Rohesh J. Fernando

Barriers to the implementation of checklists in the office‐based procedural setting

BACKGROUNDnPatient safety is critical for the patients, providers, and risk managers in the office-based procedural setting, and the same standard of care should be maintained regardless of the healthcare environment. Checklists may improve patient safety and potentially decrease risk. This study explored utilization of checklists in the office-based setting and the potential barriers to their implementation.nnnMETHODSnA cross-sectional prospective study was performed by using a 19-question anonymous survey designed with REDCap®. Medical providers including physicians and nurses from 25 different offices that performed procedures participated, and 38 individual responses were included in the study.nnnRESULTSnOnly 50% of offices surveyed use safety checklists in their practice. Only 34% had checklists or equivalent protocol for emergencies such as anaphylaxis or failed airway. As many as 23.7% of respondents indicated that they encountered barriers to implementing checklists. The top barriers identified in the study were no incentive to use a checklist (77.8%), no mandate from a local or federal regulatory agency (44.4%), being too time consuming (33.3%), and lack of training (33.3%). Reasons identified that would encourage providers to use checklists included a clear mandate (36.8%) and evidence-based research (26.3%).nnnCONCLUSIONSnChecklists are not being universally utilized in the office-based setting. There are barriers preventing their successful implementation. Risk managers may be able to improve patient safety and decrease risk by encouraging practitioners, possibly through incentives, to use customizable safety checklists.

Critical Care in a Tertiary Hospital in Malawi

BackgroundThe provision of critical care services is essential to healthcare systems and increasingly a global health focus, but many hospitals in sub-Saharan Africa are unable to meet this need. Intensive care unit (ICU) mortality in this region is high, but studies describing the provision of critical care services are scarce.MethodsThis was a retrospective cohort study of all patients admitted to the ICU at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, between September 1, 2013, and October 17, 2014. We summarized demographics, clinical characteristics, and outcomes, and analyzed factors associated with mortality.ResultsOf 390 patients admitted to ICU during the study, 44.9xa0% of patients were male, and the median age was 22xa0years (IQR 6–35) years. Although most patients (73.1xa0%) were admitted with surgical diagnoses, the highest mortality was among patients admitted with sepsis (59.3xa0%), or obstetric (44.7xa0%) or medical (40.0xa0%) diagnoses. Overall ICU mortality was high (23.6xa0%).ConclusionsThere is a shortage of data describing critical care in low-resource settings, particularly in sub-Saharan Africa. Surgical disease comprises the majority of ICU utilization in this study site, but medical and obstetric illness carried higher ICU mortality. These data may guide strategies for improving critical care in the region.

Perioperative Management of Mild Hemophilia B during and after Coronary Artery Bypass Grafting: challenges and solutions

Please cite this article as: Rohesh J. Fernando MD , Blaine E. Farmer MD , John G. Augoustides MD, FASE, FAHA , Jeffrey C. Gardner MD , Sean D. Johnson MD , Bao Ha MD , Jan-Oliver Friess MD , Markus M. Luedi MD , Gabor Erdoes MD , Peter J. Miller MD , Caroline Ripat MD, MSPHc , Michael Fabbro II DO , Perioperative Management of Mild Hemophilia B during and after Coronary Artery Bypass Grafting: challenges and solutions, Journal of Cardiothoracic and Vascular Anesthesia (2018), doi: 10.1053/j.jvca.2018.06.005

Transesophageal Echocardiographic Evaluation of a Double Orifice Mitral Valve

Intraoperative transesophageal echocardiography currently is used routinely for many cardiothoracic surgical procedures. Although it is often used for intraoperative cardiac monitoring and to confirm preoperative echocardiographic findings, it may sometimes result in the discovery of unexpected pathology. In this e-challenge, a patient was found to have a mitral valve abnormality that was not previously detected on the preoperative transthoracic echocardiogram. The mitral valve anomaly subsequently was evaluated to characterize the anatomy, interrogate the valve, and provide a diagnosis.

Acute Type B Aortic Dissection in Pregnancy – Therapeutic Challenges in a Multidisciplinary Setting ☆ ☆☆

Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston-Salem, NC Cardiothoracic Anesthesiology, Department of Anesthesiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL

Simultaneous Right-Sided and Left-Sided Infective Endocarditis – Management Challenges in a Multidisciplinary Setting☆☆☆

Cardiothoracic Section, Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, NC Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA Adult Cardiothoracic Anesthesiology, Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico, Albuquerque, NM

Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava

A persistent left superior vena cava is a congenital abnormality that affects a minority of the general population. While this finding is not hemodynamically significant in all patients, failure to recognize the altered anatomy in any of these patients can be consequential during procedures such as central venous catheter placement, pacemaker/defibrillator wire placement, and use of retrograde cardioplegia during cardiac surgery. We present a case of an intraoperative diagnosis of a persistent left superior vena cava that altered the original plan to arrest the heart using retrograde cardioplegia. Echocardiography was instrumental in this diagnosis and avoided potentially inadequate myocardial protection during cardiopulmonary bypass.

Concepts for the Development of a Customizable Checklist for Use by Patients.

Objectives Checklists are tools that are developed to complete tasks by drawing on specific and relevant knowledge and supporting communication at critical times. If checklists were designed specifically for patient use, they could promote patient engagement, potentially leading to improved quality of care. Physicians of all specialties, nurses, patients, patient advocates, and administrators can take an active role in checklist development and dissemination. Methods Our method to investigate concepts in developing a customizable patient checklist included a literature search concerning existing checklists and resources currently available to patients. Literature containing expert opinion regarding checklists, professional organization statements, and patients and providers were consulted. Results A template for designing a patient checklist was developed incorporating methods from previous literature and resources regarding checklists. This template includes a development, drafting, and validation phase. Sample content for inclusion in potential checklists for patients with diabetes and patients undergoing anesthesia was devised. Conclusions Developed by physicians with input from patients and other involved health-care providers such as nurses, this relatively novel concept of a patient’s checklist creates a role for the patient to ensure their own safety. With increasing attention to high-quality and cost-effective health care, patient satisfaction surveys will be assessed to rate overall health care. Further development of checklists will need to be guided by specific medical conditions and acceptance by patients and providers. Providers can use these checklists as a method to gauge a patient’s understanding of an intervention, solidify the patient-doctor relationship, and improve patient safety.

Survey Analysis of an Ambulatory Surgical Checklist for Patient Use

Although checklists are used as tools for providers, they have not been adequately explored as tools for patients. The purpose of this study was to survey the stakeholders on the usefulness of an ambulatory surgical checklist for patients. We performed a cross-sectional study through a survey designed to include both patients and providers. Descriptive analysis of the data was performed based on responses from 35 patients and 52 providers. Overall, 94% of patients and 83% of providers thought the checklist would be beneficial for patients. In addition, 37% of providers indicated potential barriers to checklist implementation, including fear of confusing the patient, making patients doubt the care they were receiving, taking too much time, and lack of resources. Based on survey responses, the study suggests that the ambulatory surgical checklist can potentially facilitate patient education, enable more active patient participation, increase patient satisfaction, and decrease patient anxiety.