Dissertation Defense Announcements

Acute kidney injury (AKI) has been linked to intraoperative hypotension in previous studies. AKI may lead to prolonged recovery and hospital stays and complications such as chronic kidney disease. Factors associated with robotic surgery and enhanced recovery protocols (ERPs) may contribute to intraoperative hypotension. This quality improvement project aimed to explore the occurrence of AKI in robotic cases incorporating an ERP. The project design was a retrospective review of anesthesia records of robotic surgeries performed at Atrium Health (AH) Carolinas Medical Center (CMC) over a four-month period. Records were screened for the occurrence of hypotension. The charts of patients who experienced hypotension were then screened for a pre-operative and post-operative creatinine level. AKI was defined using the Kidney Disease Improving Guidelines (KDIGO). The sample size included 34 patients who experienced hypotension. The incidence of AKI was 5.88%. AKI did not differ by age, gender, ASA score, or procedure time.

To explain changes in users’ security behaviors and behavioral intentions, we investigated the different messaging approaches that followed the Protection Motivation Theory (PMT) design guidelines. These messaging approaches were used in different
security contexts in terms of authentication (e.g., using screen lock and Two Factor Authentication) and confidentiality (e.g., sharing sensitive information via secure email). As a part of our work, in the first approach, we investigated different risk appeal messaging designs based on PMT that were more suited for the Saudi population to adopt the screen lock. Our results showed that the Saudi-customized messaging
was extremely effective in changing our participants’ locking behavior. In the second approach, to encourage users to voluntarily adopt 2FA, we investigated whether video-based risk communication messages based on PMT would be received differently if they were delivered by a human speaker from the target population versus a cartoon speaker. Our evaluation showed that a video message from a human speaker
improved our participants’ behavior versus the animated speaker video message. Regarding the last approach, we first conducted a structured interview with Gmail users who had used Gmail’s Confidential Mode (GCM) to explore what motivated them
to use the confidential mode, what their perceptions were of confidential mode, and whether they understood the features of this mode for achieving confidentiality. We found that users used GCM to share their confidential or private documents with recipients and perceived GCM to be encrypted and confidential. Encouraged by these findings, we evaluated messaging approaches that followed the PMT and paired with
anticipated regret (PMT+AR) and planning techniques (PMT+AR+P) in persuading Gmail users to utilize an encrypted email (e.g., Virtru) for sharing their sensitive information. Our evaluation showed that both messaging approaches (PMT+AR and PMT+AR+P) increased the adoption rate of utilizing an encrypted email and motivated participants to use Virtru when they shared sensitive information via email. Therefore, our results offered further insights regarding how PMT video messaging incorporated with other elements can increase the likelihood that the actual behavior will be implemented.

The incidence of residual neuromuscular blockade (rNMB) following general anesthesia remains as high as 60%, placing patients at an increased risk of developing postoperative pulmonary complications (PPCs) (Saager et al., 2019). PPCs are associated with increased readmission rates, hospital length of stay, and overall morbidity and mortality (Kirmeier et al., 2019). A quality improvement project was conducted to examine anesthesia providers' current practice using sugammadex compared to evidenced base practice guidelines revealed throughout a comprehensive literature review. An anonymous survey was distributed among anesthesia providers throughout a level 1 trauma center to identify their current practice and knowledge regarding the use of sugammadex. Seventy-seven anesthesia providers completed the survey. Almost all providers correctly identified that sugammadex interferes with hormonal birth control, while only 58% were found to correctly dose sugammadex according to the patient's actual body weight. Thirty-seven percent of anesthesia providers revealed they avoid administering sugammadex in patients with kidney disease. A cognitive aid was developed and placed throughout the operating rooms, targeting knowledge gaps identified in the survey. This quality improvement project recommends continuing the analysis of current practice trends, as this will help inform and promote best practices consistent with contemporary literature.

There are a variety of distractions that can occur in the operating room during the induction of anesthesia. A review of the literature revealed that common distractions include: noise, music, cell phones and pagers, production pressure, and unnecessary conversations. This project is part of a larger quality improvement project investigating anesthesia providers’ perceptions of the frequencies and types of distractions occurring during induction at three different sites: an ambulatory surgery center, a mid-sized, suburban hospital, and a level one trauma center. This project focuses on identifying distraction severity and frequency at an ambulatory surgery center. An anonymous, electronic survey was distributed to physician anesthesiologists, certified registered nurse anesthetists (CRNAs), and student registered nurse anesthetists (SRNAs), at these three different clinical locations within a large healthcare system. The survey asked providers to rate perceived frequency and severity of selected distractions on a modified Likert scale. A total of thirteen anesthesia providers working at the ambulatory surgery center responded to the survey. The results show that conversations were found to be the most severely distracting while music and equipment alarms were equally found to be the least distracting. Females found music, conversations, and personal cell phone use to be more distracting than males. Younger anesthesia providers found equipment alarms to be more distracting than older anesthesia providers. Across the three site locations, survey comparison found no difference between results. The aim of this project is to discover what is distracting to anesthesia providers during anesthetic induction so that future projects can begin to mitigate the occurrence of these distractors and promote increased patient safety during the induction of anesthesia.