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Robin Cox University of Calgary Primary Author / Presenting Author

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Robin Cox University of Calgary Primary Author / Presenting Author Can J Anesth/J Can Anesth (2015) 62:S1–S336 DOI 10.1007/s12630-015-0471-3 75867 - PRACTICE IMPROVEMENT BY TRACKING PEDIATRIC TONSILLECTOMY OUTCOMES Author(s) Robin Cox University of Calgary Primary Author / Presenting Author Co-Authors(s) Jon McMann - University of Calgary Michael Letal - University of Calgary Diane Duncan - University of Calgary Adam Spencer - University of Alberta Lara Cooke - University of Calgary Introduction: One method of improving anesthesia practice may be to provide outcome data to individual anesthesiologists and groups of anesthesiologists, causing them to reflect on their own practices, as well as systemic factors in the perioperative environment. We undertook to evaluate a group of pediatric patients undergoing tonsillectomy and perform a detailed analysis of their perioperative experience and outcomes with the purpose of providing feedback to anesthesiologists on their own practice and those of their peers. The expectation was that this would provide a stimulus for personal educational objectives, and changes in practice to improve perioperative and postoperative outcomes for children. Methods: Local research ethics committee approval was obtained for the study. Over a six month period, willing parents or guardians of all children undergoing tonsillectomy at a free-standing children's hospital provided written informed consent to participate. Data collected included demographics, anesthetic techniques, in-hospital outcomes as well as outcomes for the first day postoperatively. The practice of all 19 consenting anesthesiologists in the group was included. Parents/guardians received a structured telephone questionnaire on the first postoperative day, which included quantitative and qualitative data. Confidential individual patient outcomes, as well as aggregate group data, were provided to anesthesiologists, both in written format and at a facilitated group discussion session. Results: 89% (263/296) of eligible families consented to participate in the study. 243 families completed the study. 78% of parents were very satisfied and 2% were quite dissatisfied with the care they received. Individual anesthesiologists were able to reflect on their own practice, considering items such as premedication, parental presence at induction, the use of cuffed tubes, analgesic and antiemetic regimes, and fluid management. Individual comments from families were made available to the anesthesiologist who provided care to their child. Specific findings of note were a postoperative vomiting rate of 22% over 24 hours, and a mean "worst" pain score of 6.9/10, which was felt to be unacceptably high. Cuffed tubes were used in 61% of cases, parental presence in 44%, and deep extubation in 76%. Discussion: Anesthesiologists found the ability to reflect on the outcome data of their © Canadian Anesthesiologists’ Society 2015 1 3 S2 Abstracts own patients, as well as their peers to be a powerful way to stimuate practice improvement. Individual comments from families were also valued highly by participating anesthesiologists. If such models of providing outcome data to anesthesiologists were more widely made part of everyday practice, this might well lead to an improvement in patient and family satisfaction. As an example, the unacceptably high pain scores encountered in the first 24 hours will need new strategies to manage. It is hoped that tracking of perioperative outcome data will become the standard for all children in the institution. 1 3 Abstracts S3 &526629(55$1'20,=(''28%/(%/,1'678'< $XWKRU V 0DKPRXG0RXVWDID 0F*LOOXQLYHUVLW\ 3UHVHQWLQJ$XWKRU )UDQFHVFR&DUOL 0FJLOO8QLYHUVLW\ 3ULPDU\$XWKRU &R$XWKRUV V 3HU0+HOOVWURP8SSVDOD8QLYHUVLW\ /LDQH)HOGPDQ0FJLOO8QLYHUVLW\ -XDQ0DWDPFJLOO 'HERUD/LRWWDPFJLOO ,QWURGXFWLRQ3UHRSHUDWLYHRUDOFDUERK\GUDWHULFKGULQN FDUERK\GUDWH FRQWDLQLQJPDOWRGH[WULQVKDVEHHQVKRZQWRUHGXFHSRVWRSHUDWLYHLQVXOLQUHVLVWDQFH ZLWKRXWGHOD\LQJWKHJDVWULFHPSW\LQJ7KHSUHVHQWVWXG\ZDVGHVLJQHGWRPHDVXUH JDVWULFHPSW\LQJIROORZLQJLQJHVWLRQRIDFRPPHUFLDOO\DYDLODEOHRUDQJHFOHDUGULQNZLWK RUZLWKRXWZKH\SURWHLQ 0HWKRGV7KHVWXG\ZDVDSSURYHGE\WKH(WKLFVERDUGDQGIROORZHGDUDQGRPL]HG GRXEOHEOLQGHGFURVVRYHUGHVLJQ7ZHOYH PHDQDJH RWKHUZLVHKHDOWK\VXEMHFWV ZHUHHQUROOHGLQWKHVWXG\(DFKVXEMHFWXQGHUZHQWWZRPLQWHVWLQJVHVVLRQVZKHUH EORRGVDPSOHVZHUHWDNHQHYHU\PLQIRUWKHHDVXUHPHQWRIDFHWDPLQRSKHQ RQHIROORZLQJLQJHVWLRQRIRUDQJHGULQN POFDUERK\GUDWH DQGWKHRWKHU RUDQJHZLWKJRIZKH\SURWHLQ7KHWZRGULQNVZHUHLQJHVWHGRYHUWKHSHULRGRI PLQWRJHWKHUZLWKDFHWDPLQRSKHQJIRUWKHGHWHUPLQDWLRQRIJDVWULFHPSW\LQJE\ DQDO\VLVRISODVPDFRQFHQWUDWLRQV 5HVXOWV$EVRUSWLRQRIDFHWDPLQRSKHQZDVUHGXFHGZLWKZKH\LQDQGLQFUHDVHGLQ RXWVXEMHFWV,QWRWDODEVRUSWLRQZDVQXPHULFDOO\UHGXFHGZLWK$8& XPRO/ PLQIROORZLQJRUDQJHGULQNDQGXPRO/ PLQIROORZLQJRUDQJH GULQNZLWKZKH\SURWHLQ 7KHJDVWULFHPSW\LQJUDWHWHQGHGDOVRWREHVORZHUZLWK RUDQJHDQGZKH\ 7PLQ FRPSDUHGZLWKRUDQJHDORQHRQO\ 7 PLQ 16 $WPLQWKHUHWHQWLRQZDVZLWKRUDQJHGULQNRQO\DQG ZLWKRUDQJHZKH\ 16 'LVFXVVLRQ1RGHOD\HGJDVWULFHPSW\LQJZDVVHHQZLWKHLWKHUGULQNVVXJJHVWLQJWKDW DFRPPHUFLDOO\DYDLODEOHRUDQJHGULQNZLWKRUZLWKRXWZKH\SURWHLQPD\EHVDIHO\ DGPLQLVWHUHGPLQEHIRUHLQGXFWLRQRIDQHVWKHVLD 5HIHUHQFHV 6FDQG-*DVWURHQWHURO± 1 3 S4 Abstracts 'LJHVWLYH'LVHDVHVDQG6FLHQFHV9RO1R 2FWREHU SS± 1 3 Abstracts S5 76409 - KNOWLEDGE RETENTION BY ANESTHESIA RESIDENTS AFTER FOCUS TTE TRAINING Author(s) Rob Tanzola Kingston General Hospital, Queen's University Primary Author / Presenting Author Co-Authors(s) Tarit Saha - Kingston General Hospital, Queen's University Devin Sydor - Kingston General Hospital, Queen's University Dale Engen - Kingston General Hospital, Queen's University Rene Allard - Kingston General Hospital, Queen's University Introduction: Focused transthoracic echocardiography (TTE) is a valuable diagnostic tool for anesthesiologists treating patients with hemodynamic instability. Previous studies have demonstrated that training residents to perform and interpret TTE is both feasible and effective (1,2). We recently introduced a 4 week focused TTE rotation in our anesthesiology residency training program, after which our residents are able to integrate this modality into their clinical practice. However, the ability to retain information and the degree of knowledge retention after their rotation has not been assessed. This is important, because while many educational interventions have shown immediate gains in knowledge or skills, these gains are often subject to subsequent decay over a period of non-use (3). Therefore, this study’s aim was to assess knowledge retention at 6 months following the TTE rotation, and to assess any modifying any factors. Methods: Approval was obtained from the local Research Ethics Board. Residents in their postgraduate years 3-5 who had successfully passed the TTE rotation were recruited to fill out a brief questionnaire and complete a written multiple-choice exam 6 months after the end of the rotation (EOR). Residents were asked about their current self-rated knowledge and comfort level, the number of times that they used TTE since the rotation, and barriers to the use in practice. The written exam assessed ultrasound fundamentals, anatomy and imaging windows, as well as interpretation of static images and video clips of both normal and abnormal findings. Results were compared to their EOR exam results. Results: To date, 8 residents have completed both their rotation and 6-month follow-up assessments. The average EOR exam score was 43.8 (87.6%) versus the 6-month score of 43.7 (87.4%) (P=0.9). The EOR self-rated knowledge was 7.9 out of 10, compared to a 6-month self-rated knowledge score of 6.0 out of 10. At the EOR, all resident felt comfortable using TTE in their clinical practice. At 6 months 7 out of 8 residents still felt comfortable. At 6 months, all the residents had used TTE after their rotation in their practice, with an average frequency of 3.7 times. The most cited reason that residents did not use TTE more frequently was that there was no perceived clinical need. Discussion: One goal of medical education is to promote long-term knowledge and skill 1 3 S6 Abstracts retention. Residents in this study were able to maintain their exam scores 6 months after the completion of a TTE rotation. Whereas infrequently used knowledge generally decays over time, this was not the finding in this study. This may be due to the fact that all resident have incorporated focused TTE in the clinical setting since their rotation. Dispersed learning and reinforcement in this manner has been shown to improve long- term knowledge retention (5). Another explanation may be the robustness of the initial training that included a dedicated 4 weeks of study and practice to learn the required knowledge and skills. Over-learning in the initial phases of knowledge acquisition has been associated with strong long-term memory (6). Further study is required to determine if long-term retention is in fact related to clinical proficiency with focused TTE. References: 1. Can J Anesth 2013, 60: 32-37 2. Intensive Care Med 2007, 33: 1795-1799 3. Resuscitation 2006, 68: 101-108 4. Human performance 1998, 11: 57-101 5. Medical Teacher 2010, 32: 250-255 6. Adv Health Sci Educ 2010, 15: 109-128 1 3 Abstracts S7 76474 - DO CHECKLISTS IMPROVE INTERPROFESSIONAL TEAM PERFORMANCE? Author(s) Pamela Morgan Women's College Hospital, University of Toronto Primary Author / Presenting Author Co-Authors(s) Ryan Brydges - The Wilson Centre Jordan Tarshis - Sunnybrook Health Sciences Centre Tobias Everett - Hospital for Sick Children Deborah Tregunno - Queens University Heather Carnahan - Memorial
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