- 0.78 mG at the anesthesiologist's standing points respectively. Because quantities over 2 or 3 mG were accepted to be high radiation levels of EMF by many reports describing the hazards of EMF, we set 2 mG to be the cutoff value. In some of the 19 operating rooms, the measured EMF density exceeded our cutoff value. Although the health hazards related to EMF exposure are still equivocal, anesthesiologists should consider making an effort to improve their environment and reduce their exposure to EMF. (+info)
Misuse of standard error of the mean (SEM) when reporting variability of a sample. A critical evaluation of four anaesthesia journals.
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BACKGROUND: In biomedical research papers, authors often use descriptive statistics to describe the study sample. The standard deviation (SD) describes the variability between individuals in a sample; the standard error of the mean (SEM) describes the uncertainty of how the sample mean represents the population mean. Authors often, inappropriately, report the SEM when describing the sample. As the SEM is always less than the SD, it misleads the reader into underestimating the variability between individuals within the study sample. METHODS: The aim of this study was to evaluate the frequency of inappropriate use of the SEM in four leading anaesthesia journals in 2001. The journals were searched manually for descriptive statistics reporting either the mean (SD) or the mean (SEM), and inappropriate use of the SEM was noted. RESULTS: In 2001, all four anaesthesia journals published articles that used the SEM incorrectly: Anesthesia & Analgesia 27.7%, British Journal of Anaesthesia 22.6%, Anesthesiology 18.7% and European Journal of Anaesthesiology 11.5%. Laboratory reports and clinical studies were equally affected, except for Anesthesiology where 90% were basic science reports. CONCLUSIONS: One in four articles (n=198/860, 23%) published in four anaesthesia journals in 2001 inappropriately used the SEM in descriptive statistics to describe the variability of the study sample. Anaesthesia journals are encouraged to provide clearer statistical guidelines on how to report data variability in descriptive statistics. (+info)