#1 Fort Belvoir Project: Evaluation of Anesthetic Techniques for Endoscopic Retrograde Cholangiopancreatography (ERCP) - Determine the safest, most efficacious anesthetic technique for patients undergoing endoscopic retrograde cholangiopacreatography (ERCP) and pilot a change in practice at Fort Belvoir Community Hospital (FBCH).
Impact: Anesthesia providers were educated on evidence-based ERCP decision-support algorithm. All respondents to a follow up survey critically appraised the evidence and over 50% changed their practice as a result of the training which may improve patient safety and procedural success rates for ERCPs.
- Determined safest, most effective anesthetic approach for patients undergoing ERCP and pilot a practice change.
- Evidence-based ERCP decision-support algorithm created, anesthesia providers educated and follow-up survey demonstrated that >50% of providers changed their practice.
#2 Naval Station Norfolk - Portsmouth Project: Use of Manometry in the OR for Guiding Endotracheal Tube Cuff Inflation - A systematic literature review of the utility of manometry-guided endotracheal tube cuff inflation with dissemination to stakeholders and sustainment via policy.
Impact: Evidence supports use of manometry in the operating room. Findings disseminated to Portsmouth NMC Anesthesia Department. Procedural and purchase information to implement and sustain manometry use made available to Department Chairperson.
- Explored usefulness of manometry-guided endotracheal tube (ET) cuff inflation.
- Manometry most effective way to assess and maintain ideal ET Cuff inflation pressure between 20-30 mmhg.
#3 Walter Reed National Military Medical Center Project: Measuring Competency in Ultrasound Guided Regional Anesthesia - Determine the feasibility and the usability of a Test-Specific Checklist and Global Rating Scale (GRS) in evaluating Ultrasound Guided Regional Anesthesia competency in CRNAs at Kimbrough Ambulatory Surgery Center (KACC), and secondarily evaluate inter-rater reliability of the checklist and GRS.
Impact: This project demonstrated that the checklist and GRS combination is a feasible and useful tool when used in the clinical setting, and that this tool could be easily integrated into the staffing/ credentialing policies at KACC.
- Determined feasibility/usability of a Test-Specific Checklist and Global Rating Scale (GRS) in evaluating CRNA Ultrasound Guided Regional Anesthesia competency. Evaluate inter-rater reliability of checklist and GRS.
- Checklist/GRS combination is feasible and useful in a clinical setting and tool could easily be integrated into MTF staffing/ credentialing policies.
#1 Ft Bragg, NC Project: “Evidence Based Practice for Low Back Pain" (CPT James Brown, LTC Brent Donmoyer, CPT Osaze Okoro, CPT Alison Patton, CPT Lisa Taylor)
Purpose: Retrospective record review evaluating if active duty service members with nonspecific, acute LBP were managed according to the 2007 VA/DoD LBP CPG.
Impact: Gaps in LBP treatment impairs readiness - pain inhibits a service members ability to perform duties.
CPG’s + clinical judgment optimizes care.
Appropriate implementation of LBP guidelines can contain healthcare costs.
#2 Joint Base Lewis McCord (JBLM), WA Project: “Clinical Standard of Practice in the Assessment and Diagnosing of Adults with Attention Deficit and Hyperactivity Disorder" (CPT Kimberly Genkov (Duenow), MAJ Timothy Wical, MAJ Jennifer Witt)
Purpose: Clinical process evaluation of how adults with ADHD are assessed and diagnosed by behavioral health and primary care providers.
Impact: Diagnostic inconsistencies between providers and clinics. Evidence-based education was provided to standardize ADHD diagnosis in adults.
#3 Wilford Hall, Joint Base San Antonio, TX Project: “Use of STOP-BANG Screening Questionnaire in Outpatient Setting: Increasing Both Identification of Obstructive Sleep Apnea and Polysomnography Referral Accuracy” (Maj Cherie Little, Capt Angela McElroy, Maj Kenneth Smith, Capt Alyssa Turner)
Purpose: Evaluate the use of an evidence-based screening tool for OSA in the primary care setting in increasing referral accuracy.
Impact: 60% increase in sleep medicine referral accuracy - potential savings of at least $405,000 annually.
#4 Daniel K. Inouye Graduate School of Nursing, Bethesda, MD Project:Effectiveness of trigger films in preparing students for high risk/low volume events*
Title: "Trigger Films in Nurse Anesthesia Education" (LCDR Christopher Grey, Capt Megan Hylton, Capt Laura Ransom)
Purpose: “Difficult airway trigger film” developed and evaluated for effectiveness in preparing students for high risk/low volume anesthesia events.
Impact: Trigger films reduced decision time in critical “can’t intubate/can’t ventilate” situations.