Regardless of where we practice medicine, it is up to us as individual physicians to ensure the highest quality of care that we can deliver to our patients. At each location, the demography and cultural composition of our patients have revealed different approaches to language barriers, self-understanding of disease, and even the perception of pain.
As a physician, I wrote a recent essay that describes the obstacles I believe most significantly impede the adoption of standards of healthcare delivery in these diverse settings.
I have obtained Six Sigma and LEAN certification and patient safety curricula, and published work on outcomes-based research studies and clinical trials on informatics tools in peer-reviewed journals.
Perioperative Workflow Optimization with Lean management system
Continuous Practice Improvement with Six Sigma DMAIC
1. Hand Hygiene - It is important to protect yourself from infection at all times. Furthermore, one must prevent the spread of germs which could severely affect sicker patients in the hospital.
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2 & 3. Oral Airways / Ambu-Bag - It is necessary for the anesthesiologist to ventilate, or assist in exhalation of carbon dioxide from the patient. This is especially important in the beginning and end of surgery, as the lungs go off to sleep or start to work again, respectively.
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4. Oxygen canister - Necessary if the anesthesia machine or the hospital oxygen pipeline system fails.
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5. Suction canister - Aspiration due to vomiting is not uncommon at the beginning and end of surgery, especially if the patient has not adequately fasted. The anesthesiologist must detect and remove any contents from the mouth before they fall into the lungs.
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6. Pulse oximeter - In addition to the blood pressure cuff and EKG, the pulse oximeter allows for a measurement of heart rate, calculated blood oxygen levels, and detection of blood flow at the farthest reaches of the body. And all in one simple instrument applied to the finger!
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7. Bougie - A long, thin, flexible tool that allows anesthesiologist a conduit to place a breathing tube, especially in cases where the airway anatomy is more difficult than anticipated.
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8. Laryngoscope and breathing tube ( not pictured) - Perhaps the most common tool used by every anesthesiologist to secure the airway and allow for oxygenation and ventilation in elective or emergency circumstances
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9. IV start kit - An IV is placed in virtually every patient receiving surgery. It allows for the rapid delivery of important medications and fluid for hydration, and can allow for blood tests to track blood counts, electrolytes and presence of infection.
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10. Epinephrine - The ultimate common emergency medication in CPR for cardiac arrest or unstable heart rhythms. A syringe allows the anesthesiologist to titrate smaller doses of medication if necessary.
Aalap Shah, MD, is a board certified anesthesiologist, specializing in general adult and pediatric anesthesiology.
