National Multi-Institutional Validation of a Surgical Transfusion Risk Prediction Model

Preparation for transfusion is important, but excessive preparation is common, costly, and contributes to blood waste. This tool helps doctors identify patients at risk for transfusion so they can get the care they need. We evaluated the tool's performance at 414 NSQIP-contributing hospitals, and found that it showed promising generalizability and could potentially be used across a diverse range of hospitals to assist with perioperative planning.

Anesthesia Clinical Workload Estimated From Electronic Health Record Documentation vs Billed Relative Value Units

We compared EHR-based workload with reimbursement in anesthesiology and found that payments for anesthesia services are likely poorly calibrated with clinical workload, largely by not recognizing the physical and cognitive effort of caring for the sickest patients. This likely penalizes academic and safety net hospitals the most. Our method for measuring clinical workload from EHR audit log data could be used to measure the time and intensity of clinical work more objectively to better inform healthcare policy.

Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. In this paper, we describe the design and implementation of a streamlined reliable process for perioperative blood ordering and delivery to reduce red cell waste.

Personalized Surgical Transfusion Risk Prediction Using Machine Learning to Guide Preoperative Type and Screen Orders

20 million patients have surgery in the US every year, and ~ 1 million of those patients require life-saving blood transfusion. Presurgical preparation for transfusion is important to allow for safe and timely transfusion during surgery, but excessive preparation is unfortunately common, costly, and contributes to blood waste. In this paper, we develop a personalized surgical transfusion risk prediction model using a database of 3 million surgical patients, and show that using such a model to guide presurgical type and screen orders can potentially improve patient safety while reducing the number of unnecessary orders. Reproducible code is provided to make predictions for new patients.

Effect of clinician attention switching on workload and wrong-patient errors

Clinical work environments are filled with competing demands for clinicians' attention, resulting in attention switching between different tasks up to 150 times an hour. The consequences of such fragmented work are not well-understood, partially because measuring attention switching has traditionally been laborious observational work. We developed a novel scalable method of measuring clinician attention switching using passively collected EHR audit log data. As a case study, we applied this method to critical care clinicians. We found that ICU work was highly fragmented, and increased attention switching was associated with decreased clinician efficiency and increased errors.

Tracheobronchial Trauma from Double Lumen Tube Placement in Patients Undergoing Lung Transplantation

Double lumen tube (DLT) sizes can vary considerably between manufacturers. This can lead to inadvertent oversizing of DLTs, especially if using conventional height/gender based sizing, which can potentially contribute to tracheal injury. We advocate for CT based sizing of DLTs, especially in high risk patients, and for thermal softening of DLTs as routine practice to help prevent tracheobronchial injury.

Sinus of Valsalva Aneurysms - A Review with Perioperative Considerations

The sinuses of Valsalva are outpouchings in the aortic root just distal to the aortic valve that serve several physiologic functions. Aneurysm of this segment of the aorta is quite rare and infrequently encountered in clinical practice. Due to the …