anaesthesia thesis master chart

Preparing and Decoding the Master Chart

• First Online: 04 November 2018

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• Meenakshi Girish 3 &
• Senthil Amudhan 4  

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After data collection, the next logical step towards drawing meaningful conclusions from the collected data will be data analysis. However, before carrying out the actual data analysis, one has to look hard at the data and prepare it to facilitate further analysis. This will provide better insight into the feasibility of the analysis to be performed as well as the resources required. It also allows us to visualise the data and to choose appropriate and valid method of analysis which will produce reliable inferences. Construction of a Master Chart is a sine qua non of this process. Unfortunately, the various steps involved in the preparation of Master Chart are often overlooked by many researchers. This chapter takes the reader through the various steps involved in the preparation and decoding of Master Chart.

Organising is what you do before you do something, so that when you do, you do not get it mixed up—AA Milne

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Department of Pediatrics, NKP Salve Institute of Medical Sciences, Nagpur, India

Meenakshi Girish ( Associate Professor )

Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India

Senthil Amudhan ( Associate Professor )

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Girish, M., Amudhan, S. (2018). Preparing and Decoding the Master Chart. In: Parija, S., Kate, V. (eds) Thesis Writing for Master's and Ph.D. Program. Springer, Singapore. https://doi.org/10.1007/978-981-13-0890-1_10

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• Bibliography
• More Referencing guides Blog Automated transliteration Relevant bibliographies by topics
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Dissertations / Theses on the topic 'Quality anesthesia'

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Wilton, Ashley Jordan, and Ashley Jordan Wilton. "Respiratory Management Education for the Post Anesthesia Care Unit Registered Nurse." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624297.

Seneca, Martha E. "Improving Anesthesia Professional Adherence to Hand Hygiene." UNF Digital Commons, 2014. http://digitalcommons.unf.edu/etd/502.

Borendal, Wodlin Ninnie. "Fast track abdominal hysterectomy : On the mode of anesthesia, postoperative recovery and health economics." Doctoral thesis, Linköpings universitet, Obstetrik och gynekologi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-70469.

Fasting, Sigurd. "Routine based recording of adverse eventsduring anaesthesia : application in quality improvement and safety." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2003. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-327.

Lemos, Jeconias Neiva [UNESP]. "Controle de qualidade em anestesia ambulatorial: avaliação dos serviços na visão dos pacientes." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/148962.

Lemos, Jeconias Neiva. "Controle de qualidade em anestesia ambulatorial avaliação dos serviços na visão dos pacientes /." Botucatu, 2017. http://hdl.handle.net/11449/148962.

Schwerdtfeger, Cristiane Milanezi Marques de Almeida. "Qualidade de recuperação em anestesia: abordagem da satisfação dos pacientes submetidos ao procedimento anestésico." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/61/61132/tde-04112010-151350/.

Johansson, Marita, and Cathrin Jonasson. "En varm patient : Sjuksköterskans omvårdnad och förebyggande av hypotermi i samband med dagkirurgisk operation." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-15141.

Martins, Marcelo de Jesus. "Pregabalina para melhoria na qualidade de recuperação anestésica em cirurgia bariátrica ensaio clínico randomizado, duplo cego, placebo controlado /." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/152421.

Maurice-Szamburski, Axel. "Le vécu du patient en anesthésie." Thesis, Aix-Marseille, 2016. http://www.theses.fr/2016AIXM5020.

Popov, Débora Cristina Silva. "Indicadores para avaliação do cuidado de enfermagem com o paciente na sala de recuperação pós-anestésica." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/7/7139/tde-31082016-160123/.

HOURDIN, DOMINIQUE. "Qualite de reveil apres anesthesie par le propofol a debit constant : choix des tests de reveil utilisables ;analyse critique et resultats." Amiens, 1988. http://www.theses.fr/1988AMIEM040.

Auquier, Pascal. "Concepts et mesure de la qualité de vie liée à la santé : exemples et applications." Montpellier 1, 1996. http://www.theses.fr/1996MON1T026.

Merheb, Farid Capanema. "Estudo analítico de anestésicos injetáveis e validação de estabilidade." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-27052015-145720/.

Bussat, Sophie. "Qualité de récupération psychomotrice après une coloscopie sous anesthésie générale : intérêt des tests de réveil." Bordeaux 2, 1994. http://www.theses.fr/1994BOR2M046.

Roussel, Olivier. "Interet de la surveillance simultanee non invasive de l'hemodynamique et de la pression tele-expiratoire en gaz carbonique : valeur predictive sur la qualite de la perfusion tissulaire." Lyon 1, 1991. http://www.theses.fr/1991LYO1M112.

Piffaut, Vincent. "Evaluation de la qualité formatrice des stages d'enseignement spécialisé d'anesthésie réanimation en Aquitaine par les internes." Bordeaux 2, 1996. http://www.theses.fr/1996BOR23033.

Robert, Valérie Mertes Paul Michel. "Satisfaction et vécu périopératoire des patients opérés sous anesthésie péribulbaire dans le service d'ophtalmologie A au CHU de Nancy." [S.l] : [s.n], 2003. http://www.scd.uhp-nancy.fr/docnum/SCDMED_T_2003_ROBERT_VALERIE.pdf.

Costa, Maria Francisca Monteiro da. "Quality of Recovery after anesthesia." Dissertação, 2013. https://repositorio-aberto.up.pt/handle/10216/72117.

Costa, Maria Francisca Monteiro da. "Quality of Recovery after anesthesia." Master's thesis, 2013. https://repositorio-aberto.up.pt/handle/10216/72117.

Sousa, Cristina Maria Marques Torrao Dionisio de. "Quality of recovery after anesthesia: Comparing the Quality of Recovery-15 Score and the Postoperative Quality of Recovery Scale." Dissertação, 2016. https://repositorio-aberto.up.pt/handle/10216/89273.

Sousa, Cristina Maria Marques Torrao Dionisio de. "Quality of recovery after anesthesia: Comparing the Quality of Recovery-15 Score and the Postoperative Quality of Recovery Scale." Master's thesis, 2016. https://repositorio-aberto.up.pt/handle/10216/89273.

Hung, Chih-Cheng, and 洪至正. "Effect of General Anesthesia on Quality of Recovery after Transaxillary Endoscopic Breast Augmentation." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/t7fv9s.

Soares, Mariana Araujo Teixeira da Silva. "Patient satisfaction with anesthesia for curative neoplastic surgery: the impact of quality of recovery." Dissertação, 2018. https://hdl.handle.net/10216/111971.

Soares, Mariana Araujo Teixeira da Silva. "Patient satisfaction with anesthesia for curative neoplastic surgery: the impact of quality of recovery." Master's thesis, 2018. https://hdl.handle.net/10216/111971.

Ho, Xing-Hua, and 何幸樺. "Exploring the quality of (medical) care of which ovetime stay factor at (Post Anesthesia Care Unit，PACU) in one medical center." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/69bm7s.

Chou, Yu-fang, and 周郁芳. "The influence of service quality on surgical patients’ satisfaction and their intend to return: intervention of the education for preoperative anesthesia." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/13581413953452820071.

Trinh, Caroline. "Documentation of adverse events in the department of anesthesiology: a single institution experience." Thesis, 2020. https://hdl.handle.net/2144/41735.

MEI-CHIN, CHEN, and 陳美錦. "A study of the relationship between job stress,job satisfaction and quality of life among the anesthesia nurses of medical centers insouthern Taiwan." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/19472554918207076358.

Žánová, Libuše. "Návrat do života po pobytu na intenzivní péči po závažných chirurgických výkonech." Master's thesis, 2019. http://www.nusl.cz/ntk/nusl-404160.

CHIN, JO-CHI, and 秦若琪. "A Study of the Relationship between Shared Decision Making and Anesthetic Quality." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/dej9zc.

吳鋼治. "A study on the anesthetic preoperative evaluation processes:in view of cost of quality." Thesis, 2004. http://ndltd.ncl.edu.tw/handle/73167734701788341391.

Jin-Yu, Chen, and 陳瑾玉. "A study of service quality on preoperative anesthetic visit in a medical center." Thesis, 2006. http://ndltd.ncl.edu.tw/handle/45101795789084647179.

Hillebrecht, Anna-Lena. "Die Auswirkungen der zahnärztlichen Behandlung in Intubationsnarkose auf die mundgesundheitsbezogene Lebensqualität von Patienten mit kognitiver Einschränkung." Doctoral thesis, 2020. http://hdl.handle.net/21.11130/00-1735-0000-0005-1361-8.

Anesthesiology Thesis/Dissertation Topics for MD/DNB

1.      Effects of intravenous dexmedetomidine in patients receiving 0 5% hyperbaric bupivacaine spinal asaesthesia.

2.      A comparative study of patient controlled epidural analgesia vs continous epidural infusion in labour analgesia using ropivacaine with fentanyl.

3.      To study correlation of extravascular lung water and compliance of lung in mechanicaly ventilated patients in ICU of a tertiary care centre.

4.      Combination of ropivacaine and dexmedetomidine for supraclavicular brachial plexus block using ultrasound and nerve stimulator guided technique: An intervention study to determine the effective volume.

5.      Comparison of efficacy of sedation with dexmedetomidine plus ketamine and propofol plus fentanyl in adult patients undergoing out-patient colonoscopy.

6.      To study the correlation between cerebral,rSO2 and outcomes in severe head injury cases.

7.      Comparision of dexmedetomidine and ketamine vs propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterisation lab.

8.      To compare the analgesic efficacy of continuous femoral nerve block (CFNB) with local anaesthetic through a catheter versus patient controlled analgesia with intravenous morphine after total knee arthroplasty.

9.      Correlation between centrally versus peripherally transduced venous pressure in patients undergoing craniotomy.

10.   To study the incidence and risk factors of post-operative sore throat in patients undergoing elective surgeries under general anaesthesia with endotracheal tube.

11.   A comparative study of scoring systems used to predict difficult airway.

12.   An assessment of satisfaction of family members of patients admitted in the ICU.

13.   Comparative study of IV dexmedetomidine vs IV midazolam for sedation during tympanoplasty and modified plasty and modified radical mastoidectomy.

14.   Comparison between epidural tramadol and fentanyl for post operative analgesia.

15.   The efficacy of dexmedetomidine as an adjuvant in brachial plexus block by supraclavicular approach with 0.25% bupivacaine.

16.   Effect of low dose intravenous dexmedetomidine on characteristics of spinal anaesthesia with 05% hyperbaric bupivacaine.

17.   Effects of IV dexmedetomidine as a pre-medication on clinical profile of bupivacaine spinal anaesthesia in lower abdominal surgeries.

18.   Comparison of haemodynamic changes of proseal LMA and endotracheal tube for laparoscopic surgeries.

19.   Comparative study of intrathecal isobaric 0.5% bupivacaine and isobaric 0.75% ropivacaine for lower abdominal and lower limb surgeries.

20.   Comparison of recovery characteristics of desflurane, sevoflurane and propofol in patients undergoing laparoscopic cholecystectomy.

21.   Effect of preoperative intramuscular morphine injection for post operative analgesia in patients undergoing joint replacement surgery.

22.   Evaluation of efficacy of tranversus abdominis plane block for post operative analgesia in patients undergoing total abdominal hysterectomy.

23.   A comparative study between ropivacaine with fentanyl versus bupivacaine with fentanyl for post operative epidural analgesia in patients undergoing elective lower abdominal and lower limb surgeries.

24.   To compare the effect of preloading with 6% (HES) hexaethyl starch versus intravenous ephedrine for the prevention of hypotension following spinal anesthesia for parturients undergoing caesarean section.

25.   Comparative study of dexmedetomidine and lignocaine for attenuation of cardiovascular stress response to laryngoscopy and endotracheal intubation.

26.   Effect of addition of intrathecal fentanyl to hyperbaric bupivacaine (0.5%) for casearean section.

27.   Comparative study of the intubating conditions and cardiovascular effects following succinylcholine and rocuronium in adult elective surgical patients.

28.   Attenuation of the circulatory responses to endotracheal intubation with preinduction intravenous labetalol.

29.   Comparative evaluation of bupivacaine and bupivacaine with dexmedetomidine in subarachnoid block.

30.   Comparative evaluation of thiopentone sodium and propofol for electro convulsive therapy.

31.   Comparative study of 0.5% lignocaine with dexmedetomidine and 0.5% lignocaine in intravenous regional anaesthesia.

32.   Comparison of efficacy of levobupivacaine and clonidine with bupivacaine and clonidine in spinal anaesthesia for lower segment caesarean section.

33.   A comparative study of intrathecal dexmedetomidine and fentanyl as an adjuvant to bupivacaine.

34.   Comparision of bupivacaine,bupivacaine plus clonidine, bupivacaine plus dexmeditomedine intrathecally in lower abdominal surgeries.

35.   The effects of ephedrine infusion for the prevention of hypotension during spinal anaesthesia for elective lower segment caesarean section.

36.   The comparative study of epidural anaesthesia between isobaric ropivacaine 0.5% and isobaric bupivacaine 0.5% for lower abdominal surgeries in tertiary care institute.

37.   A comparative study on effect of adding dexmedetomidine and dexamethasone to local anaesthetics in brachial plexus block.

38.   A randomised study on the efficacy of ketamine and pethidine in the treatment of postoperative shivering in patients undergoing general anaesthesia.

39.   A double blinded randomized control trial to compare hyperbaric ropivacaine (18 mg) with hyperbaric bupivacaine (18 mg) for spinal anaesthesia in lower limb orthopedic surgeries.

40.   Comparative evaluation of addition of dexamethasone to two different local anaesthetics in supraclavicular brachial plexus block

41.   Comparative study of propofol versus ketamine as inducing agent on hemodynamic and seizure activity in modified electroconvulsive therapy.

42.   Prevention of sevoflurane related emergence agitation in children undergoing general anaesthesia : a comparison study between dexmedetomidine and propofol.

43.   A comparative study of hernial block versus subarachanoid block for elective inguinal hernia repair.

44.   Effect of dexmedetomidine in supraclavicular brachial plexus block as an adjuvent : A comparative study.

45.   Mechanical complications during insertion of central venous catheter in subclavian vein and internal jugular vein – A comparitive study.

46.   Comparison of ambu laryngeal mask airway with soft seal laryngeal mask airway during routine surgical procedure.

47.   Study of efficacy of dexmethasone as preemptive analgesic in patients undergoing total abdominal hysterectomy under spinal anaesthesia.

48.   A clinical assessment of macintosh,miller blades and king visionTM video laryngoscope for laryngeal exposure and difficulty in endotracheal intubation.

49.   Comparison of two doses of dexmedetomidine combined with ketamine for anesthesia in dilatation and curettage.

50.   Evaluation of effect of low dose of intravenous dexmedetomidine supplementation on sensory and motor blockade produced by intrathecal hyperbaric bupivacaine.

51.   Comparison of the effects of lateral and sitting position during induction of spinal anaesthesia with plain levobupivacaine in cesarean section.

52.   Comparitive study of bupivacaine with dexmedetomidine and bupivacaine alone in  supraclavicular brachial plexus block.

53.   A comparative study of propofol and thiopentone with local anaesthetic spray as inducing agents for I gel insertion.

54.   A comparative study of perioperative effects of preemptive dose of dexamethasone versus clonidine in lower abdominal surgeries under spinal anaesthesia.

55.   Intravenous dexmedetomidine vs. intravenous clonidine to prolong bupivacaine spinal anesthesia.

56.   Comparative study of the effect of IV ketamine and IV tramadol for control of shivering in cases of caesarean section under spinal anaesthesia.

57.   Comparison of inj. Lignocaine (preservative free) 1.5mg/kg IV with oral pregabalin 150 mg for attenuation of haemodyanamic response to laryngoscopy and tracheal intubation.

58.   Comparative study of supraclavicular block using bupivacaine with perineural dexamethasone, bupivacaine with I.V. dexamethasone and bupivacaine only.

59.   Comparative study of intrathecal bupivacaine with fentanyl and intrathecal bupivacaine with clonidine for quality of anaesthesia and duration of post operative pain relief in patients undergoing lower abdominal and lower limb surgeries.

60.   A comparison of efficacy of pre-emptive analgesia with three small doses of N-Methyl-D- aspartate antagonist ketamine for improving post operative analgesia after laparoscopic surgeries,

61.   A study of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair.

62.   Identification of risk factors for hypotension after spinal anaesthesia in patients undergoing casarean section.

63.   Use of McCoy and truview laryngoscope blades for intubation in patients with anticipated difficult airway with respect to ease of intubation and haemodynamic response.

64.   Audit of perioperative complication of patients unergoing turp surgeries :: an anaesthetist’s perspective.

65.   An audit of blood and blood products transfusion practices in elective spine surgery.

66.   The type of anaesthesia and outcome in preeclamptic patients undergoing caesarean  section an observational study.

67.   Comparison of palonosetron, ondansetron, and metoclopramide in controlling post operative nausea and vomiting in obstetrical and gynaecological surgeries.

68.   Comparison between intranasal dexmedetomidine and intranasal midazolam for preanaesthetic sedation in children.

69.   Comparison between 0.125% bupivacaine and 0.125% ropivacaine for epidural analgesia during labour.

70.   Dexamethasone as an adjuvant to local anaesthetic in supra clavicular block a  comparitive study.

71.   Observational study of hemodynamic effects of etomidate and propofol used as induction agents in patients planned for off pump cabg

72.   An observational study to compare the haemodynamic parameters following spinal anaesthesia with hyperbaric bupivacaine in hypertensive and normotensive patients.

73.   Correlation of leak around uncuffed endotracheal tube and postoperative morbidity in children: an observational study.

74.   A cross-sectional observational analysis of preoperative blood glucose levels in patients presenting for surgery.

75.   Monitoring of depth of anaesthesia using entropy monitor during cardiopulmonary bypass-a prospective study.

76.   An evaluation of procedural sedation techniques in duchenne muscular dystrophy patients undergoing stem cell therapy.

77.   Anaesthesia risk stratifaction: comparison between silverman-holt aggregate preoperative evaluation (SHAPE) and american society of anaesthesiologists physical status (ASA PS) evaluation systems.

78.   Efficacy of spinal anaesthesia for laparoscopic ventral hernia repair

79.   Comparative study of nalbuphine vs. pentazocine for postoperative analgesia.

80.   Comparative study of intrathecal isobaric levobupivacaine versus hyperbaric bupivacaine in lower abdominal surgery.

81.   Comparative study of 0.5% (heavy) intrathecal bupivacaine alone with 0.5% (heavy) intrathecal bupivacaine midazolam combination in patients undergoing elective inguinal hernia repair.

82.   Comparative evaluation of induction with propofol and sevoflurane for insertion of laryngeal mask airway in children.

83.   Hemodynamic behaviour,ECG changes and postoperative outcome of hypertensive and normotensive patients under spinal anaesthesia.

84.   The comparision of single bolus dose of dexmedetomidine with bolus plus infusion of  dexmedetomidine on characteristics of spinal anaesthesia with hyperbaric bupivacaine.

85.   Evaluation of airway and predicting difficult endo- tracheal intubation in diabetic patients -A comparison with non diabetic patients.

86.   Observational study for dose-response characteristics of intrathecal hyperbaric bupivacaine(0.5%) by using sequential combined spinal epidural anesthesia (SCSEA) in patients aged over sixty year for orthopedic surgeries.

87.   A comparison of thyromental height with the ratio of patient’s height to thyromental distance and the upper lip bite test in predicting difficult laryngoscopy.

88.   A comparetive study of arterial PH and chloride levels following 6% HES 130/0.4 saline solution or 6% HES 130/0.4 balanced solution used during cardiac surgery involving cardiopulmonary bypass.

89.   A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.

90.   A prospective comparative study of ondansetron against tramadol pretreatment to reduce pain on injection of propofol.

91.   A comparative study between clinical efficacies of levobupivacain plain and levobupivacaine with fentanyl for urological surgeries under subarachnoid block.

92.   A prospective study to compare efficacy of interlaminar vs caudal epidural steroids in chronic lower back pain.

93.   A comparison of the efficacy of fentanyl and clonidine for attenuation of pressor response to endotracheal intubation.

94.   Pre treatment with intravenous granisetron to alleviate pain on propofol injection: A double blind randomised controlled study using normal saline as control.

95.   Randomised prospective study of comparison of USG guided subcostal transversus abdominis plane block techinque (sta block) versus conventional port site infiltration techinque used in laparoscopic cholecystectomy for post operative analgesia.

96.   Correlation of bispectral index with depth of sedation: A comparison between dexmedetomidine versus propofol in patients undergoing infraumabilical surgery under subarachnoid block.

97.   Ultrasonographic measurement of optic nerve sheath diameter to detect raised intracranial pressure in head injury patients in ICU and its correlation with CT scan findings.

98.   Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.

99.            A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.

100.          Effect of dexmedetomidine hydrochloride as an adjuvant to lignocaine hydrochlorid for intravenous regional anaesthesia.

101.           Comparison between palonosetron and granisetron in prevention of postoperative nausea and vomiting (PONV) in elective laparoscopic surgeries under general anaesthesia.

102.           A comparison of upper Lip Bite Test with modified mallampati classification in predicting difficulty in endotracheal intubation.

103.           Postoperative nausea and vomiting -prophylaxis with palonosetron hydrochloride.

104.           Comparison of dexmedetomidine and midazolam for sedation in post -operative surgical patients.

105.           Study of hemodynamic changes during laparoscopic surgery using non-invasive cardiac output monitor (NICOM) Low flow anaesthesia : a prospective observational study.

106.           Intraperitoneal instillation of ropivacaine compared with bupivacaine for post operative analgesia after laparoscopic procedures.

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Cures Act summary

Considerations and guidance for anesthesia practices and providers, open anesthesia records: guidance for anesthesia providers on implementing the cures act.

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Priya Ramaswamy , David T. Chin , David Robinowitz; Open Anesthesia Records: Guidance for Anesthesia Providers on Implementing the Cures Act. ASA Monitor 2021; 85:e3–e4 doi: https://doi.org/10.1097/01.ASM.0000733900.18773.a4

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Priya Ramaswamy, MD, MEng, Clinical Informatics Fellow, University of California, San Francisco. @PriyaRamaswamy

David T. Chin, MD, Resident Physician/CA-2, University of California, San Francisco. @dvdtchn

David Robinowitz, MD, MHS, MS, Professor of Clinical Anesthesia, Pediatric Anesthesiologist, and Medical Director, Anesthesia Informatics, University of California, San Francisco.

The notion that patients have a right to access their medical records was introduced by Shenkin and Warner in 1973 in NEJM . At that time, in most of the United States, patients could only obtain their medical records through litigation ( N Engl J Med 1973;283:688-92 ). Since then, we have made significant strides thanks in part to legislation such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Health Information Technology for Economic and Clinical Health Act (HITECH), and the creation of the Office of the National Coordinator (ONC). The advent and near universal adoption of electronic health records (EHRs), patient portals, and consumer technology have increased patient access to multiple parts of the patient record by streamlining the process of data delivery. What used to require hours of photocopying can now be accomplished in a few “clicks.” Many patients now have near-immediate access to health data such as laboratory and imaging results. However, offering patients access to their physician's clinical notes has not been a widespread practice, nor has it been a legal requirement.

Recommendations for Transparent Anesthetic Records

The OpenNotes movement started in 2010 and was initially pioneered at three medical centers across the country: Boston's Beth Israel Deaconess Medical Center, Pennsylvania's Geisinger Health System, and Seattle's Harborview Medical Center. Outpatient clinical notes were shared by providers with over 20,000 patients, and the initial study found overwhelming patient satisfaction and perceived benefit of the practice with minimal to no change in physician workload ( Ann Intern Med 2012;157:461-70 ). Several studies have confirmed that sharing provider notes with patients results in increased patient satisfaction, patient-physician trust, and patient engagement, among other positive findings ( JAMA Netw Open 2020;3:e201753 ; J Am Med Inform Assoc 2019;26:1115-19 ; BMJ Qual Saf 2017;26:262-70 ). The OpenNotes movement has since expanded to the Veteran's Affairs system and other health care systems across the country, and now over 40 million patients have access to their providers' notes ( asamonitor.pub/2UmhKIk ).

In 2016, the 21st Century Cures Act (Cures Act) was signed into law. Among the many provisions of the Cures Act is a focus on “empowering patients and improving patient access to their electronic health information.” The Cures Act directed the ONC and Health and Human Services Secretary to determine what electronic health information (EHI) would be mandated to be shared with patients via application programming interfaces (APIs, like Epic's MyChart) ( asamonitor.pub/3kjYWEh ). In 2019, the ONC released the first version of the U.S. Core Data for Interoperability (USCDI), which expanded prior EHI definitions to encompass clinical notes. With this addition, it is now required that physician notes from both inpatient and outpatient settings become readily available to patients “without special effort,” “at no cost,” and “updated automatically” ( asamonitor.pub/3kjYWEh ). Anesthesia provider notes and anesthesia records are not excluded from these requirements.

On May 1, 2020, the ONC published the Cures Act Final Rule, which mandated that clinical notes must be shared with patients by November 2, 2020 (six months following the release of the Final Rule). However, given the burdens imposed by the COVID-19 pandemic response, the ONC extended the deadline to April 5, 2021. The Cures Act also requires that by October 6, 2022, health systems must share clinical notes with third party applications specified by patients, meaning notes must be accessible and able to be downloaded to a smartphone or tablet.

We believe it is imperative to bring the new federal requirements to the attention of anesthesia providers.

Implementing open anesthetic records, a novel concept in our field, will require a host of considerations for practices, providers, and their patients. We anticipate significant lessons will need to be learned along the way. Patient and physician satisfaction with open notes have not included specialty specific notes like those from anesthesia providers ( BMJ Qual Saf 2017;26:262-70 ). We do not know the impact that open anesthetic records will have on anesthesia practice, but we envision that the provider-patient relationship will evolve. It is important to bring awareness of the coming changes with respect to transparent anesthetic records, and we acknowledge that there will be challenges in implementation. We provide a list of summary recommendations for implementing open anesthetic records in Table. While these recommendations are a start, they are by no means all-encompassing.

Primarily, anesthetic records are different from any other clinical note type. These records can be difficult to understand for non-anesthesia medical professionals let alone patients. Anesthesiologists should consider providing basic anesthesia literacy to their patients in anticipation of the layperson accessing their own anesthetic records. This education includes discussing the need for intraoperative labs, differing goals of intraoperative lab values (which may be significantly different from “normal” ranges, i.e., ACT values), and the eventual incorporation of those labs into open records. For example, a slightly elevated INR may be inconsequential to the anesthesiologist but may raise questions to a parent following their child's lab results in real-time. Groups may want to consider holding off on the release of intraoperative labs until after the surgical procedure has been completed so that providers are available to answer questions about released medical records

When implementing open anesthetic records, the nuances of anesthetic note types should also be examined. In some systems, preoperative evaluations are often a work in progress and are not finalized until the day of surgery. A pre-anesthesia clinic note may differ from the pre-anesthesia evaluation the day of surgery once new medical information is available. We recommend a disclosure statement be made that not all information (i.e., labs, imaging) reviewed by anesthesiologists are copied in the preoperative note. The timely release of preoperative notes will depend on the culture of the anesthesia system. With regard to trainee notes, the OpenNotes culture has historically released notes after final signature from the supervisory physician. However, many intraoperative anesthetic records have a supervisory physician “attest,” which can be at any time during the case. Accordingly, the release of notes when the supervising physician “attests” or “signs” may not be appropriate for anesthetic record workflows. Institutions should exercise caution when implementing blanket rules for note release. Lastly, many anesthetic records have historically been documented in paper charts prior to the implementation of electronic charting. The decision for retrospective openness to anesthetic records and the technical feasibility of sharing older paper records through electronic format should be weighed by each anesthesia group.

Open anesthetic records documenting anesthesia-related procedures and detailing adverse events will also uncover challenges. Difficult line placements or numerous block/neuraxial attempts will become very public to the patient now. Teaching programs, in particular, have to be sensitive to the needs of the patient while balancing trainee procedural education. Adverse events and poor outcomes will all likely be published unless they are flagged by the provider because they fall into the Cures Act exception categories ( asamonitor.pub/3kjYWEh ). In these instances, consider building in a “hold release” option for providers who may want to delay or block the release of anesthetic records during certain circumstances.

While reviewing their records, patients may seek out clarifications or answers. Patients may also find inaccuracies in their notes, for example an incorrect preoperative medical condition listed, and they will seek to rectify it. Currently, most anesthesia providers do not have ways for patients to easily contact them with questions or concerns regarding their anesthetic care, like a formal answering service. At minimum, some systems may want to consider a “Frequently Asked Questions” link or attachment with the open anesthetic records. Others may want to have a more traditional electronic or telephone contact service to address patient inquiries and have workflows in place to address and correct errors. All follow-up communication with the patient should be documented in their medical records.

Open anesthetic records may empower patients. Armed with previous anesthetic records, patients may be better prepared to communicate prior adverse events or side effects. We may also see more patients who seek the same “cocktail” of anesthetics that were provided to them in the past or may ask for the same anesthesia providers who have cared for them. Overall, patients should be able to better communicate their satisfaction or dissatisfaction with prior anesthetic experiences. Anesthesia providers will also have access to a wealth of important information, like airway management details, from prior out-of-network anesthetic records.

Future iterations of transparent anesthetic records will have to rely on feedback from patients and anesthesia providers. With the roll-out of open anesthetic records, we can also learn about special considerations for anesthesia subspecialties like pediatrics, obstetrics, and regional. For example, the release of ultrasound images captured while performing a nerve block or transesophageal echocardiogram may alter workflows. Future studies that evaluate patient engagement with their anesthetic records and follow-up communication with their anesthesia providers could provide many valuable insights. Depending on a practice's EHR build, released anesthetic record contents will vary. Patients will experience inter-practice information inequality, and these differences may call for further standardization of released anesthesia records. Implementation of open anesthetic records may even inspire a complete redesign of how anesthetic records are presented to make it easier for the layperson to comprehend. Overall, we hope open anesthesia records will further empower our patients, improve their satisfaction, and improve the quality of services we provide.

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