On March 3, 2023, several clinicians and staff members from the Department of Anesthesiology presented at the 13th Annual Patient Safety & Quality Symposium. This year’s program, “Tapping the power of collaboration by embracing shared goals,” focused on how teams can strengthen collaboration to meet the goals of an organization for optimal patient care. The symposium was presented by Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis Children’s Hospital, BJC HealthCare, and Barnes-Jewish Hospital Center for Practice Excellence and sponsored by The Foundation for Barnes-Jewish Hospital.
The following presentations were made at the annual symposium:
Tapping the Power of Collaboration by Embracing Shared Goals
Sandra Filla, MSN, RN, AGCNS, Perioperative Services, Barnes-Jewish Hospital, Ballwin, MO and Ivan Kangrga, MD, PhD, Perioperative Services, Barnes-Jewish Hospital, St. Louis, MO
Each division at WashU has established its own safety initiatives and quality improvement efforts, but this can cause these divisions to be siloed in their way of thinking and operating. Dr. Kangrga and his team wanted to align best practices across all divisions at the School of Medicine, so they created one multidiscipline committee with smaller break-out committees. The goal was to eliminate duplicative work, with each subcommittee reporting back at the monthly safety quality meeting. This allowed for best practices to be shared across all operating rooms within the BJH system.
Derek Clary, DO1, Bhavi Mehta, MD2, Sherman Tomlin, Mr.2, Jason Gillihan, MD3, Ivan Kangrga, MD, PhD4 and Helga Komen, MD3, (1)Anesthesiology, Barnes-Jewish Hospital, St. Louis, MO, (2)Barnes-Jewish Hospital, St. Louis, MO, (3)Anesthesiology, Washington University School of Medicine, St. Louis, MO, (4)Perioperative Services, Barnes-Jewish Hospital, St. Louis, MO
In an urgent or emergent setting of a difficult airway, every second counts. The necessary equipment for intubation of difficult airway needs to be readily available. To ensure this, Difficult Airway carts (DA carts) were created and stocked in a standardized fashion across the Department of Anesthesiology and Barnes-Jewish Hospital. Given recent advancements in airway management equipment, DA carts needed to be revised and in 2021, DA carts were rebuilt in collaboration between the Department of Anesthesiology and Barnes-Jewish Hospital. The rollout of revised carts occurred across all 14 locations on BJH North and South Campuses in November 2021.
Ten months after rollout, the team completed audits to verify that carts across all locations were appropriately stocked, sealed, and positioned in their designated locations. The team concluded that besides daily and monthly checks of DA carts performed by the assigned members of the team, periodical independent audits are necessary to guarantee the availability and accessibility of life-saving difficult airway equipment.
Encouraging Rational Use of Volatile Anesthetics
Caellagh Catley, BS1, Joshua Perez-Cruet, BS1, Ryan Guffey, MD2, Ivan Kangrga, MD, PhD3 and Helga Komen, MD2, (1)Washington University School of Medicine, St. Louis, MO, (2)Anesthesiology, Washington University School of Medicine, St. Louis, MO, (3)Perioperative Services, Barnes-Jewish Hospital, St. Louis, MO
Volatile anesthetics contribute significantly to the cost and waste of hospital care. To reduce both cost and harmful emissions, the Washington University Department of Anesthesiology trained Barnes Jewish Hospital staff on more environmentally sustainable anesthetic techniques, including low-flow anesthesia. For the period 2017 to 2018, the total expenditure, patient burden, and utilization rates of each gas were tracked. The calculated climate impact and cost of gas use per case hour were analyzed using an interrupted time series analysis with time points marking each intervention. Results revealed that there was a statistically significant difference in the cost per case-hour (p= <0.001) and carbon dioxide equivalence per case-hour (p<0.001). Scientists observed a 68 percent drop in global warming potential and a 36 percent decrease in the cost of anesthetic gas during the preintervention compared to post-intervention periods.
Congratulations to all anesthesiology clinicians & staff on their presentations and their continued commitment to safety and quality.