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  1. Article ; Online: Lack of Validity of Absolute Percentage Errors in Estimated Operating Room Case Durations as a Measure of Operating Room Performance: A Focused Narrative Review.

    Dexter, Franklin / Epstein, Richard H

    Anesthesia and analgesia

    2024  

    Abstract: Commonly reported end points for operating room (OR) and surgical scheduling performance are the percentages of estimated OR times whose absolute values differ from the actual OR times by ≥15%, or by various intervals from ≥5 to ≥60 minutes. We show that ...

    Abstract Commonly reported end points for operating room (OR) and surgical scheduling performance are the percentages of estimated OR times whose absolute values differ from the actual OR times by ≥15%, or by various intervals from ≥5 to ≥60 minutes. We show that these metrics are invalid assessments of OR performance. Specifically, from 19 relevant articles, multiple OR management decisions that would increase OR efficiency or productivity would also increase the absolute percentage error of the estimated case durations. Instead, OR managers should check the mean bias of estimated OR times (ie, systematic underestimation or overestimation), a valid and reliable metric.
    Language English
    Publishing date 2024-03-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000006931
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Variability in Large Language Models' Responses to Medical Licensing and Certification Examinations. Comment on "How Does ChatGPT Perform on the United States Medical Licensing Examination? The Implications of Large Language Models for Medical Education and Knowledge Assessment".

    Epstein, Richard H / Dexter, Franklin

    JMIR medical education

    2023  Volume 9, Page(s) e48305

    Language English
    Publishing date 2023-07-13
    Publishing country Canada
    Document type Journal Article
    ISSN 2369-3762
    ISSN 2369-3762
    DOI 10.2196/48305
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Absence of a Comprehensive Literature Search Protocol in a Systematic Review of Published Studies Describing Operating Room Optimization.

    Dexter, Franklin / Epstein, Richard H

    Journal of medical systems

    2023  Volume 47, Issue 1, Page(s) 35

    MeSH term(s) Humans ; Operating Rooms ; Publications ; Systematic Reviews as Topic
    Language English
    Publishing date 2023-03-13
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 423488-1
    ISSN 1573-689X ; 0148-5598
    ISSN (online) 1573-689X
    ISSN 0148-5598
    DOI 10.1007/s10916-023-01937-0
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  4. Article ; Online: Associations Between Fresh Gas Flow and Duration of Anesthetic on the Maximum Potential Benefit of Anesthetic Gas Capture in Operating Rooms and in Postanesthesia Care Units to Capture Waste Anesthetic Gas.

    Dexter, Franklin / Epstein, Richard H

    Anesthesia and analgesia

    2023  Volume 137, Issue 5, Page(s) 1104–1109

    Abstract: Background: Sevoflurane and desflurane are halogenated hydrocarbons with global warming potential. We examined the maximum potential benefit assuming 100% efficiency of waste gas capture technology used in operating rooms and recovery locations.: ... ...

    Abstract Background: Sevoflurane and desflurane are halogenated hydrocarbons with global warming potential. We examined the maximum potential benefit assuming 100% efficiency of waste gas capture technology used in operating rooms and recovery locations.
    Methods: We performed computer simulations of adult patients using the default settings of the Gas Man software program, including the desflurane vaporizer setting of 9% and the sevoflurane vaporizer setting of 3.7%. We performed 21 simulations with desflurane and 21 simulations with sevoflurane, the count of 21 = 1 simulation with 0-hour maintenance + (1, 2, 3, 4, or 5 hours of maintenance) × (0.5, 1, 2, or 4 L per minute fresh gas flow during maintenance).
    Results: (1) A completely efficient gas capture system could recover a substantive amount of agent even when the case is managed with low flows. All simulations had at least 22 mL agent recovered per case, considerably greater than the 12 mL that we considered the minimum volume of economic and environmental importance. (2) All 42 simulations had at least 73% recovery of the total agent administered, considerably greater than the median 52% recovery measured during an experimental study with one gas capture technology and desflurane. (3) The maximum percentage desflurane (or sevoflurane) that could be captured decreased substantively with progressively longer duration anesthetics for low-flow anesthetics but not for higher-flow anesthetics. However, for all 8 combinations of drug and liters per minute simulated, there was a substantively greater recovery in milliliters of agent for longer duration anesthetics. In other words, if gas capture could be near perfectly efficient, it would have greater utility per case for longer duration anesthetics. (4) Even using a 100% efficient gas capture process, at most 6 mL liquid desflurane or 3 mL sevoflurane per case would be exhaled during the patient's stay in the postanesthesia care unit. Therefore, the volume of agent exhaled during the first 1 hour postoperatively is not a substantial amount from an environmental and economic perspective to warrant consideration of agent capture by having all these patients in the postanesthesia care unit, or equivalent locations, using the specialized anesthetic gas scavenging masks with access to the hospital scavenging system at each bed.
    Conclusions: Simulations with Gas Man show a strong rationale based on agent uptake and distribution for using volatile anesthetic agent capture in operating rooms if the technology can be highly efficient at volatile agent recovery.
    Language English
    Publishing date 2023-09-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000006610
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Nasal cannula and face mask gas flow rates when connecting to the Y-piece of the anesthesia circuit.

    Salas, Alejandra Silva-De Las / Epstein, Richard H

    Journal of clinical anesthesia

    2024  Volume 95, Page(s) 111463

    Abstract: Study objective: To determine the relationship between the delivered gas flows via nasal cannulas and face masks and the set gas flow and the breathing circuit pressure when connecting to the Y-adapter of the anesthesia breathing circuit and using the ... ...

    Abstract Study objective: To determine the relationship between the delivered gas flows via nasal cannulas and face masks and the set gas flow and the breathing circuit pressure when connecting to the Y-adapter of the anesthesia breathing circuit and using the oxygen blender on the anesthesia machine, relevant to surgery when there is concern for causing a fire. The flow rates that are delivered at various flow rates and circuit pressures have not been previously studied.
    Design: Laboratory investigation.
    Setting: Academic medical center.
    Patients: None.
    Interventions: The gas flows from each of 3 anesthesia machines from the same manufacturer were systematically increased from 1 to 15 L/min with changes to the adjustable pressure limiting valve to maintain 0-40 cm water pressure in the breathing circuit for nasal cannula testing and at 20-30 cm water circuit pressure for face masks.
    Measurements: The delivered gas flows to the cannula were determined using a float-ball flowmeter for combinations of set gas flows and circuit pressures after connecting the cannula tubing to the Y-piece of the anesthesia circuit via a tracheal tube adapter. Decreasing the supply tubing length on the delivered flow rates was evaluated.
    Main results: There was a highly linear relationship between the anesthesia circuit pressure and the delivered nasal cannula flow rates, with 0 flow observed when the APL valve was fully open (i.e., 0 cm water). However, even under maximum conditions (40 cm water and 15 L/min), the delivered nasal cannula flow rate was 3.5 L/min. Shortening the 6.5-ft cannula tubing increased the flow at 20 and 30 cm water by approximately 0.12 L/min/ft. The estimated FiO
    Conclusions: When using a nasal cannula adapted to the Y-piece of the anesthesia circuit, the delivery system is linearly dependent on the pressure in the circuit and uninfluenced by the flow rate set on the anesthesia machine. However, only modest flow rates (≤ 3.5 L/min) and a limited increase in the inspired FiO
    MeSH term(s) Cannula ; Masks ; Humans ; Equipment Design ; Anesthesia, Inhalation/instrumentation ; Anesthesia, Inhalation/methods ; Oxygen/administration & dosage ; Anesthesia, Closed-Circuit/instrumentation ; Anesthesia, Closed-Circuit/methods
    Chemical Substances Oxygen (S88TT14065)
    Language English
    Publishing date 2024-04-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2024.111463
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  6. Article ; Online: Lack of validity and generalizability of predicted probabilities of surgical case cancellation from excluding consideration of preoperative anesthesia evaluation.

    Dexter, Franklin / Epstein, Richard H

    Journal of clinical anesthesia

    2022  Volume 84, Page(s) 110996

    MeSH term(s) Humans ; Anesthesia/adverse effects ; Preoperative Care ; Anesthesiology ; Probability ; Elective Surgical Procedures
    Language English
    Publishing date 2022-11-09
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2022.110996
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  7. Article ; Online: Scheduling staff for ambulatory anaesthesia.

    Dexter, Franklin / Epstein, Richard H

    Current opinion in anaesthesiology

    2022  Volume 35, Issue 6, Page(s) 679–683

    Abstract: Purpose of review: In this study, we summarize six articles published from January 2020 through June 2022 covering anaesthesia staff scheduling and consider their relevance to ambulatory surgery. Staff scheduling refers to the planned shift length of ... ...

    Abstract Purpose of review: In this study, we summarize six articles published from January 2020 through June 2022 covering anaesthesia staff scheduling and consider their relevance to ambulatory surgery. Staff scheduling refers to the planned shift length of each person working on specific dates.
    Recent findings: Increasing shift lengths compensates for COVID-19 pandemic staffing issues by reducing patient queues and mitigating the impact of staff absence from SAR-CoV-2 infection. Reduced labour costs can often be achieved by regularly scheduling more practitioners than expected from intuition. Probabilities of unscheduled absences, estimated using historical data, should be incorporated into staff scheduling calculations. Anesthetizing locations, wherein anaesthesiologists are scheduled, may need to be revised if the practitioner is lactating to facilitate uninterrupted breast milk pumping sessions. If room assignments are based on the educational value for residents, then schedule other practitioners based on residents' expected work hours, not their planned shift lengths. Mixed integer programming can be used effectively to reduce variability among resident physicians in workloads during their rotations.
    Summary: Readers can reasonably select among these studies and benefit from the one or two applicable to their facilities' characteristics and work hours.
    MeSH term(s) Female ; Humans ; Personnel Staffing and Scheduling ; Internship and Residency ; Lactation ; Pandemics/prevention & control ; COVID-19 ; Anesthesia/adverse effects
    Language English
    Publishing date 2022-10-20
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 645203-6
    ISSN 1473-6500 ; 0952-7907
    ISSN (online) 1473-6500
    ISSN 0952-7907
    DOI 10.1097/ACO.0000000000001189
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  8. Article ; Online: Bibliometric Analysis of Contributions of Anesthesiology Journals and Anesthesiologists to Operating Room Management Science.

    Dexter, Franklin / Scheib, Sara / Xie, Wei / Epstein, Richard H

    Anesthesia and analgesia

    2024  Volume 138, Issue 5, Page(s) 1120–1128

    Abstract: Background: Anesthesiology journals appear to have been progressively publishing a smaller percentage of operating room (OR) management studies. Similarly, non-anesthesiologists have increasingly been authors of these publications. Five hypotheses were ... ...

    Abstract Background: Anesthesiology journals appear to have been progressively publishing a smaller percentage of operating room (OR) management studies. Similarly, non-anesthesiologists have increasingly been authors of these publications. Five hypotheses were formulated to evaluate these impressions based on 2 of the authors' curation of an online, comprehensive bibliography of OR management articles and corresponding referenced course materials.
    Methods: We studied all 2938 publications having Scopus' SciVal topic T.6319 (OR management) more than 28 years from 1996 through May 2023, including 8608 distinct authors.
    Results: Half (50%) of the publications were absent from PubMed, and the percentage absent has been increasing progressively (Kendall's τ = 0.71; P < .0001). Fewer than half were published in journals including anesthesiology as the sole classification (20%) or as one of the classifications (27%). The anesthesiology journals have been publishing a progressively decreasing fraction (τ = -0.61; P < .0001). Among the 11 authors each contributing at least 1% of the OR management science publications, 9 were anesthesiologists and the other 2 had anesthesiologists as coauthors on all these publications. Only 3% of authors had at least 10 OR management publications from earlier years. There were 75% of authors with no such earlier publications and 85% with 0 or 1. There was a progressive increase in the number of authors publishing OR management annually and with at most 1 such earlier publication (τ = 0.90; P < .0001). Only 20% of publications had any author with at least 10 earlier OR management publications, 48% had every author with no such earlier publications, and 60% had all authors with 0 or 1.
    Conclusions: Although most of the authors with the greatest production of OR management science were anesthesiologists, the percentage of publications in anesthesiology journals has been decreasing progressively. Anesthesiologists cannot rely solely on anesthesiology journals to keep up with the field. For most publications, every author had few or no earlier publications on the topic. Clinicians and managers relying on OR management science will continue to need to apply more information when judging whether published results can reliably be applied to their facilities.
    MeSH term(s) Humans ; Anesthesiology ; Anesthesiologists ; Operating Rooms ; Periodicals as Topic ; Bibliometrics
    Language English
    Publishing date 2024-04-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80032-6
    ISSN 1526-7598 ; 0003-2999
    ISSN (online) 1526-7598
    ISSN 0003-2999
    DOI 10.1213/ANE.0000000000006694
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  9. Article ; Online: Simply Adjusting for Schedulers' Bias in Estimated Case Durations Can Accomplish the Same Objectives of Improving Predictions as Use of Machine Learning.

    Dexter, Franklin / Epstein, Richard H

    JAMA surgery

    2021  Volume 156, Issue 11, Page(s) 1074–1075

    MeSH term(s) Bias ; Humans ; Machine Learning
    Language English
    Publishing date 2021-07-09
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2021.3126
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  10. Article ; Online: Cancellation rates after virtual, telephone-based preoperative anesthesia evaluations.

    Dexter, Franklin / Epstein, Richard H

    Journal of clinical anesthesia

    2021  Volume 76, Page(s) 110563

    MeSH term(s) Anesthesia/adverse effects ; Anesthesiology ; Humans ; Preoperative Care ; Telephone
    Language English
    Publishing date 2021-10-29
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1011618-7
    ISSN 1873-4529 ; 0952-8180
    ISSN (online) 1873-4529
    ISSN 0952-8180
    DOI 10.1016/j.jclinane.2021.110563
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