Samuel Wald

All Publications

• Perceptions of Use of Names, Recognition of Roles, and Teamwork After Labeling Surgical Caps. JAMA network open Wong, B. J., Nassar, A. K., Earley, M., Chen, L., Roman-Micek, T., Wald, S. H., Shanafelt, T. D., Goldhaber-Fiebert, S. N. 2023; 6 (11): e2341182

  Abstract

  Communication failures in perioperative areas are common and have negative outcomes for both patients and clinicians. Names and roles of teammates are difficult to remember or discern contributing to suboptimal communication, yet the utility of labeled surgical caps with names and roles for enhancing perceived teamwork and connection is not well studied.To evaluate the use of labeled surgical caps in name use and role recognition, as well as teamwork and connection, among interprofessional perioperative teammates.In this quality improvement study, caps labeled with names and roles were distributed to 967 interprofessional perioperative clinicians, along with preimplementation and 6-month postimplementation surveys. Conducted between July 8, 2021, and June 25, 2022, at a single large, academic, quaternary health care center in the US, the study comprised surgeons, anesthesiologists, trainees, and all interprofessional hospital staff who work in adult general surgery perioperative areas.Labeled surgical caps were offered cost-free, although not mandatory, to each interested clinician.Quantitative survey of self-reported frequency for name use and role recognition as well as postimplementation sense of teamwork and connection. The surveys also elicited free response comments.Of the 1483 eligible perioperative clinicians, 967 (65%; 387 physicians and 580 nonphysician staff; 58% female) completed preimplementation surveys and received labeled caps, and 243 of these individuals (51% of physicians and 8% of staff) completed postimplementation surveys. Pre-post results were limited to physicians, due to the low postsurvey staff response rate. The odds of participants reporting that they were often called by their name increased after receiving a labeled cap (adjusted odds ratio [AOR], 13.37; 95% CI, 8.18-21.86). On postsurveys, participants reported that caps with names and roles substantially improved teamwork (80%) and connection (79%) with teammates. Participants who reported an increased frequency of being called by their name had higher odds for reporting improved teamwork (AOR, 3.46; 95% CI, 1.91-6.26) and connection with teammates (AOR, 3.21; 95% CI, 1.76-5.84). Free response comments supported the quantitative data that labeled caps facilitated knowing teammates' names and roles and fostered a climate of wellness, teamwork, inclusion, and patient safety.The findings of this quality improvement study performed with interprofessional teammates suggest that organizationally sponsored labeled surgical caps was associated with improved teamwork, indicated by increased name use and role recognition in perioperative areas.

  View details for DOI 10.1001/jamanetworkopen.2023.41182

  View details for PubMedID 37976068

• Improving Operating Room Efficiency Through Reducing First Start Delays in an Academic Center. Journal for healthcare quality : official publication of the National Association for Healthcare Quality Singh, D., Cai, L., Watt, D., Scoggins, E., Wald, S., Nazerali, R. 2023

  Abstract

  BACKGROUND: Delays in operating room (OR) first-case start times can cause additional costs for hospitals, healthcare team frustration and delay in patient care. Here, a novel process improvement strategy to improving first-case start times is presented.METHODS: First case in room start times were recorded for ORs at an academic medical center. Three interventions-automatic preoperative orders, dot phrases to permit re-creation of unavailable consent forms, and improved H&P linking to the surgical encounter-were implemented to target documentation-related delays. Monthly percentages of first-case on-time starts (FCOTS) and time saved were compared with the "preintervention" time period, and total cost savings were estimated.RESULTS: During the first 3-months after implementation of the interventions, the percentage of FCOTS improved from an average of 36.7%-52.7%. Total time savings across all ORs over the same time period was found to be 55.63 hours, which is estimated to have saved a total of $121,834.52 over the 3-month interventional period.CONCLUSIONS: By implementing multiple quality improvement interventions, delays to first start in room OR cases can be meaningfully reduced. Quality improvement protocols targeted toward root causes of OR delays can be a significant driver to reduce healthcare costs.

  View details for DOI 10.1097/JHQ.0000000000000398

  View details for PubMedID 37596242

• Single Institution's Plastic Surgery Case Trends and Considerations in the Midst of COVID-19. Plastic and reconstructive surgery Ma, I. T., Dayani, F., Yesantharao, P., Chang, J., Hawn, M. T., Wald, S., Lee, G. K., Nazerali, R. 2021

  View details for DOI 10.1097/PRS.0000000000008657

  View details for PubMedID 34878421

• COVID-19 Preoperative Assessment and Testing: From Surge to Recovery. Annals of surgery Lu, A. C., Schmiesing, C. A., Mahoney, M., Cianfichi, L., Semple, A. K., Watt, D., Fischer, S., Wald, S. H. 2020

  View details for DOI 10.1097/SLA.0000000000004124

  View details for PubMedID 32541233

• Asymptomatic SARS-CoV-2 Transmission from Community Contacts in Healthcare Workers. Annals of surgery Graham, L. A., Maldonado, Y. A., Tompkins, L. S., Wald, S. H., Chawla, A., Hawn, M. T. 2020

  View details for DOI 10.1097/SLA.0000000000003968

  View details for PubMedID 32487801

• COVID-19: Common Critical and Practical Questions. Anesthesia and analgesia Lu, A. C., Sastry, S. G., Wong, B. J., Deng, A., Wald, S. H., Pearl, R. G., Tsui, B. C. 2020

  View details for DOI 10.1213/ANE.0000000000004938

  View details for PubMedID 32366770

• N95 Respirator Alternatives And Conservation Strategies. Anesthesia and analgesia Wong, B. J., Lu, A. C., Tarlow, B. D., Tompkins, L. S., Chawla, A. n., Pearl, R. G., Wald, S. H. 2020

  View details for DOI 10.1213/ANE.0000000000005134

  View details for PubMedID 32701549

• Determination of Length of Time for "Post-Aerosol Pause" for Patients Under Investigation or Positive for COVID-19. Anesthesia and analgesia Wald, S. H., Arthofer, R. n., Semple, A. K., Bhorik, A. n., Lu, A. C. 2020

  View details for DOI 10.1213/ANE.0000000000004921

  View details for PubMedID 32345854

  View details for PubMedCentralID PMC7202114

• A Framework for Prioritizing Head and Neck Surgery during the COVID-19 Pandemic. Head & neck Topf, M. C., Shenson, J. A., Holsinger, F. C., Wald, S. H., Cianfichi, L. J., Rosenthal, E. L., Sunwoo, J. B. 2020

  Abstract

  The COVID-19 pandemic has placed an extraordinary demand on the United States healthcare system. Many institutions have cancelled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent - proceed with surgery, less urgent - consider postpone >30 days, less urgent - consider postpone 30-90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/hed.26184

  View details for PubMedID 32298036

• Resuscitation on collapsed healthcare worker while taking care of suspected or confirmed COVID patient: Questions and Answers. Anesthesia and analgesia Lu, A. C., Wong, B. J., Sastry, S. G., Wald, S. H., Pearl, R. G., Tsui, B. C. 2020

  View details for DOI 10.1213/ANE.0000000000005136

  View details for PubMedID 32701548

• Commentary: How Should Hospitals Respond to Surgeons' Requests to Schedule Overlapping Surgeries? Neurosurgery Morris, A. J., Mello, M. M., Sanford, J. A., Green, R. B., Wald, S. H., Kadry, B., Macario, A. 2018; 82 (4): E91–E98

  View details for PubMedID 29351634

• Commentary: How Should Hospitals Respond to Surgeons' Requests to Schedule Overlapping Surgeries? NEUROSURGERY Morris, A. J., Mello, M. M., Sanford, J. A., Green, R. B., Wald, S. H., Kadry, B., Macario, A. 2018; 82 (4): E91–E97

  View details for DOI 10.1093/neuros/nyx627

  View details for Web of Science ID 000439686300003

• Overlapping Surgery: A Case Study in Operating Room Throughput and Efficiency. Anesthesiology clinics Morris, A. J., Sanford, J. A., Damrose, E. J., Wald, S. H., Kadry, B. n., Macario, A. n. 2018; 36 (2): 161–76

  Abstract

  A keystone of operating room (OR) management is proper OR allocation to optimize access, safety, efficiency, and throughput. Access is important to surgeons, and overlapping surgery may increase patient access to surgeons with specialized skill sets and facilitate the training of medical students, residents, and fellows. Overlapping surgery is commonly performed in academic medical centers, although recent public scrutiny has raised debate about its safety, necessitating monitoring. This article introduces a system to monitor overlapping surgery, providing a surgeon-specific Key Performance Indicator, and discusses overlapping surgery as an approach toward OR management goals of efficiency and throughput.

  View details for DOI 10.1016/j.anclin.2018.01.002

  View details for PubMedID 29759280

• Into the Wilderness?: The Growing Importance of Nonoperating Room Anesthesia Care in the United States. Anesthesia and analgesia Lu, A. C., Wald, S. H., Sun, E. C. 2017; 124 (4): 1044–46

  View details for PubMedID 28319544

• Unexpected Profound Hypotension During Sinus Surgery SIMULATION IN HEALTHCARE-JOURNAL OF THE SOCIETY FOR SIMULATION IN HEALTHCARE Wang, C., Myo, C. C., Kuchta, K., Wald, S. H. 2012; 7 (1): 54-60

  View details for DOI 10.1097/SIH.0b013e318223d755

  View details for Web of Science ID 000300414000010

  View details for PubMedID 21937964

• Economic Advantages to a Distraction Decision Tree Model for Management of Neonatal Upper Airway Obstruction PLASTIC AND RECONSTRUCTIVE SURGERY Kohan, E., Hazany, S., Roostaeian, J., Allam, K., Head, C., Wald, S., Vyas, R., Bradley, J. P. 2010; 126 (5): 1653-1665

  View details for DOI 10.1097/PRS.0b013e3181ef8e82

  View details for Web of Science ID 000283844700030

• Dexmedetomidine and ketamine for fiberoptic intubation in a child with severe mandibular hypoplasia JOURNAL OF CLINICAL ANESTHESIA Iravani, M., Wald, S. H. 2008; 20 (6): 455-457

  Abstract

  A 6-year-old girl with Treacher Collins syndrome presented for implantation of a hearing device. The patient was developmentally delayed and had severe micrognathia. After induction of anesthesia with dexmedetomidine and ketamine, the patient tolerated the introduction of a flexible fiberoptic bronchoscope without any change in respiration, and intubation was achieved easily.

  View details for DOI 10.1016/j.jclinane.2008.03.012

  View details for Web of Science ID 000260134200011

  View details for PubMedID 18929288

• Successful blood conservation during craniosynostotic correction with dual therapy using procrit and cell saver JOURNAL OF CRANIOFACIAL SURGERY Krajewski, K., Ashley, R. K., Pung, N., Wald, S., Lazareff, J., Kawamoto, H. K., Bradley, J. P. 2008; 19 (1): 101-105

  Abstract

  Craniosynostotic correction typically performed around infant physiologic nadir of hemoglobin (approximately 3-6 months of age) is associated with high transfusion rates of packed red blood cells and other blood products. As a blood conserving strategy, we studied the use of 1) recombinant human erythropoietin or Procrit (to optimize preoperative hematocrit) and 2) Cell Saver (to recycle the slow, constant ooze of blood during the prolonged case).UCLA Patients with craniosynostosis from 2003-2005 were divided into 1) the study group (Procrit and Cell Saver) or 2) the control group (n = 79). The study group 1) received recombinant human erythropoietin at 3 weeks, 2 weeks, and 1 week preoperatively and 2) used Cell Saver intraoperatively. Outcomes were based on morbidities and transfusion rate comparisons.The 2 groups were comparable with regards to age (5.66 and 5.71 months), and operative times (3.11 vs 2.59 hours). In the study group there was a marked increase in preoperative hematocrit (56.2%). The study group had significantly lower transfusions rates (5% vs 100% control group) and lower volumes transfused than in the control group (0.05 pediatric units vs 1.74 pediatric units). Additionally, of the 80% of patients in the study group who received Cell Saver blood at the end of the case, approximately 31% would have needed a transfusion if the recycled blood were unavailable.Our data showed that for elective craniosynostotic correction, successful blood conserving dual therapy with Procrit and Cell Saver might be used to decrease transfusion rates and the need for any blood products.

  View details for Web of Science ID 000252619900016

  View details for PubMedID 18216672

• Scenario and checklist for airway rescue during pediatric sedation. Simulation in healthcare Chen, M. I., Edler, A., Wald, S., Dubois, J., Huang, Y. M. 2007; 2 (3): 194-198

  View details for DOI 10.1097/SIH.0b013e3181461b60

  View details for PubMedID 19088623

• Continuous monitoring of dynamic pulmonary compliance enables detection of endobronchial intubation in infants and children ANESTHESIA AND ANALGESIA Mahajan, A., Hoftman, N., Hsu, A., Schroeder, R., Wald, S. 2007; 105 (1): 51-56

  Abstract

  Auscultation of breath sounds is used routinely to confirm tracheal placement of endotracheal tubes (ETT). In infants and children, this method is limited by the conduction of breath sounds bilaterally, despite endobronchial intubation. Although several methods of detecting endobronchial intubation have been described, none is both simple and reliable. In this investigation, we determined whether changes in pulmonary compliance and airway pressures, measured using continuous side stream spirometry, can reliably detect endobronchial intubation in pediatric patients.Forty patients aged 1 month to 6 years were included. After endotracheal intubation the ETT was incrementally advanced as two observers monitored breath sounds and spirometry (Pressure-Volume Loops). Changes in pulmonary compliance, peak inspiratory pressure, or auscultation were reported, at which point ETT position was confirmed by fiberoptic bronchoscopy.Endobronchial intubation decreased measured pulmonary compliance by 45 +/- 11% (mean +/- sd; P < 0.001, Range 26%-66%) and increased peak airway pressures by 26 +/- 17% (mean +/- sd; P < 0.001, Range 0-87). Changes in peak airway pressures were smaller and more variable when compared to changes in compliance. Breath-sound auscultation failed to detect endobronchial intubation in 7.5% of cases.Pulmonary compliance changes are a sensitive and an accurate indicator of endobronchial intubation in infants and children. Both increased peak airway pressures and changes in breath sounds are less sensitive indicators of endobronchial intubation.

  View details for DOI 10.1213/01.ane.0000268119.55909.b4

  View details for Web of Science ID 000247444800016

  View details for PubMedID 17578956

• Experience with the Arndt paediatric bronchial blocker BRITISH JOURNAL OF ANAESTHESIA Wald, S. H., Mahajan, A., Kaplan, M. B., Atkinson, J. B. 2005; 94 (1): 92-94

  Abstract

  Previously reported techniques for single lung ventilation in children have failed to provide consistent, single lung ventilation with relative ease and reliability. We report our experience with the use of a new device, the Arndt 5 French (Fr) paediatric endobronchial blocker, for single lung ventilation in a series of 24 children. We were able to achieve single lung ventilation in 23 of the 24 patients (aged 2-16 yr). Placement required approximately 5-15 min. Attempts at placement were aborted in one patient who was unable to tolerate even short periods of apnoea because of lung pathology. Although it has some limitations, our experience suggests that the paediatric bronchial blocker can be used as a consistent, safe method of single lung ventilation in most young children.

  View details for DOI 10.1093/bja/aeh292

  View details for Web of Science ID 000226415700016

  View details for PubMedID 15486004