Tag: physician anaesthesiologists

Categories : GastrointestinalTags : Leave a comment

Propofol and Physician Anaesthesiologists Speed Up Endoscopy

On By ModernMedia
Photo by Anna Shvets on Pexels

Using a physician anaesthesiologist-led model administering fast-acting propofol increases patient access to care, compared to previous models which used nurse-administered sedation for gastrointestinal (GI) endoscopy procedures, according to work done by the University of Colorado Hospital.

“The Anaesthesia Care Team model allows us to optimise patient flow and utilise faster-acting medications, resulting in shorter total case lengths and reduced post-anaesthesia care unit (PACU) length of stay for upper and lower GI endoscopic procedures, compared to a model where nurses provided sedation,” said Dr Adeel A. Faruki, senior author of the study. “This allows for scheduling more patients in fewer rooms in the GI suite per day and increases patient access to care.”

Most anaesthesia care in the US is delivered either by a physician anaesthesiologist or a non-physician anaesthesia practitioner supervised by a physician anaesthesiologist within the Anaesthesia Care Team model. This model and physician-led anaesthesia care is seen as the gold standard for ensuring patient safety and the best outcomes.

The University of Colorado Hospital previously used a model where GI procedural nurses provided sedation under supervision from gastroenterologists for cases that did not require general anesthesia (called the GI luminal unit). The hospital transitioned to the Anaesthesia Care Team model for all GI cases July 1, 2021.

In the study, researchers compared GI cases performed under the previous nurse-provided sedation model to those performed under the Anaesthesia Care Team model. They found it took less time to start the procedure (sedation start to scope-in time) when deep sedation with propofol (MAC) was provided by the Anaesthesia Care Team than when nurses administered sedation with fentanyl, midazolam and diphenhydramine. That change, along with a redesigned patient flow, provided the opportunity to increase daily GI procedural volume by 25%, while using the same number of procedural suites, Dr Faruki said.

Propofol is a fast-acting and effective medication with a higher-risk-profile, which physician anesthesiologists have the skills and training to deliver and monitor. “Propofol can result in very deep levels of sedation in a short period of time and, therefore, at most institutions, is restricted for use by anesthesia providers,” said Andrew Mariotti, lead author of the study and M.D. candidate at the University of Colorado. “Unlike GI procedural nurses, the Anesthesia Care Team has the training and expertise to perform advanced airway and cardiovascular interventions if an emergency arises.”

The researchers analysed the sedation-to-scope-in time of 5640 endoscopy patients, comparing 4,606 who received nurse-administered sedation for GI procedures, to 1034 who had MAC. The time was reduced by 2 to 2-1/2 minutes per case with MAC. Extrapolating to the typical cases performed at their hospital over a year (more than 2600 cases), the authors said the time savings equates to more than 5300 minutes, or 90 hours.

Sincerecovery also is faster with propofol, there were time savings in the PACU of 7 minutes for upper GI endoscopies and 2 minutes in lower-GI cases. The researchers also found patients reported being less groggy.

GI endoscopies account for about two-thirds of all endoscopies in the US. The time savings for Anesthesia Care Team-administered MAC sedation likely would apply to non-GI procedures as well, the authors noted.

This research is presented at the American Society of Anesthesiologists’ ADVANCE 2022, the Anesthesiology Business Event.

Source: EurekAlert!

Categories : HospitalsTags : Leave a comment

Physician Anaesthesiologist-led Teams Reduce Cardiac Arrests and Deaths

On By ModernMedia
Source: Vidal Balielo Jr on Pexels

Rapid response teams led by physician anaesthesiologists resulted in a significant decrease in cardiac arrest and death, after a transition from nurse-only rapid response teams, according to a study presented at the ANESTHESIOLOGY® 2021 annual meeting.

“As anaesthesiologists, we care for the entire spectrum of a patient’s life from in utero to end of life,” said lead author Faith Factora, MD, medical director, Surgical Intensive Care Unit, Cleveland Clinic. “Our training gives us experience performing practical skills like resuscitation and CPR, in addition to more subtle skills like implementing quality improvement projects and developing safety processes for patient care. Our specialty affects entire patient populations of hospital care and this study represents an example of the care we provide across the spectrum of our patients’ lives and our health care institutions.”

Analysing 458 233 patient hospitalisations, the study found 103 103 patients who were cared for by the original nurse-led rapid response team and 355 130 patients were cared for by the physician anaesthesiologist-led rapid response team. Patients of the physician-led team had a 50% less chance of experiencing cardiac arrest and a 27% less chance of death, compared to the original nurse-led rapid response team.

Rapid response teams address early clinical deterioration, initiating critical care interventions before an emergency or intubation occurs outside of the intensive care unit. By implementing a hospital-wide system led by anaesthesiologists, using principles of monitoring and patient safety that guide the specialty, the physician-led team showed a decrease in cardiac arrests and deaths. The system included early warning systems, including regular monitoring of patients’ conditions and vital sign checks on a regular basis that triggered alerts if critical criteria were met. Examples of conditions that triggered alerts were low blood pressure or high heart rates.

Physician anaesthesiologists are champions of patient safety, uniquely educated and trained for critical moments in health care, with an ability to navigate life-and-death moments in patient care unmatched by other professions. Their education and training is extensive, with up to 14 years of education, including medical school, and 12 000 to 16 000 hours of clinical training.

Source: American Society of Anesthesiologists