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Walden University College of Health Sciences This is to certify that the doctoral dissertation by Veronica Laviece Givan has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Diana Naser, Committee Chairperson, Health Services Faculty Dr. Nicoletta Alexander, Committee Member, Health Services Faculty Dr. Michael Brunet, University Reviewer, Health Services Faculty The Office of the Provost Walden University 2019 Parent/patient satisfaction surveys are important tools used to measure quality of health care provided by physicians, nurses, and hospitals. Research has been conducted on patient satisfaction in adult settings; however, a gap exists in the research about pediatric patient satisfaction in relationship to nurse interactions and interactions with physicians in various clinical settings. The purpose of this descriptive quantitative study was to determine whether a significant difference exists in overall parent/patient satisfaction scores and interaction of patients with nurses, and physicians, as well as interaction with anesthesiologists in terms of pain management in the pediatric surgical service in comparison to the medical inpatient unit and intensive care unit. Watson's caring science theory served as the framework for this study. Research questions evaluated parent/patient satisfaction scores and tested interactions between the parent/patient and the physicians, nurses, and anesthesiologists in a children's hospital. A total of 675 parent/patient satisfaction surveys from a children's hospital were analyzed using an independent samples t test, Levene's test, and regression analysis. The data analysis revealed a significant difference between overall parent/patient satisfaction scores (p = .021) in the pediatric surgical service as compared with the medical unit and for the parent/patient satisfaction survey responses (p = .004) for the interaction with nurses and physicians in the pediatric surgical service as compared with intensive care units. The potential social change that could result from this study is that health care organizations should record patient experiences to facilitate and improve the quality of care, interactions with physicians and nurses, and clinical outcomes

The development of anesthesia has greatly contributed to the safety of surgeries, reduced the level of invasiveness of many procedures, and provided increased comfort for patients. The delivery of anesthetics has been primarily provided by one of two unique health care providers: a trained physician who has specialized in anesthesia, or an advanced practice nurse—the certified registered nurse anesthetist (CRNA). Both providers have a similar scope of practice, are nationally certified, and often work side-by-side. However, in recent years there has been some controversy between the two providers regarding autonomy, safety, and quality of services. The purpose of this study was to utilize current research comparing the two professions to determine if there is a difference in the quality of care and cost effectiveness between these two providers. This research was focused on studies performed in the United States after 1985. Results indicated no significant differences in quality of care between providers; however, a cost difference does exist. CRNA's provide a high quality of care equivalent to their physician counterparts, but at a reduced price. They additionally offer access to care in rural areas that lack anesthesiologists. Limitations include an inability to assess the impact of doctoral level programs for nurse anesthetists (required for entry into practice beginning in 2025) and how this may affect the main components of patient care assessed in this study (quality of care and cost). Future studies should look at ways to improve the relationship between the two providers and to remove barriers to nurse anesthetists’ scope of practice in order to increase overall access to care.

Hospital administrators are being held accountable by patients, insurers, and other stakeholders in evaluating their overall hospital performance to reduce costs and improve efficiency. With the move to alternative payment models and value-based purchasing, hospital administrators must understand the economic viability and value that their specialty services bring to their facility. The purpose of this study was to identify the determinants New England acute care hospital administrators’ utilize in making the choice of anesthesia practice model for their facility. A quantitative, exploratory study of factors hospital administrators use when choosing an anesthesia practice model utilizing a non-experimental, correlational research design was completed. The research was descriptive in nature to determine the factors that influenced a hospital administrator when making decisions about the type of anesthesia practice model that would be the best for their hospital. This research examined seventeen independent variables that were hypothesized to determine hospital administrators’ choice of anesthesia practice model. After the final logistic regression analysis, it was determined that the presence of a hospital being located in a medically underserved area (MUA) alone was a predictor of type of anesthesia practice model utilized. In light of the study limitations and prior literature on the CRNA-only model being present in almost 100% of rural facilities, more exploration is necessary to come to more robust conclusions on predictors of choice of anesthesia practice model determined by hospital administrators. This study showed that there are definitive areas that hospital administrators identify as high importance to the healthy functioning of their facility. By addressing these needs, an anesthesia department could contribute to the overall stability of the hospital, while at the same time, making themselves a more valuable asset overall. Value-driven services offered by anesthesia departments may be the determining factor in choice of anesthesia practice model. By measuring and analyzing anesthesia provider and hospital demographics and hospital administrators’ perceptions of anesthesia services, the objective data collected may assist in defining the most appropriate practice model for a hospital.

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Bakgrund: Postoperativt illamående och kräkningar (PONV, Post Operative Nausea and Vomiting) är ett vanligt problem efter anestesi. Även om många riktlinjer och riskbedömningsverktyg har utvecklats för PONV, så är implementeringen ofta svår. Attityder och kunskap kring ämnet har visat sig påverka implementeringen av riktlinjer. Syfte: Syftet med denna studie var att undersöka anestesipersonals kunskap och attityder kring PONV och kliniska riktlinjer för att förebygga PONV. Metod: Studien är utformad som en kvantitativ, deskriptiv enkätstudie. En totalundersökning genomfördes på en anestesiklinik på ett större sjukhus i Mellansverige. Enkäten innehöll frågor angående anestesipersonals attityder och kunskaper kring riktlinjer och PONV. Resultat: Anestesipersonalens kunskap om PONV var god och stämde överens med skattningen av de egna kunskaperna. Av respondenterna angav 45,5 % att PONV är ett vanligt problem inom anestesi medan 36,3 % såg det som ett stort problem på kliniken. Riktlinjer för PONV ansågs förbättra patientvården och vara av stort värde för att identifiera riskpatienter, men samtidigt framkom att endast 48,5 % uppgav att de använder riktlinjer för PONV dagligen. Större delen av respondenterna ansåg att det föreligger ett delat ansvar för att riktlinjer följs, men det rådde delade meningar om vilka som delade detta ansvar. Slutsats Orsakerna till den diskrepans som förelåg mellan respondenternas positiva attityder och användandet av riktlinjer kan inte till fullo utläsas i huvudresultat. Det kan dock med stöd av tidigare studier argumenteras att externa faktorer på kliniken spelar in. För att klargöra problemet vidare och hur riktlinjer bättre ska kunna implementeras i den kliniska verksamheten så krävs ytterligare studier i ämnet. / Background: Postoperative nausea and vomiting (PONV) is a common problem after anesthesia. Even though many guidelines and risk assessment tools for PONV have been developed, implementation often is difficult. Attitudes and knowledge regarding the subject have been shown to influence the implementation. Aim: The aim of this study was to investigate anesthesia staffs knowledge and attitudes regarding PONV and guidelines. Method: The study is designed as a quantitative, descriptive questionnaire study. A census of an anesthesia clinic of a larger Swedish hospital was executed. The questionnaire contained questions concerning anesthesia staffs attitudes and knowledge about guidelines and PONV. Results: The anesthesia staffs knowledge of PONV was good and correlated with their self-assessment. Of the respondents 45,5 % stated that PONV was a common problem in anesthesia, while 36,3 % regarded it as a big problem in their clinic. Guidelines for PONV were seen as improving patient care and to be of great value for identifying risk patients, while only 48,5 % stated that they use PONV guidelines daily. The major part of the respondents deemed the responsibility for following guidelines as collective, however the opinion on exactly who shared this responsibility differed. Conclusion: The reason for the discrepancy that occurred between the respondents’ positive attitudes and the use of guidelines cannot be fully deduced from the main results. However, with the support of earlier studies it can be argued that external factors in the clinic contribute. Further studies of the subject is needed to clarify the problem.

Bakgrund: Bristande kommunikation mellan vårdpersonal är en av de vanligaste orsakerna till de skador och avvikelserapporter som årligen uppstår inom hälso- och sjukvården. Vid ett överrapporteringstillfälle finns risk att information missförstås eller att information inte överlämnas vilket därmed kan äventyra patientsäkerheten och en god vård. Eftersom användandet av kommunikationsverktyg förespråkas fanns det skäl att beskriva betydelsen av kommunikationsverktyg vid överrapportering. Syfte: Syftet var att beskriva betydelsen av att använda kommunikationsverktyg vid överrapportering från anestesipersonal till postoperativ avdelning. Metod: En systematisk litteraturstudie med kvantitativ ansats användes. Sökningarna genomfördes i två vetenskapliga databaser, Cinahl och Pubmed. Totalt elva artiklar identifierades och data extraherades genom en dataextraktionsmall. Resultat: Resultatet sammanfattas i tre kategorier; förändrad tid för överrapportering, minskad informationsförlust och förändringar i teamet. Genom användandet av kommunikationsverktyg ökade eller minskade tiden för överrapportering. Informationsförlusten minskade då det blev minskat antal fel, lättare att komma ihåg detaljer samt antalet mellanhänder minskade. Förändringar i teamet kunde ses utifrån att användandet av kommunikationsverktyg skapade förutsättningar för ett förbättrat samarbete i teamet samtidigt som det fanns en del svårigheter med rutinförändringar i samband med introduktionen av ett kommunikationsverktyg. Slutsats: Resultatet visar på flertalet fördelar med användandet av kommunikationsverktyg men även utmaningar i det. Vidare forskning inom området behövs för att utvärdera kommunikationsverktygets inverkan på patientens säkerhet. / Background: Lack of communication between healthcare professionals is one of the most common causes of the injuries and deviation reports that occur annually in the healthcare system. In the event of a handover, there is a risk that information will be misunderstood or that information will not be submitted, which may compromise patient safety. Because the use of communication tools is advocated, there was reason to describe the importance of communication tools in handover. Purpose: The purpose was to describe the importance of using communication tools in handover from anesthetic staff to post-operative department. Methods: A systematic literature review with quantitative approach was used. Searches were conducted in Cinahl and Pubmed. A total of eleven articles were identified and data extracted by an extraction template. Results: The result is summarized in three categories; changed time for over-reporting, reduced information loss and changes in the team. The use of communication tools increased or decreased the time for over-reporting. The information loss decreased as the number of errors decreased, the details were easier to remember and the number of intermediaries decreased. Changes in the team could be seen from the view that the use of communication tools created the conditions for improved collaboration in the team, while there were some difficulties with routine changes in connection with the introduction of a communication tool. Conclusion: The result shows the many advantages of using communication tools but also challenges in it. Further research in the field is needed to evaluate the impact of the communication tool on the patient's safety.

Performance of hand hygiene is among the most effective means of preventing healthcare associated infections (HAI) among patients. Deaths resulting from HAIs are one of the top ten leading causes of death in the United States. Any improvement in the frequency of hand hygiene among healthcare professionals may have a direct impact on patient mortality and associated costs. While anesthesia professionals have been found to have low rates of hand hygiene adherence, few targeted studies seeking to improve hand hygiene adherence among this group exist. Studies conducted to improve hand hygiene among health care professionals have reported limited improvement, with overall inconclusive recommendations for improving prolonged hand hygiene adherence rates. The purpose of this project was to improve anesthesia professionals’ hand hygiene through encouragement of performance and education on the current state of research in the area of anesthesia associated HAIs. Hand hygiene rates were evaluated through measuring the amount of hand sanitizer used at eleven anesthesia workstations in the main operating room of a hospital. Measurements were taken at baseline and continued for three months after the educational program was implemented.