Intraoperative patient information handover between anesthesia providers

Currently,no reported studies have evaluated intraoperative handover among anesthesia providers.Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and,in many instances,significant intraoperative events are disregarded.An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide（120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs） and a smaller survey selection of CRNAs（10 institutions about 300 CRNAs in the metropolitan area of Detroit,MI,USA） to collect information on handover practices.The response rate to this survey（n=216） was comprised of approximately 5%（n = 71） of the resident population in US anesthesia programs,5%（n=87） of MDAs,and 20%（n=58） of the CRNAs.Out of all respondents（n=212）,49.1%had no hand-over protocol at their institution and 88%of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In addiiton,84.8%of all responders reported situations where there was insufficient information received during a patient handover.Only 7%of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs.In contrast,60%reported rarely having complications,31%reported sometimes having complications,and 3%reported frequent complications.In conclusion,handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

Utilization and quality assessment of digestive endoscopy in China:results from 5-year consecutive nationwide surveys

Background:Worldwide,the volume and availability of digestive endoscopy have undergone dramatic development in recent years,with increasing attention on quality assurance.We investigated the utilization and quality of digestive endoscopy in China from 2015 to 2019 and developed a quantitative quality evaluation tool for medical institutions.Methods:We invited all tertiary/secondary hospitals in Chinese mainland to participate in the survey annually.The questionnaires included the personnel,annual volume,and quality indicators of endoscopy.An endoscopy quality index(EQI)was developed based on recorded quality indicators using principal component analysis to determine the relative weight.Results:From 2015 to 2019,806,1412,2644,2468,and 2541 hospitals were respectively enrolled in this study.The average annual volume of endoscopy increased from 12,445 to 16,206(1.30-fold)and from 2938 to 4255(1.45-fold)in tertiary and secondary hospitals,respectively.The most obvious growth was observed in diagnostic colonoscopy(1.44-fold for all hospitals after standardization).The proportion of early cancer among all esophageal and gastric cancers during diagnostic esophagogastroduodenoscopy increased from 12.3%(55,210/448,861)to 17.7%(85,429/482,647)and from 11.4%(69,411/608,866)to 16.9%(107,192/634,235),respectively.The adenoma detection rate of diagnostic colonoscopy increased from 14.9%(2,118,123/14,215,592)to 19.3%(3,943,203/20,431,104).The EQI model included 12 quality indicators,incorporating 64.9%(7.792/12)of the total variance into one comprehensive index.According to the EQI measurements,the quality of endoscopy was higher in tertiary hospitals and hospitals in developed areas with higher volume or more endoscopists than that in other hospitals.Conclusions:Digestive endoscopy in China has developed considerably in recent years in terms of both volume and quality.The EQI is a promising tool to quantify the quality of endoscopy at different hospitals.

Patient Feedback for Acupuncture Practice Improvement:A Survey from Mayo Clinic

Objective： To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. Methods： Patients who were referred for an acupuncture consult to the Center for Integrative Medicine at Mayo Clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. Results： In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider（76 cases, 74%） and appointment length（74 cases, 68%） were ＂just right＂. Seventy cases（70%） of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients（62%） were willing to pay for additional costs not covered by insurance. Conclusions： We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.