Seshadri C Mudumbai1, Tessa L Walters1, Steven K Howard1, T Edward Kim1, Gregory Milo Lochbaum1, Stavros G Memtsoudis2, Zeev N Kain3, Alex Kou1, Robert King4, Edward R Mariano5. 1. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. 2. Departments of Anesthesiology and Public Health, Weill Cornell Medical College, New York, NY, USA. 3. Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, CA, USA. 4. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA. 5. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: emariano@stanford.edu.
Abstract
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
Authors: Brian K Tse; Tessa L Walters; Steven K Howard; T Edward Kim; Stavros G Memtsoudis; Eric C Sun; Alex Kou; Lorrie Graham; Robert King; Edward R Mariano Journal: J Anesth Date: 2017-05-05 Impact factor: 2.078
Authors: Brandon Kandarian; Pier F Indelli; Sanjay Sinha; Oluwatobi O Hunter; Rachel R Wang; T Edward Kim; Alex Kou; Edward R Mariano Journal: Korean J Anesthesiol Date: 2019-02-19
Authors: Mallika Tamboli; Jody C Leng; Oluwatobi O Hunter; Alex Kou; Seshadri C Mudumbai; Stavros G Memtsoudis; Tessa L Walters; Gregory Milo Lochbaum; Edward R Mariano Journal: Korean J Anesthesiol Date: 2019-12-23