To the Editor,

Intraoperative anesthetic management has implications beyond the operating room.1 In most academic medical centres, a trainee’s encounter with a patient is typically limited to the intraoperative period, concluding with sign-out to postanesthesia care unit (PACU) staff. When sign-out has been completed, trainees return to the operating room to care for the next patient on their schedule. This workflow focused on efficiency offers little opportunity for residents to obtain feedback on their intraoperative anesthetic management. We designed a survey to elucidate practices and perceptions of postoperative care and feedback among anesthesia trainees and PACU nursing staff with specific focus on identifying gaps in postoperative follow-up.

Between 20 September and 15 October 2016, all anesthesiology residents and PACU nursing staff at Beth Israel Deaconess Medical Center, Boston, MA, USA, were invited to participate in the online survey. This survey was performed as the first step of a larger project aimed at creating an effective electronic perioperative feedback tool. The Institutional Committee on Clinical Investigations determined the survey exempt from review. Participation was voluntary, with no incentives, and anonymity of responses was maintained. Topics addressed include PACU handoff, knowledge of a patient’s PACU course, and patient follow-up practices (Supplement; available as Electronic Supplementary Material). Study data were collected and managed using the Research Electronic Data Capture survey tool. Responses are presented as descriptive statistics and median [interquartile range (IQR)]. SAS 9.3 (SAS Institute Inc., Cary, NC, USA) was used for all analyses.

Thirty-two residents (62%) and 32 nurses (53%) completed the survey. Perceptions of residents and nurses are presented in the Table. Residents more favorably perceived their awareness of postoperative pain control than the nurses with whom they worked. Both residents’ and nurses’ responses indicate that residents do not routinely follow up with patients in the PACU, either in person or electronically. Residents were unaware of the amount of pain medications or anti-emetics their patients required. They were unaware of whether their patient triggered a rapid response or experienced clinical delays in discharge from PACU. Residents however strongly agreed that this knowledge could influence their future anesthetics. Residents indicated that the workflow pattern served as a barrier to postoperative follow-up. Anesthesia trainees agreed strongly (90 [69-99] %) that they were interested in receiving automated feedback on their patients’ PACU course.

Table Resident and nursing perception of postoperative care
Full size table

Participant responses indicate that workflow was perceived by residents as a barrier to follow-up. Residents disagreed with statements regarding their knowledge of their patients’ postoperative care. Our findings suggest that trainees get a fragmented picture of their patients’ perioperative course and call for focusing our attention on this aspect of perioperative care. We acknowledge that our study has multiple limitations including a single-centre design, a modest response rate, and likely response bias. The variance in responses of residents and nurses potentially indicates a wide variety of practice patterns or difficulty with the generalizability of the survey questions. Although the survey was centred around our institutional practices, we argue that the trainees’ perceptions about lack of feedback surrounding PACU care may be representative of a larger gap in resident training. The few feedback tools designed for anesthesia trainees have focused exclusively on intraoperative management.2,3 Given the strong interest in receiving postoperative feedback, trainee engagement in building and implementing an automated tool could be considered a pragmatic next step in addressing this knowledge gap.