Clinical Assistant Professor, Anesthesiology, Perioperative and Pain Medicine
Board Certification: American Board of Anesthesiology, Anesthesia (2021)
Fellowship: Stanford University Anesthesiology Fellowships (2021) CA
Residency: Stanford University Anesthesiology Residency (2020) CA
Internship: Stanford University Internal Medicine Residency (2016) CA
Medical Education: The University of Chicago Pritzker School of Medicine (2015) IL
Expert Consensus Regarding Core Outcomes for Enhanced Recovery after Cesarean Delivery Studies: A Delphi study.
BACKGROUND: Heterogeneity among reported outcomes from enhanced recovery after cesarean delivery impact studies is high. This study aimed to develop a standardized enhanced recovery core outcome set for use in future enhanced recovery after cesarean delivery studies.METHODS: An international consensus study involving physicians, patients and a director of Midwifery and Nursing Services, was conducted using a three-round modified Delphi approach (2 rounds of electronic questionnaires and a 3rd round e-discussion), to produce the core outcome set. An initial list of outcomes was based on a previously published systematic review. Consensus was obtained for the final core outcome set, including definitions for key terms, and preferred units of measurement. Strong consensus was defined as ≥70% agreement and weak consensus as 50-69% agreement. Of the 64 stakeholders who were approached, 32 agreed to participate. All 32, 31 and 26 stakeholders completed Rounds 1, 2 and 3, respectively.RESULTS: The number of outcomes in the final core outcome set was reduced from 98 to 15. Strong consensus (≥70% stakeholder agreement) was achieved for 15 outcomes. The core outcome set included: length of hospital stay; compliance with enhanced recovery protocol; maternal morbidity (hospital re-admissions or unplanned consultations); provision of optimal analgesia (maternal satisfaction, compliance with analgesia, opioid consumption / requirement and incidence of nausea or vomiting); fasting times; breastfeeding success; and times to mobilization and urinary catheter removal. The Obstetric Quality of Recovery-10 item composite measure was also included in the final core outcome set. Areas identified as requiring further research included readiness for discharge and analysis of cost savings.CONCLUSIONS: Results from an international consensus to develop a core outcome set for enhanced recovery after cesarean delivery are presented. These are outcomes that could be considered when designing future enhanced recovery studies.
View details for DOI 10.1097/ALN.0000000000004263
View details for PubMedID 35511169
Assessing the Magnitude and Costs of Intraoperative Inefficiencies Attributable to Surgical Instrument Trays
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS
2014; 219 (4): 646-655
Efficiency in the operating room has become a topic of great interest. This study aimed to quantify the percent use of instruments among common instrument trays across 4 busy surgical services: Otolaryngology, Plastic Surgery, Bariatric Surgery, and Neurosurgery. We further aimed to calculate the costs associated with tray and instrument sterilization, as well as the implications of missing or damaged instruments.This was a single-site, observational study conducted on the surgical instrumentation at a large academic medical center in Chicago. Data were collected through direct observation by a trained investigator. Operating room instrument use and labor time required for cleaning and repacking instrument trays in central sterile processing (CSP) were analyzed using descriptive statistics and linear regression. Institutional data on volume and expenses were gathered from hospital leadership.Forty-nine procedures and 237 individual trays were observed. Average instrument (±SD)use rates were 13.0% for Otolaryngology (±4.2%), 15.5% for Plastic Surgery (±2.9%), 18.2% for Bariatric Surgery (±5.0%), and 21.9% for Neurosurgery (±1.7%). An increasing number of instruments per tray was associated with decreased use and increased instrument error rate. Using recorded labor time, the cost of cleaning and repackaging an individual instrument was calculated to be $0.10. Adding in CSP operating expenses and instrument depreciation per use, total processing cost per instrument increases to $0.51 or more.Our study demonstrates that the percent use of instruments across surgical specialties and multiple tray types is low. Attention to tray composition may result in immediate and significant cost savings.
View details for DOI 10.1016/j.jamcollsurg.2014.06.019
View details for Web of Science ID 000342422500008
View details for PubMedID 25154669