Publications by authors named "Grant C Lynde"

20 Publications

  • Page 1 of 1

Anatomy of a successful stewardship intervention: Improving perioperative prescribing in penicillin-allergic patients.

Infect Control Hosp Epidemiol 2021 Aug 16:1-7. Epub 2021 Aug 16.

Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia.

Objective: To evaluate whether a series of quality improvement interventions to promote safe perioperative use of cephalosporins in penicillin-allergic patients improved use of first-line antibiotics and decreased costs.

Design: Before-and-after trial following several educational interventions.

Setting: Academic medical center.

Patients: This study included patients undergoing a surgical procedure involving receipt of a perioperative antibiotic other than a penicillin or carbapenem between January 1, 2017, and August 31, 2019. Patients with and without a penicillin allergy label in their electronic medical record were compared with respect to the percentage who received a cephalosporin and average antibiotic cost per patient.

Methods: A multidisciplinary team from infectious diseases, allergy, anesthesiology, surgery, and pharmacy surveyed anesthesiology providers about their use of perioperative cephalosporins in penicillin-allergic patients. Using findings from that survey, the team designed a decision-support algorithm for safe utilization and provided 2 educational forums to introduce this algorithm, emphasizing the safety of cefazolin or cefuroxime in penicillin-allergic patients without history of a severe delayed hypersensitivity reaction.

Results: The percentage of penicillin-allergic patients receiving a perioperative cephalosporin improved from ∼34% to >80% following algorithm implementation and the associated educational interventions. This increase in cephalosporin use was associated with a ∼50% reduction in antibiotic cost per penicillin-allergic patient. No significant adverse reactions were reported.

Conclusions: An educational antibiotic stewardship intervention produced a significant change in clinician behavior. A simple intervention can have a significant impact, although further study is needed regarding whether this response is sustained and whether an educational intervention is similarly effective in other healthcare systems.
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http://dx.doi.org/10.1017/ice.2021.310DOI Listing
August 2021

Approach to Perioperative Anaphylaxis in 2020: Updates in Diagnosis and Management.

Curr Allergy Asthma Rep 2021 01 6;21(1). Epub 2021 Jan 6.

Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA, USA.

Purpose Of Review: The goal of the paper is to review the epidemiology, pathogenesis, diagnosis, and manifestations of perioperative anaphylaxis (POA). We seek to review the most common culprits of POA and different diagnostic modalities for evaluation.

Recent Findings: Specific IgE testing has a limited role in POA evaluation due to lack of widespread availability and low sensitivity. Basophil activation testing is complementary to skin tests and can assist NMBA sensitivity diagnosis in complex cases. In the past years, there has been an exponential increase in suspected teicoplanin allergic reactions in the European Union. Chlorhexidine is also being increasingly implicated as a culprit in POA. Multiple classes of perioperative medications cause POA. Diagnostic modalities available include skin testing with nonirritating concentrations, basophil activation tests, specific IgE, and drug provocation testing. An accurate record and critical analysis of perioperative events is more important than isolated test results. Future studies evaluating the pathophysiology of these reactions and other therapeutic strategies, such as targeting the MRGPRX2 receptor, are needed.
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http://dx.doi.org/10.1007/s11882-020-00980-yDOI Listing
January 2021

Development of a Novel Preoperative Venous Thromboembolism Risk Assessment Model.

Am Surg 2020 Sep 23;86(9):1098-1105. Epub 2020 Sep 23.

1371 Department of Surgery, Emory University, Atlanta, GA, USA.

Introduction: Standardization of preoperative venous thromboembolism (VTE) risk assessment remains challenging due to variation in risk assessment models (RAMs) and the cumbersome workflow addition that most RAMs represent. We aimed to develop a parsimonious RAM that is automatable and actionable within the preoperative workflow.

Methods: We performed a case-controlled review of all 18 VTE cases reported over a 12-month period and 171 matched controls included in an institutional National Surgical Quality Improvement Project (NSQIP) data set. We examined the predictive value of the Caprini, Padua, and NSQIP RAMs. We identified the 5 most impactful risk factors in VTE development by contribution to the known RAMs. We compared the predictive ability of cancer, age, body mass index, black race, and American Society of Anesthesiologists Physical Status (ASA-PS) score, to the Caprini, Padua, and NSQIP RAMs for VTE outcomes. Finally, we evaluated concordance between each of the models.

Results: The Caprini Score was found to be 88.9% sensitive and 32.7% specific using a threshold of 5. The Padua score was found to be 61.1% sensitive and 47.4% specific using a threshold of 4. The novel 5-factor RAM was found to be 94.4% sensitive and 38.0% specific using a threshold of 4. The Caprini and Padua models were discordant in 26% of patients.

Discussion: Cumbersome manual data entry contributes to the ongoing challenge of standardized VTE risk assessment and prophylaxis. Universally documented information and patient demographics can be utilized to create clinical decision support tools that can improve the efficiency of perioperative workflow and improve the quality of care.
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http://dx.doi.org/10.1177/0003134820943556DOI Listing
September 2020

Management of Coronavirus Disease 2019 Intubation Teams.

A A Pract 2020 Jun;14(8):e01263

From the Emory University, Atlanta, Georgia.

Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure. We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.
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http://dx.doi.org/10.1213/XAA.0000000000001263DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323820PMC
June 2020

The Human-Machine Interface in Anesthesiology: Corollaries and Lessons Learned From Aviation and Crewed Spaceflight.

Anesth Analg 2020 05;130(5):1255-1260

Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington.

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http://dx.doi.org/10.1213/ANE.0000000000004628DOI Listing
May 2020

A Streamlined Approach to Optimize Perioperative Antibiotic Prophylaxis in the Setting of Penicillin Allergy Labels.

J Allergy Clin Immunol Pract 2020 04 28;8(4):1316-1322. Epub 2019 Dec 28.

Department of Anesthesiology, Emory University School of Medicine, Atlanta, Ga.

Background: Patients with penicillin allergy labels often receive alternative antibiotics for perioperative prophylaxis, as opposed to first-line cephalosporins (cefazolin/cefuroxime). Provider misconceptions about the risk of cross-reactivity likely drive this prescribing behavior, which is problematic because of its association with increased risk of surgical-site infections.

Objective: To develop, implement, and assess the safety of a streamlined approach to perioperative antibiotic selection for surgical patients with a penicillin allergy label, to reduce the use of second-line antibiotics.

Methods: A multidisciplinary task force developed an institutional algorithm for antibiotic selection in penicillin-allergic surgical patients. The percentage of patients receiving a first-line cephalosporin was compared before and after algorithm utilization. The safety of this approach was assessed via chart review of all patients who received epinephrine or diphenhydramine in the operating room, or diphenhydramine within 24 hours postoperatively, assessing for any adverse reactions to cephalosporin administration.

Results: Between September 2016 and May 2019, 9.3% of surgical patients had documented penicillin allergy (n = 2296). At baseline, 22% of these patients received a cephalosporin, with an increase to more than 80% after algorithm implementation (P < .0001). Among 551 patients with penicillin allergy label who received a cephalosporin after algorithm implementation, no immediate allergic reactions requiring epinephrine were identified; 1 patient had a delayed rash that did not require cephalosporin discontinuation. Three patients received diphenhydramine for "itching" without rash in the setting of concomitant narcotic administration.

Conclusions: Using a streamlined algorithm, we were able to significantly reduce the use of second-line antibiotics in penicillin-allergic surgical patients without severe adverse reactions.
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http://dx.doi.org/10.1016/j.jaip.2019.12.016DOI Listing
April 2020

Lack of association between intraoperative handoff of care and postoperative complications: a retrospective observational study.

BMC Anesthesiol 2019 10 15;19(1):182. Epub 2019 Oct 15.

Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA.

Background: The significance of intraoperative anesthesia handoffs on patient outcomes are unclear. One aspect differentiating the disparate results is the treatment of confounding factors, such as patient comorbidities and surgery time of day. We performed this study to quantify the significance of confounding variables on composite adverse events during intraoperative anesthesia handoffs.

Methods: In this retrospective study, we analyzed data from the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP). We examined the effects of intraoperative handoffs between anesthesia personnel. A total of 12,111 cases performed examined at two hospitals operated by a single healthcare system that were that included in the ACS NSQIP database performed. The presence of attending and anesthetist or resident handoffs, patient age, sex, body mass index, American Society of Anesthesiologists Physical Status (ASA-PS) classification, case length, surgical case complexity, and evening/weekend start time were measured.

Results: A total of 2586 of all cases in the NSQIP dataset experienced a handoff during the case. When analyzed as a single variable, attending handoffs were associated with higher rates of adverse outcomes. However, once confounding variables were added into the analysis, attending handoffs and complete care transitions were no longer statistically significant.

Conclusions: Inclusion of significant covariates is essential to fully understanding the impact provider handoffs have on patient outcomes. Case timing and lengthy case duration are more likely to result in both a handoff and an adverse event. The impact of handoffs on patient outcomes seen in the literature are likely due, in part, to how covariates were addressed.
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http://dx.doi.org/10.1186/s12871-019-0858-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794912PMC
October 2019

Chronic Atypical Antipsychotic Use Is Associated With Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit: A Propensity-Matched Retrospective Observational Study.

Anesth Analg 2020 01;130(1):141-150

From the Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.

Background: Atypical antipsychotics are efficacious for chemoprophylaxis against chemotherapy-induced nausea and vomiting, but perioperative investigations have been scant. We sought to examine the association between chronic atypical antipsychotic therapy and the likelihood of postoperative nausea and vomiting.

Methods: In this single-center, propensity-matched, retrospective, observational study, elective noncardiac surgical cases from January 2014 to December 2017 were examined with regard to the primary outcome of rescue antiemetic administration in the postanesthesia care unit as a measure of postoperative nausea and vomiting. Chronic administration of olanzapine, aripiprazole, and risperidone was the exposure of interest. Other independent variables included outpatient antiemetics, modified Apfel score, age, American Society of Anesthesiologists physical status score, case length, and exposures to emetogenic and chemoprophylactic agents. Logistic regression was performed using case-level data. Conditional logistic regression was performed after 1:2 propensity matching, sampling without replacement. Monte Carlo simulation was performed to compute the mean patient-level treatment effect on the treated.

Results: Of 13,660 cases, 154 cases with patients receiving atypical antipsychotics were matched against 308 cases without, representing 115 and 273 unique patients, respectively. In a well-balanced cohort, the mean patient-level odds of being administered rescue antiemetic was lower for patients chronically taking the 3 atypical antipsychotics under consideration as compared to those not on atypical antipsychotics, with an odds ratio of 0.29 (95% CI, 0.11-0.75; P = .015).

Conclusions: Chronic atypical antipsychotic therapy is associated with reduced risk of postanesthesia care unit antiemetic administration. These findings support the need for prospective studies to establish the safety and efficacy of postoperative nausea and vomiting chemoprophylaxis with these agents.
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http://dx.doi.org/10.1213/ANE.0000000000003990DOI Listing
January 2020

Highly visible sepsis publications from 2012 to 2017: Analysis and comparison of altmetrics and bibliometrics.

J Crit Care 2018 12 30;48:357-371. Epub 2018 Sep 30.

Department of Anesthesiology, Emory University, 1750 Gambrell Dr, Atlanta, GA 30322, USA; Department of Anesthesiology, Children's Healthcare of Atlanta, 1405 Clifton Rd, Atlanta, GA 30329, USA. Electronic address:

Purpose: We sought to delineate highly visible publications related to sepsis. Within these subsets, elements of altmetrics performance, including mentions on Twitter, and the correlation between altmetrics and conventional citation counts were ascertained.

Materials And Methods: Three subsets of sepsis publications from 2012 to 2017 were synthesized by the overall Altmetric.com attention score, number of mentions by unique Twitter users, and conventional citation counts. For these subsets, geolocated Twitter activity was plotted on a choropleth, the lag between publication date and altmetrics mentions was characterized, and correlations were examined between altmetrics performance and normalized conventional citation counts.

Results: Of 57,152 PubMed query results, Altmetric.com data was available for 28,344 (49.6%). The top 50 publications by Altmetric.com attention score and Twitter attention represented a mix of original research and other types of work, garnering attention from Twitter users in 143 countries that was highly contemporaneous with publication. Altmetrics performance and conventional citation counts were poorly correlated.

Conclusions: While unreliable to gauge impact or future citation potential, altmetrics may be valuable for parties who wish to detect and drive public awareness of research findings and may enable researchers to dynamically explore the reach of their work in novel dimensions.
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http://dx.doi.org/10.1016/j.jcrc.2018.09.033DOI Listing
December 2018

Determination of ED50 and time to effectiveness for intrathecal hydromorphone in laboring patients using Dixon's up-and-down sequential allocation method.

BMC Anesthesiol 2018 10 5;18(1):140. Epub 2018 Oct 5.

Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.

Background: With the increasing occurrence of drug shortages, understanding the pharmacokinetics of alternative intrathecal opioid administration has gained importance. In particular, additional data are needed to comprehensively evaluate the analgesic properties of intrathecal hydromorphone in the laboring patient. In a phase 2 clinical trial, we set out to determine the median effective dose (ED) and time to effectiveness for this drug in this population.

Methods: Using Dixon's up-and-down sequential allocation method, twenty women presenting for labor analgesia were prospectively enrolled. A combined spinal-epidural technique was used to deliver the determined dose of intrathecal hydromorphone. Visual analog pain scores were obtained assessing peak pain scores during serial uterine contractions. Effective pain relief was defined as achieving a pain score of less than or equal to 3 out of 10. The dose was deemed to be ineffective if the patient failed to achieve this level of relief after 30 min.

Results: The ED of hydromorphone in our population was 10.9 μg (95% confidence interval 5.6-16.2 μg). Amongst patients for whom the dose was effective, the median time to pain relief was 24 min. One patient experienced both nausea and pruritus. No other complications were noted.

Conclusion: Due to the prolonged time to onset, hydromorphone cannot be recommended in favor of substantively better alternatives such as sufentanil and fentanyl.

Trial Registration: Clinicaltrials.gov registration number: NCT01598506.
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http://dx.doi.org/10.1186/s12871-018-0603-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173834PMC
October 2018

Crowdsourcing sugammadex adverse event rates using an in-app survey: feasibility assessment from an observational study.

Ther Adv Drug Saf 2018 Jul 18;9(7):331-342. Epub 2018 Apr 18.

Emory University and Children's Healthcare of Atlanta, 3B South, 1364 Clifton Road NE, Atlanta, GA 30322, USA.

Background: Mobile applications (apps) have become a ubiquitous source of clinical decision support. We sought to ascertain the feasibility of using an app platform to obtain a crowdsourced measure of adverse drug reaction reporting rates associated with sugammadex administration and compare it with traditionally-derived estimates.

Methods: Using the widely-distributed anesthesia calculator app, 'Anesthesiologist', we surveyed anesthesia providers regarding their experience with adverse drug reactions associated with sugammadex administration.

Results: Data were analyzed from 2770 participants in 119 countries responding between March 2016 and May 2017, who were estimated to have administered between 1.6-2.9 million doses (588-1040 administrations per participant). A low and high-end reporting rate of adverse events was estimated based on respondents' reported frequency and duration of sugammadex use. The estimated reporting rate of anaphylaxis due to sugammadex was 0.0055-0.098%, similar in range to previously published estimates.

Conclusions: Use of an in-app survey facilitated a global assessment of anesthesia providers and could have useful applications in monitoring adverse events and estimating their rates. Further work is needed to validate this approach for other medications and clinical domains.
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http://dx.doi.org/10.1177/2042098618769565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048631PMC
July 2018

Etomidate Is a First-Line Induction Agent in Critically Ill Patients.

Crit Care Med 2018 09;46(9):1492-1494

Both authors: Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.

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http://dx.doi.org/10.1097/CCM.0000000000003290DOI Listing
September 2018

Anesthesia Care Handovers and Risk of Adverse Outcomes.

JAMA 2018 06;319(21):2235

Department of Anesthesiology, Emory University, Atlanta, Georgia.

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http://dx.doi.org/10.1001/jama.2018.4430DOI Listing
June 2018

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes.

Korean J Anesthesiol 2018 Oct 30;71(5):374-385. Epub 2018 May 30.

Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.

Background: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU).

Methods: This retrospective observational study included patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one-group before-and-after design, we compared the categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity-matched set of patients receiving neostigmine or sugammadex.

Results: In total, 7,217 surgical cases met the inclusion criteria: 3,798 before and 3,419 after sugammadex introduction. The incidence of PACU MV was 2.3% before and 1.8% after (P = 0.118) sugammadex introduction. PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (P = 0.005). Ventilation because of other causes was unchanged. PACU LOS and emergence time were unchanged in the propensity-matched set of 1,444 patients.

Conclusions: rNMB was an important contributor to PACU MV utilization and its incidence significantly decreased after sugammadex introduction. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.
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http://dx.doi.org/10.4097/kja.d.18.00063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193591PMC
October 2018

Variable effectiveness of stepwise implementation of nudge-type interventions to improve provider compliance with intraoperative low tidal volume ventilation.

BMJ Qual Saf 2018 12 18;27(12):1008-1018. Epub 2018 May 18.

Department of Anesthesiology, Emory University, Atlanta, Georgia, USA.

Background: Identifying mechanisms to improve provider compliance with quality metrics is a common goal across medical disciplines. Nudge interventions are minimally invasive strategies that can influence behavioural changes and are increasingly used within healthcare settings. We hypothesised that nudge interventions may improve provider compliance with lung-protective ventilation (LPV) strategies during general anaesthesia.

Methods: We developed an audit and feedback dashboard that included information on both provider-level and department-level compliance with LPV strategies in two academic hospitals, two non-academic hospitals and two academic surgery centres affiliated with a single healthcare system. Dashboards were emailed to providers four times over the course of the 9-month study. Additionally, the default setting on anaesthesia machines for tidal volume was decreased from 700 mL to 400 mL. Data on surgical cases performed between 1 September 2016 and 31 May 2017 were examined for compliance with LPV. The impact of the interventions was assessed via pairwise logistic regression analysis corrected for multiple comparisons.

Results: A total of 14 793 anaesthesia records were analysed. Absolute compliance rates increased from 59.3% to 87.8%preintervention to postintervention. Introduction of attending physician dashboards resulted in a 41% increase in the odds of compliance (OR 1.41, 95% CI 1.17 to 1.69, p=0.002). Subsequently, the addition of advanced practice provider and resident dashboards lead to an additional 93% increase in the odds of compliance (OR 1.93, 95% CI 1.52 to 2.46, p<0.001). Lastly, modifying ventilator defaults led to a 376% increase in the odds of compliance (OR 3.76, 95% CI 3.1 to 4.57, p<0.001).

Conclusion: Audit and feedback tools in conjunction with default changes improve provider compliance.
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http://dx.doi.org/10.1136/bmjqs-2017-007684DOI Listing
December 2018

Evidence for increased use of the Society of Pediatric Anesthesia Critical Events Checklist in resource-limited environments: A retrospective observational study of app data.

Paediatr Anaesth 2018 02 28;28(2):167-173. Epub 2017 Dec 28.

Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.

Background: Electronic decision support tools in anesthesiology practice have great value, including the potential for mobile applications to simplify delivery of best-practice guidelines.

Aims: We sought to combine demographics with usage information to elucidate important patterns in the rate of use of the Society of Pediatric Anesthesia Critical Events Checklist, as measured by in-app accesses of the checklist via the freely available anesthesia calculator app anesthesiologist.

Methods: We performed a retrospective analytic observational case-control study using analytics and survey data collected from the app. Users of the app were classified on the basis of whether or not they had accessed the checklist. This classification was used to perform logistic regression against a number of independent variables, including frequency of app use, country income level, professional role, rating of app importance, length of time in practice, group size, practice model, community served, and primary practice environment.

Results: Individual app users practicing in low- and middle-income countries have a significantly higher rate of Society for Pediatric Anesthesia Critical Events Checklist utilization as compared with high-income countries. Rural practitioners had higher utilization of the checklist. Practice size did not affect the utilization of the checklist. The checklist was used for both provider learning and for just-in-time patient care.

Conclusion: mHealth apps are invaluable resource in everyday clinical practice. Mobile app analytics and in-app survey data reveal variable penetration and applicability of such technology worldwide. mHealth apps may be particularly impactful in limited-resource areas, such as lower-income environments and rural communities.
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http://dx.doi.org/10.1111/pan.13305DOI Listing
February 2018

Opportunities and Limitations in Mobile Technology.

Anesth Analg 2017 10;125(4):1416

Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia,

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http://dx.doi.org/10.1213/ANE.0000000000002337DOI Listing
October 2017

Working toward quality in obstetric anesthesia: a business approach.

Authors:
Grant C Lynde

Curr Opin Anaesthesiol 2017 Jun;30(3):280-286

Department of Anesthesiology, Emory University, Atlanta, Georgia, USA.

Purpose Of Review: Physicians are increasingly required to demonstrate that they provide quality care. How does one define quality? A significant body of literature in industries outside of health care provides guidance on how to define appropriate metrics, create teams to troubleshoot problem areas, and sustain those improvements.

Recent Findings: The modern quality movement in the United States began in response to revolutionary gains in both quality and productivity in Japanese manufacturing in the 1980's. Applying these lessons to the healthcare setting has been slow. Hospitals are only now introducing tools such as failure mode and effect analysis, Lean and Six Sigma into their quality divisions and are seeing significant cost reductions and outcomes improvements.

Summary: The review will discuss the process for creating an effective quality program for an obstetric anesthesia division. Sustainable improvements in delivered care need to be based on an evaluation of service line needs, defining appropriate metrics, understanding current process flows, changing and measuring those processes, and developing mechanisms to ensure the new processes are maintained.
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http://dx.doi.org/10.1097/ACO.0000000000000451DOI Listing
June 2017

Update in the Management of Patients with Preeclampsia.

Anesthesiol Clin 2017 Mar 12;35(1):95-106. Epub 2016 Dec 12.

Department of Anesthesiology, Emory University, 1354 Clifton Road Northeast, Atlanta, GA 30322, USA. Electronic address:

Hypertensive disorders of pregnancy complicate approximately 10% of all deliveries in the United States and are a leading cause of maternal and fetal morbidity and mortality. Preeclampsia is defined as hypertension in association with proteinuria, thrombocytopenia, impaired liver function, renal insufficiency, pulmonary edema, or new-onset cerebral or visual disturbances. The greatest risk factor for the development of preeclampsia is a history of preeclampsia. There currently is no effective means for the prevention of preeclampsia. Approximately 39% of patients diagnosed with preeclampsia have hypertension and approximately 20% have proteinuria 3 months postpartum. Preeclampsia increases the risk of patients developing hypertension later in life.
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http://dx.doi.org/10.1016/j.anclin.2016.09.009DOI Listing
March 2017

A survey of anesthesiologist and anesthetist attitudes toward single-use vials in an academic medical center.

J Clin Anesth 2014 Mar 21;26(2):125-30. Epub 2014 Feb 21.

Department of Anesthesiology, Emory University, 49 Jesse Hill Jr. Drive, N.E., Atlanta, GA 30303, USA. Electronic address:

Study Objective: To evaluate whether proper implementation of safety measures was uniform at 5 hospitals, and to elucidate motivating factors that lead to nonadherence.

Design: Electronic anonymous survey instrument.

Setting: Academic medical center.

Measurements: Of the 319 surveys sent to anesthesia providers across 5 hospitals, 89 responses were obtained. Questions addressed compliance with Centers of Disease Control (CDC) safety standards and the rationale for anesthesia providers' decisions to comply or not comply with these standards.

Main Results: 59.6% of respondents reported that they had reused vials between cases, while 40.4% had never done so. Of the 89 respondents, 63 (44%) felt that cost was the primary factor that prevented them from using entirely new medications on each case. Thirty-two (23%) reported convenience/efficiency as the reason; 11 (8%) responded that time prevented them from using entirely new medications on each case; 14 (10%) reported that the environment was a driving factor; and 3 individuals (2%) responded apathy. Eighteen (13%) responded "other" and, when asked to amplify a response, most of these individuals reported that they do use entirely new medications on each case.

Conclusions: Safe anesthetic practices were not uniform among respondents, and one of the main reasons given for noncompliance with safe standards was cost.
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http://dx.doi.org/10.1016/j.jclinane.2013.08.007DOI Listing
March 2014
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