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Dive into the research topics where Tessa L. Walters is active.

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Featured researches published by Tessa L. Walters.


Journal of Ultrasound in Medicine | 2013

A Randomized Comparison of Long-and Short-Axis Imaging for In-Plane Ultrasound-Guided Femoral Perineural Catheter Insertion

Edward R. Mariano; T. Edward Kim; Natasha Funck; Tessa L. Walters; Michael J. Wagner; T. Kyle Harrison; Nicholas J. Giori; Steven T. Woolson; Toni Ganaway; Steven K. Howard

Continuous femoral nerve blocks provide effective analgesia after knee arthroplasty, and infusion effects depend on reliable catheter location. Ultrasound‐guided perineural catheter insertion using a short‐axis in‐plane technique has been validated, but the optimal catheter location relative to target nerve and placement orientation remain unknown. We hypothesized that a long‐axis in‐plane technique for femoral perineural catheter insertion results in faster onset of sensory anesthesia compared to a short‐axis in‐plane technique.


Journal of Ultrasound in Medicine | 2014

A randomized comparison of proximal and distal ultrasound-guided adductor canal catheter insertion sites for knee arthroplasty.

Edward R. Mariano; T. Edward Kim; Michael J. Wagner; Natasha Funck; T. Kyle Harrison; Tessa L. Walters; Nicholas J. Giori; Steven T. Woolson; Toni Ganaway; Steven K. Howard

Proximal and distal (mid‐thigh) ultrasound‐guided continuous adductor canal block techniques have been described but not yet compared, and infusion benefits or side effects may be determined by catheter location. We hypothesized that proximal placement will result in faster onset of saphenous nerve anesthesia, without additional motor block, compared to a distal technique.


Anesthesia & Analgesia | 2015

Why the Perioperative Surgical Home Makes Sense for Veterans Affairs Health Care.

Edward R. Mariano; Tessa L. Walters; T. Edward Kim; Zeev N. Kain

• Volume 120 • Number 5 www.anesthesia-analgesia.org 1163 Copyright


Pain Medicine | 2015

Perioperative Surgical Home and the Integral Role of Pain Medicine

Tessa L. Walters; Edward R. Mariano; J. David Clark

Many criticisms surround the current management of the surgical experience. These include the fragmented nature of care delivered perioperatively with multiple transitions, the high costs of many common procedures, and the sometimes disappointing outcomes given the monetary and human investments made in surgical care ⇓. Modeled in some ways after the concept of the patient-centered medical home, the American society of anesthesiologists has articulated a definition of the perioperative surgical home (PSH) as “a patient-centered and physician-led multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience” ⇓. Though, we do not yet fully understand the potential benefits of the PSH model, a recent review suggests that the quality of care is often improved, and costs are reduced ⇓. At the core of the PSH concept is the notion that various groups of health care specialists should work together to provide optimal care. Complementary to that notion, and particularly relevant to reducing fragmented treatment as well as improving the patients experience, is the recognition that the seamless longitudinal management of specific aspects of care may facilitate optimal outcomes. Pain management in the immediate postoperative period is already one of the better developed components of the PSH, and one on which further expansion of the model can be based ⇓. As our understanding of factors predisposing patients to excessive acute postoperative pain, persistent postoperative pain, poor functional outcomes, and the prolonged use of opioids grows, so too will our ability to contribute to the perioperative management of surgical patients. Figure ⇓ displays a roadmap of key goals for comprehensive pain management in the perioperative setting. Figure 1 A roadmap of pain management in perioperative pain care. In this model pain management issues are addressed at several points in the PSH process. The goals …


Seminars in Cardiothoracic and Vascular Anesthesia | 2016

Design and Implementation of a Perioperative Surgical Home at a Veterans Affairs Hospital

Tessa L. Walters; Steven K. Howard; Alex Kou; Edward J. Bertaccini; T. Kyle Harrison; T. Edward Kim; Audrey Shafer; Carlos Brun; Natasha Funck; Lawrence C. Siegel; Erica Stary; Edward R. Mariano

The innovative Perioperative Surgical Home model aims to optimize the outcomes of surgical patients by leveraging the expertise and leadership of physician anesthesiologists, but there is a paucity of practical examples to follow. Veterans Affairs health care, the largest integrated system in the United States, may be the ideal environment in which to explore this model. We present our experience implementing Perioperative Surgical Home at one tertiary care university-affiliated Veterans Affairs hospital. This process involved initiating consistent postoperative patient follow-up beyond the postanesthesia care unit, a focus on improving in-hospital acute pain management, creation of an accessible database to track outcomes, developing new clinical pathways, and recruiting additional staff. Today, our Perioperative Surgical Home facilitates communication between various services involved in the care of surgical patients, monitoring of patient outcomes, and continuous process improvement.


Healthcare | 2016

The Perioperative Surgical Home model facilitates change implementation in anesthetic technique within a clinical pathway for total knee arthroplasty.

Seshadri C. Mudumbai; Tessa L. Walters; Steven K. Howard; T. Edward Kim; Gregory Milo Lochbaum; Stavros G. Memtsoudis; Zeev N. Kain; Alex Kou; Robert King; Edward R. Mariano

BACKGROUND The challenge of knowledge translation in medical settings is well known, and implementing change in clinical practice can take years. For the increasing number total knee arthroplasty (TKA) patients annually, there is ample evidence to endorse neuraxial anesthesia over general anesthesia. The rate of adoption of this practice, however, is slow at the current time. We hypothesized that a Perioperative Surgical Home (PSH) model facilitates rapid change implementation in anesthesia. METHODS The PSH clinical pathways workgroup at a tertiary care Veterans Affairs hospital embarked on a 5-month process of changing the preferred anesthetic technique for patients undergoing TKA. This process involved multiple sequential steps: literature review; development of a work document; training of staff; and prospective collection of data. To assess the impact of this change, we examined data 6 months before (PRE, n=90) and after (POST) change implementation (n=128), and our primary outcome was the overall proportion of spinal anesthesia usage for each 6 month period. Secondary outcomes included minor and major complications associated with anesthetic technique. RESULTS Over a period of one year, there was an increase in the proportion of patients who received spinal anesthesia (13% vs. 63%, p<0.001). For the following year, 53-92% of TKA patients per month received spinal anesthesia. There were no differences in major complications. CONCLUSION Rapid and sustained change implementation in clinical anesthesia practice based on emerging evidence is feasible. IMPLICATIONS Perioperative Surgical Home model may facilitate rapid change implementation in surgical care. LEVEL OF EVIDENCE Cohort study, Level 2.


Regional Anesthesia and Pain Medicine | 2017

Adherence to a Multimodal Analgesic Clinical Pathway: A Within-Group Comparison of Staged Bilateral Knee Arthroplasty Patients

Rachel C. Steckelberg; Natasha Funck; T. Edward Kim; Tessa L. Walters; Gregory Milo Lochbaum; Stavros G. Memtsoudis; Nicholas J. Giori; Pier Francesco Indelli; Lorrie J. Graham; Edward R. Mariano

Background and Objectives Multimodal analgesic clinical pathways for joint replacement patients often include perineural catheters, but long-term adherence to these pathways has not yet been investigated. Our primary aim was to determine adherence rate to a knee arthroplasty clinical pathway for patients undergoing staged bilateral procedures. Methods This study was performed at a hospital with a Perioperative Surgical Home program and knee arthroplasty clinical pathway using multimodal analgesia and adductor canal catheters. Data were examined for all orthopedic surgery patients over a 4-year period. We included patients who had staged bilateral knee arthroplasty electively scheduled on 2 separate dates. The primary outcome was rate of adductor canal catheter utilization as a measure of adherence to the clinical pathway. Other outcomes included rates of neuraxial anesthesia and minor and major perioperative complications. Results We analyzed data for 103 unique patients. The interval between surgeries was a median of 261 days (10th–90th percentile, 138–534 days). All 103 patients had adductor canal catheters for both the first and second surgeries (P > 0.999). Forty-one percent of patients had the same surgeon for both surgeries, but only 2% had the same anesthesiologist (P < 0.001). From the first to the second surgery, utilization of neuraxial anesthesia increased from 51% to 68%, respectively (P = 0.005). There were no differences in minor or major complications. Conclusions For staged bilateral knee arthroplasty patients, 100% clinical pathway adherence including perineural catheters and multimodal analgesia is feasible despite multiple variables. We believe that patient-centered acute pain management requires consistent and reliable delivery of care.


Journal of Ultrasound in Medicine | 2015

Comparative Effectiveness of Infraclavicular and Supraclavicular Perineural Catheters for Ultrasound-Guided Through-the-Catheter Bolus Anesthesia

T. Kyle Harrison; T. Edward Kim; Steven K. Howard; Natasha Funck; Michael J. Wagner; Tessa L. Walters; Catherine M. Curtin; James Chang; Toni Ganaway; Edward R. Mariano

Using a through‐the‐needle local anesthetic bolus technique, ultrasound‐guided infraclavicular perineural catheters have been shown to provide greater analgesia compared to supraclavicular catheters. A through‐the‐catheter bolus technique, which arguably “tests” the anesthetic efficacy of the catheter before initiating an infusion, has been validated for infraclavicular catheters but not supraclavicular catheters. This study investigated the through‐the‐catheter bolus technique for supraclavicular catheters and tested the hypothesis that infraclavicular catheters provide faster onset of brachial plexus anesthesia.


Seminars in Cardiothoracic and Vascular Anesthesia | 2018

Perioperative Surgical Home Reduces Rapid Response Calls to a Postoperative Surgical Ward: How Anesthesiologists Are Improving the Inpatient Safety Net:

Tessa L. Walters; T. Edward Kim; Edward R. Mariano; Geoffrey K. Lighthall

Background. The Perioperative Surgical Home (PSH) is an anesthesiologist-led, coordinated care model that may improve patient experience and safety. We hypothesized that PSH will decrease activation of the rapid response system for surgical inpatients. Methods. This retrospective study was performed at an academic Veterans Affairs hospital with a PSH. Data from both medical and surgical cohorts admitted to a single ward were analyzed for the Pre-PSH (July 2006 to October 2010) and Post-PSH (November 2011 to May 2015) epochs. The primary outcome was incidence of rapid response team (RRT) activations per 1000 bed-days. Results. Surgical patients had 5.8 RRT activations per 1000 bed-days Pre-PSH versus 3.7/1000 bed-days Post-PSH (P = .006). There was no difference in RRT activations per 1000 bed-days for medical patients before and after PSH implementation. Pre-PSH was an independent predictor of mortality in the multivariable model (odds ratio = 1.7; P = .010). Conclusion. PSH is associated with decreased RRT activations among surgical inpatients only.


Journal of Anesthesia | 2016

Use of a home positive airway pressure device during intraoperative monitored anesthesia care for outpatient surgery

Lindsay K. Borg; Tessa L. Walters; Lawrence C. Siegel; John Dazols; Edward R. Mariano

Perioperative positive airway pressure (PAP) is recommended by the American Society of Anesthesiologists for patients with obstructive sleep apnea, but a readily available and personalized intraoperative delivery system does not exist. We present the successful use of a patient’s own nasal PAP machine in the operating room during outpatient foot surgery which required addition of a straight adaptor for oxygen delivery and careful positioning of the gas sampling line to permit end-tidal carbox dioxide monitoring. Home PAP machines may provide a potential alternative to more invasive methods of airway management for patients with obstructive sleep apnea under moderate sedation.

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