Scott Springman

Patient safety in outpatient surgery: The viewpoint of the healthcare providers

The objective of this study is to understand the viewpoint of healthcare providers with regard to patient safety in outpatient surgery settings. Two methods were used to gather data from the healthcare providers: (1) questionnaire with open-ended questions about six predefined stages of the patient care process; (2) survey with closed questions. With the first method, the main quality and safety of care issues concerned communication to patients, coordination of reports and forms, patient and staff time pressures and standards of care. The first two stages of the outpatient surgery process, i.e. patient work-up prior to day of surgery and patient admission and preparation on the day of surgery, yielded many more comments than the other four stages. The results of the structured questionnaire show that, overall, the healthcare providers report high quality of care provided by themselves (98%) and their surgery centre (96%). With regard to patient safety (i.e. cancellations of surgeries, patient safety problems and serious mistakes), there was a clear difference in perceptions reported by the physicians vs. the nurses and other staff. Nurses and other staff were more likely to report patient safety problems than physicians. The combination of qualitative data from the initial questionnaire and the quantitative data from the structured questionnaire provides a rather complete view of the outpatient surgery staff perceptions of quality and safety of care. This research highlights the importance of getting input from the healthcare providers regarding the quality and safety of care rather than relying only on traditional measures about patient outcomes.

Care transitions in the outpatient surgery preoperative process: facilitators and obstacles to information flow and their consequences

Patient care transitions have been shown to be critical points at which failure as well as recovery from potential failure may occur. The purpose of this research was to identify transitions in patient care and the flow of associated information at different steps in the outpatient surgery preoperative care process and, in turn, attempt to identify breakdowns in the information flow process and their ramifications. A study of one organization’s preoperative process for outpatient surgery was conducted, employing four means of data collection to gather information on preoperative work processes: employee shadowing, patient shadowing, clinic observation, and dictated feedback. Various facilitators and obstacles in information flow were found to be present in the preoperative care process. Obstacles often resulted in negative consequences for healthcare providers and patients. Helping care providers understand how their actions affect the various elements of the preoperative process, through improved awareness, may be one way to improve information flow problems within the outpatient surgery process.

Computer-Assisted Continuous Infusion for the Delivery of Target-Controlled Infusions of Propofol During Outpatient Surgery

Propofol was administered intravenously using a first‐order, three‐compartment, computer‐controlled infusion pump (CCIP) based on the Ohmeda 9000 syringe pump. The CCIP system produced a target‐controlled infusion (TCI) based on the estimated blood concentration (EBC). Twenty‐five patients undergoing ambulatory surgery completed the study. The induction EBC was 4.72 ± 0.28 μg/ml, and was achieved rapidly with minimal hemodynamic changes. The emergence EBC was 1.55 ± 0.21 μg/ml, and the discharge EBC was 1.06 ± 0.22 μg/ml. The EBC, together with clinical signs, allowed for predictable inductance and emergence from anesthesia using propofol.

Integration of the enterprise electronic health record and anesthesia information management systems.

Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system-wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS.

Patient Care Process and Information Flow in Outpatient Surgery

Patient care transitions have been shown to be critical points at which failure as well as recovery from potential failure may occur. The purpose of this research is to identify transitions in patient care and the flow of information for different steps of the outpatient surgery preoperative care process and, in turn, identify breakdowns in the process of the information flow and their consequences. A study of one hospital’s preoperative process in outpatient surgery was conducted. The design of this study involved four data collection methods to gather data on preoperative work processes: employee shadowing, patient shadowing, clinic observation, and dictated feedback from midlevel providers. Various facilitators and obstacles of information flow were found to be present in the preoperative care process that affected the flow of patient information and resulted in negative consequences for healthcare providers and patients.