Anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) are important contributors to success in the operating room (OR). However, novel changes in healthcare delivery in the United States are modifying the ways in which anesthesia professionals contribute to the operating room team. As a result of an increased emphasis on surgical outcomes, medical management experts recommend several team training intervention programs to increase efficiency and quality of care in the O.R. Across the literature, team training interventions in the OR are implemented via impactful changes in the practices of information technology systems and non-technical skills acquisition. The following article will describe recent developments in these arenas, while suggesting the path forward in reference to the role of anesthesia professionals.
Anesthesia Information Management Systems (AIMS) are a specialized form of technology that allow anesthesiologists and CRNAs to track, monitor, and gauge the administration of and effect from anesthesia throughout the perioperative cycle. The most typical form of AIMS is a software or hardware addition to the normal electronic medical records (EMR) system. AIMS can integrate information from multiple streams, led by the anesthesiologist, at multiple time points throughout the operative journey. Moreover, during surgery, most sophisticated AIMS can adapt to real-time changes in order to allow the anesthesiologist and surgeon to focus less on vital signs and more on the patient, allowing for greater capacity for decision-making. AIMS also formulate intensely accurate records of administered medications throughout the surgery, which is useful for post-operative billing, inventory, and reimbursement processes. In this way, AIMS increases the availability of historical records for surgeries, both fulfilling insurance reimbursement requirements and post-operative recovery. Changes with AIMS have sought to integrate the technologies as a team training intervention. A recently published study examined the impact of linking AIMS with the operating room data management system. The authors found that when access to AIMS data was increased, non-anesthesia medical professionals in the OR also increased the utilization and accuracy of the anesthesia data. In addition, the intersection of AIMS and operating room data management systems allow practitioners to refer back to focused data, aiding in the realms of retrospective and clinical research.
Team training interventions can also take the form of non-technical skills acquisition. In 2017, the Journal of Patient Safety published a paper which explored the effects of a brief team training intervention on the care teams’ observed NOTSS score, or nontechnical skills in surgery score. The researchers sought to find a potential solution to address the statistic that nearly 60% of adverse events that occur during surgery are the result of less than optimal teamwork and communication. So, the researchers devised an intervention. The study was designed as a pre-test, post-test interrupted time series design that had repeated measures analysis to evaluate presence and strength of longitudinal changes in surgical team members’ NOTSS score. The intervention was executed in a large tertiary hospital with over twenty operating rooms to attain a strong statistical power. The team training program involved a narrative training DVD with live follow-up. In the end, the researchers found a strong post-test rise in NOTSS score among intervention recipients, increasing confidence in the team training intervention program. Future studies will validate the use of this specific form of team training, while recognizing the context for different anesthesia and surgical professionals.
Anesthesiologists and CRNAs have a vital role to play in the evolution of surgical teams in the OR. As cornerstones of the surgical experience, anesthesia practitioners are valuable candidates for leadership in terms of patient advocacy alongside intra-practitioner communication and unity. As research into optimal ways to improve operational excellence in the OR continues, anesthesia management companies, anesthesiologists, and CRNAs can emerge as leaders in the journey for excellence and accurate patient care.