management of common post-operative emergencies are july interns ready for prime time? jocelyn...
TRANSCRIPT
![Page 1: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/1.jpg)
Management of Common Post-Operative Emergencies
Are July Interns Ready for Prime Time?
Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts
Department of SurgeryUniversity of Cincinnati
![Page 2: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/2.jpg)
INTRODUCTION
• PGY 1 residents are initial responders
• Medical schools use USMLE Steps 1
and 2 and exams to assess knowledge
• No standardized education in the
management of inpatient emergencies
• Wide variation in clinical experience
![Page 3: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/3.jpg)
WHAT WE EXPECT FROM GRADUATING MEDICAL STUDENTS
• Direct supervision common in the OR, ICU,
and trauma bay
• Often not directly supervised in response to
concerns from the surgical ward
– Patient emergencies are inevitable
• We expect that they have certain basic skills
– Early and adequate assessment
– Judgment to call for help
![Page 4: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/4.jpg)
ARE SURGICAL INTERNS READY FOR PRIME TIME?
We hypothesized that new surgical
interns may not be adequately
prepared to evaluate and manage
potential patient care emergencies
![Page 5: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/5.jpg)
METHODS
• Patient care simulation performed
during orientation for residents
– June 2006 and 2007
– 16 surgical residents
– General and plastic surgery, urology
![Page 6: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/6.jpg)
METI – ECS SIMULATOR
• Computer interface
• Generates vital signs which are reproduced on a monitor
• Physical exam findings
• Human controller alters physiologic status in real-time
• Equipped with microphone and speaker
![Page 7: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/7.jpg)
IN-PATIENT ROOM SETUP
![Page 8: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/8.jpg)
CASE SCENARIOS
• Each participant received one scenario
– Post-op a fib, pneumothorax, early sepsis
• Typical “patient sign out”
– Patient name, age, and procedure performed
• Participants “called to the bedside”
![Page 9: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/9.jpg)
EVALUATION
• Initial assessment of patient status
• Assess and monitor a patient
undergoing obvious deterioration
• Communication with team members
and upper-level resident
• Basic emergency patient management
principles
![Page 10: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/10.jpg)
PGY 1 RESIDENTS MAY NOT IDENTIFY PHYSIOLOGIC COMPROMISE DURING
INPATIENT EMERGENCIES
Score (%)How performed?
1 Did not
2Poorly
3 Correctly
Requests updated vitals 9 (56) 2 (13) 5 (31)
Performs pulse exam and reassess
4 (25) 10 (63) 2 (13)
Listens for breath sounds 4 (27) 3 (20) 8 (53)
Places patient on monitor 11 (73) - 4 (27)
Monitors blood pressure 8 (53) 4 (27) 3 (20)
![Page 11: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/11.jpg)
INTERNS MAY NOTCOMMUNICATE EFFECTIVELY
Score (%)How performed?
1 Did not
2Poorly
3 Correctly
Identifies self to patient/RN 8 (50) - 8 (50)
Delegates/communicates tasks to team members 3 (19) 11(69) 2 (12)
Calls appropriately for help from additional staff (any) 10 (67) 2 (13) 3 (20)
Communicates with upper-level resident 10(63) 3 (19) 3 (19)
![Page 12: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/12.jpg)
PGY 1 RESIDENTS DID NOT UTILIZE BASIC INTERVENTIONS
DURING EMERGENCY SCENARIOS
Score (%)How performed?
1 Did not
2Poorly
3 Correctly
Evaluates airway 7 (44) 4 (25) 5 (31)
Administers O2 7 (44) 5 (31) 4 (25)
Acknowledges IV access
4 (25) 7 (44) 5 (31)
Administers IV therapy
4 (27) 6 (40) 5 (33)
![Page 13: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/13.jpg)
SUMMARY
• We expect that graduating medical students
can respond to inpatient emergencies
• There is no standardized educational
process to ensure this
• Interns may not be prepared to recognize
and manage acute post-operative
complications
![Page 14: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/14.jpg)
CONCLUSIONS
• Medical students have the skill-set
• Without structured educational process or experience, they do not know how to use this skill-set
• We recommend a structured educational process that prepares entering surgical residents to use their medical knowledge to safely manage inpatient emergencies
![Page 15: Management of Common Post-Operative Emergencies Are July Interns Ready for Prime Time? Jocelyn Logan-Collins, Stephen Barnes, Karen Huezo, Timothy Pritts](https://reader036.vdocuments.site/reader036/viewer/2022062805/5697c0091a28abf838cc750d/html5/thumbnails/15.jpg)
ACKNOWLEDGMENTS
We would like to thank the staff of the U.S. Air Force Center for the Sustainment of Trauma and Readiness Skills (C-STARS Cincinnati) for their time and expertise