Richard H Epstein

Summary

Affiliation: Thomas Jefferson University
Country: USA

Publications

  1. doi request reprint Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA
    Anesthesiology 116:683-91. 2012
  2. ncbi request reprint Implications of resolved hypoxemia on the utility of desaturation alerts sent from an anesthesia decision support system to supervising anesthesiologists
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA 19107, USA
    Anesth Analg 115:929-33. 2012
  3. pmc Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data
    Franklin Dexter
    Department of Anesthesia, University of Iowa, Iowa City, 52242, USA
    BMC Med Inform Decis Mak 11:2. 2011
  4. doi request reprint Development of a staff recall system for mass casualty incidents using cell phone text messaging
    Richard H Epstein
    Department of Anesthesiology, Thomas Jefferson University Hospital, 111 S 11th St, Suite 5480G, Philadelphia, PA 19107, USA
    Anesth Analg 110:871-8. 2010
  5. doi request reprint Automated correction of room location errors in anesthesia information management systems
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    Anesth Analg 107:965-71. 2008
  6. ncbi request reprint Anesthesia information management systems: a survey of current implementation policies and practices
    Richard H Epstein
    Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
    Anesth Analg 105:405-11. 2007
  7. ncbi request reprint Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    Anesth Analg 105:1053-60, table of contents. 2007
  8. doi request reprint Implications of event entry latency on anesthesia information management decision support systems
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA
    Anesth Analg 108:941-7. 2009
  9. doi request reprint Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit
    Jesse M Ehrenfeld
    From the Departments of Anesthesiology and Bioinformatics and Surgery, Vanderbilt University, Nashville, Tennessee Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa Department of Nursing, Vanderbilt University Medical Center Departments of Anesthesiology, Bioinformatics, and Surgery, Vanderbilt University Medical Center, Nashville, Tennessee and Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania
    Anesth Analg 117:1444-52. 2013
  10. doi request reprint Case cancellation rates measured by surgical service differ whether based on the number of cases or the number of minutes cancelled
    Jesse M Ehrenfeld
    CPHIDepartment of Anesthesiology, Jefferson Medical College, 111 S 11th St, Suite, 6215F Gibbon Bldg, Philadelphia, PA 19107
    Anesth Analg 117:711-6. 2013

Detail Information

Publications40

  1. doi request reprint Influence of supervision ratios by anesthesiologists on first-case starts and critical portions of anesthetics
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA
    Anesthesiology 116:683-91. 2012
    ..A simulation study showed peak occurrence of critical portions during first cases, and frequent supervision lapses. These predictions were tested using real data from an anesthesia information management system...
  2. ncbi request reprint Implications of resolved hypoxemia on the utility of desaturation alerts sent from an anesthesia decision support system to supervising anesthesiologists
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA 19107, USA
    Anesth Analg 115:929-33. 2012
    ..As part of a voluntary application for an investigative device exemption from our IRB to implement such functionality, we evaluated the maximum potential utility of such an alert system...
  3. pmc Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data
    Franklin Dexter
    Department of Anesthesia, University of Iowa, Iowa City, 52242, USA
    BMC Med Inform Decis Mak 11:2. 2011
    ....
  4. doi request reprint Development of a staff recall system for mass casualty incidents using cell phone text messaging
    Richard H Epstein
    Department of Anesthesiology, Thomas Jefferson University Hospital, 111 S 11th St, Suite 5480G, Philadelphia, PA 19107, USA
    Anesth Analg 110:871-8. 2010
    ..Because cell phone use is widespread within the department, we developed and tested a staff recall system, based in our anesthesia information management system (AIMS), using Short Message Service (SMS) text messaging...
  5. doi request reprint Automated correction of room location errors in anesthesia information management systems
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    Anesth Analg 107:965-71. 2008
    ..Because of automatic documentation, AIMS would be ideal platforms for OR managerial decision support if the correct locations of cases in progress were known accurately. Trust is diminished if recommendations are poor...
  6. ncbi request reprint Anesthesia information management systems: a survey of current implementation policies and practices
    Richard H Epstein
    Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
    Anesth Analg 105:405-11. 2007
    ....
  7. ncbi request reprint Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    Anesth Analg 105:1053-60, table of contents. 2007
    ..Although such transactions occur innocently during the course of normal clinical care, many are suspicious for diversion...
  8. doi request reprint Implications of event entry latency on anesthesia information management decision support systems
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA
    Anesth Analg 108:941-7. 2009
    ..DSS performance is impacted by latency from the actual time an event occurs to when it is written to the database, as well as how often the database is queried. Such latencies may result in poor DSS recommendations...
  9. doi request reprint Lack of utility of a decision support system to mitigate delays in admission from the operating room to the postanesthesia care unit
    Jesse M Ehrenfeld
    From the Departments of Anesthesiology and Bioinformatics and Surgery, Vanderbilt University, Nashville, Tennessee Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa Department of Nursing, Vanderbilt University Medical Center Departments of Anesthesiology, Bioinformatics, and Surgery, Vanderbilt University Medical Center, Nashville, Tennessee and Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania
    Anesth Analg 117:1444-52. 2013
    ..e., neither too late nor too early to act upon) and the PACU slot can be cleared quickly. We evaluated the maximum potential benefit of such a system, using assumptions deliberately biased toward showing utility...
  10. doi request reprint Case cancellation rates measured by surgical service differ whether based on the number of cases or the number of minutes cancelled
    Jesse M Ehrenfeld
    CPHIDepartment of Anesthesiology, Jefferson Medical College, 111 S 11th St, Suite, 6215F Gibbon Bldg, Philadelphia, PA 19107
    Anesth Analg 117:711-6. 2013
    ..It is unknown whether there is a difference between these 2 methods...
  11. doi request reprint Explanation for the near-constant mean time remaining in surgical cases exceeding their estimated duration, necessary for appropriate display on electronic white boards
    Vikram Tiwari
    Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
    Anesth Analg 117:487-93. 2013
    ..We test the hypothesis that, with an accurate probabilistic model, until closure begins the estimated mean time remaining would be the mean time from the start of closure to OR exit...
  12. doi request reprint Increased mean time from end of surgery to operating room exit in a historical cohort of cases with prolonged time to extubation
    Franklin Dexter
    From the Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa and Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania
    Anesth Analg 117:1453-9. 2013
    ..We quantified the increases in the mean times from end of surgery to exit from the OR associated with prolonged extubations and tested whether the increases were economically important (≥ 5 minutes)...
  13. doi request reprint Role of communication systems in coordinating supervising anesthesiologists' activities outside of operating rooms
    Bettina Smallman
    Department of Anesthesiology, State University of New York Upstate, Syracuse, NY, USA
    Anesth Analg 116:898-903. 2013
    ..We evaluated the maximal potential of communication systems to increase the productivity of anesthesia care by enhancing anesthesiologists' coordination of care (activities) among operating rooms (ORs)...
  14. doi request reprint Validation of a system to detect scheduled drug diversion by anesthesia care providers
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University Hospital, 111 South 11th St, Suite 6215F, Philadelphia, PA 19107, USA
    Anesth Analg 113:160-4. 2011
    ..In this report, we demonstrate prospectively the utility of our methodology to detect diversion by unsuspected individuals...
  15. doi request reprint Anesthesia information management system implementation: a practical guide
    Stanley Muravchick
    Department of Anesthesiology and Critical Care, Dulles Suite 680, 3400 Spruce Street, Philadelphia, PA 19104 4283, USA
    Anesth Analg 107:1598-608. 2008
    ..This collaborative effort summarizes essential considerations for successful AIMS implementation, including product evaluation, assessment of information technology needs, resource availability, leadership roles, and training...
  16. doi request reprint Communication latencies of wireless devices suitable for time-critical messaging to anesthesia providers
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, 111 South 11th St, Suite 6215F, Philadelphia, PA 19107, USA
    Anesth Analg 116:911-8. 2013
    ..The most time-critical communications determine maximum acceptable latencies. We studied the reliability of several alphanumeric messaging systems to identify an appropriate technology for such use...
  17. doi request reprint The design and implementation of an automated system for logging clinical experiences using an anesthesia information management system
    Allan Simpao
    Department of Anesthesiology, Jefferson Medical College, 111 South 11th St, Philadelphia, PA 19107, USA
    Anesth Analg 112:422-9. 2011
    ..We based our analysis on the data reporting requirements of the American College of Graduate Medical Education (ACGME)...
  18. doi request reprint Adoption of anesthesia information management systems by academic departments in the United States
    Christoph B Egger Halbeis
    Department of Anesthesiology, Stanford UniversitySchool of Medicine, Stanford, California, 300 Pasteur Drive, Stanford, CA 94305, USA
    Anesth Analg 107:1323-9. 2008
    ..In this study, we assessed the adoption of AIMS at academic anesthesia departments and explored the motivations for and resistance to AIMS adoption...
  19. ncbi request reprint Uncertainty in knowing the operating rooms in which cases were performed has little effect on operating room allocations or efficiency
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    Anesth Analg 95:1726-30, table of contents. 2002
    ..We conclude that, in most circumstances, data-cleaning steps to resolve uncertainty in OR locations are not necessary to make accurate OR allocations...
  20. ncbi request reprint Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency
    Amr E Abouleish
    Department of Anesthesiology, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555 0591, USA
    Anesth Analg 96:1109-13, table of contents. 2003
    ..The group can then use these estimates when negotiating for subsidies with its hospital, medical school, or multispecialty medical group...
  21. doi request reprint Mean arterial pressures bracketing prolonged monitoring interruptions have negligible systematic differences from matched controls without such gaps
    Richard H Epstein
    Department of Anesthesia, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
    Anesth Analg 113:267-71. 2011
    ..We studied whether ignoring missing vital signs during gaps systematically biases monitoring results...
  22. ncbi request reprint Statistical power analysis to estimate how many months of data are required to identify PACU staffing to minimize delays in admission from ORs
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA
    J Perianesth Nurs 17:84-8. 2002
    ..Tampering with PACU staffing more often than every 4 months is unlikely to result in improvements in OR efficiency and may harm recruitment and retention of nursing staff...
  23. pmc Automated identification of drug and food allergies entered using non-standard terminology
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA
    J Am Med Inform Assoc 20:962-8. 2013
    ..Our goal was to develop a high-performance, easily maintained algorithm to identify medication and food allergies and sensitivities from unstructured allergy entries in electronic health record (EHR) systems...
  24. ncbi request reprint Statistical power analysis to estimate how many months of data are required to identify operating room staffing solutions to reduce labor costs and increase productivity
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, and Medical Data Applications, Ltd, USA
    Anesth Analg 94:640-3; table of contents. 2002
    ..When applied routinely for adjusting staffing (e.g., on a quarterly basis), 9 to 12 mo of data should be used...
  25. doi request reprint Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday
    Richard H Epstein
    Department of Anesthesiology, Jefferson Medical College, Philadelphia, PA, USA
    Can J Anaesth 60:1070-6. 2013
    ..Principally, this has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. We tested hypotheses relevant to the economic benefit of avoiding prolonged tracheal extubation times...
  26. pmc Metabolic syndrome increases risk for pulmonary embolism after hip and knee arthroplasty
    Boris Mraovic
    Boris Mraovic, MD, Associate Professor, Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, 111 South 11th Street Suite G8280, Philadelphia, PA 19107, USA
    Croat Med J 54:355-61. 2013
    ..To investigate whether patients with metabolic syndrome (MetS) undergoing total hip or knee replacement have an increased risk for pulmonary embolism (PE)...
  27. doi request reprint Communication latencies of Apple push notification messages relevant for delivery of time-critical information to anesthesia providers
    Brian S Rothman
    Division of Multispecialty Adult Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
    Anesth Analg 117:398-404. 2013
    ..In this study, we assessed the reliability of the APN service...
  28. doi request reprint Root causes of intraoperative hypoglycemia: a case series
    Eric S Schwenk
    Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
    J Clin Anesth 24:625-30. 2012
    ..To describe the root causes of intraoperative hypoglycemic events...
  29. ncbi request reprint Optimizing second shift OR staffing
    Franklin Dexter
    Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, USA
    AORN J 77:825-30. 2003
    ..Managers do not need hospital information systems staff members to provide data from both anesthesia billing and OR information systems to make second-shift staffing decisions. One or the other is adequate...
  30. ncbi request reprint Scheduling of cases in an ambulatory center
    Franklin Dexter
    Department of Anesthesia, University of Iowa College of Medicine, 6 John Colloton Pavillon, Iowa City, IA 52242, USA
    Anesthesiol Clin North America 21:387-402. 2003
    ..In contrast, OR allocation decisions tend to be different than what OR managers do in practice. This means that it is important to apply the statistical methods for allocating OR time...
  31. ncbi request reprint Holiday and weekend operating room on-call staffing requirements
    Franklin Dexter
    Department of Anesthesia and Health Management and Policy, University of Iowa, Iowa City, IA 52242, USA
    Anesth Analg 103:1494-8. 2006
    ..Every facility that performs cases on holidays has in some way decided on its operating room (OR) and anesthesia staffing for holidays. Previous studies have not examined how best to calculate appropriate holiday staffing...
  32. doi request reprint Calculating institutional support that benefits both the anesthesia group and hospital
    Franklin Dexter
    Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, IA 52242, USA
    Anesth Analg 106:544-53, table of contents. 2008
    ..e., OR allocations). Such an agreement creates incentives whereby the hospital and anesthesia group both profit from increased OR workload and from more accurate specialty-specific staffing...
  33. ncbi request reprint Validity and usefulness of a method to monitor surgical services' average bias in scheduled case durations
    Franklin Dexter
    Division of Management Consulting, Department of Anesthesia, 6 JCP, University of Iowa, Iowa City, Iowa 52242, USA
    Can J Anaesth 52:935-9. 2005
    ..We describe a method to monitor surgical services' average bias in scheduled case durations...
  34. ncbi request reprint Validation of statistical methods to compare cancellation rates on the day of surgery
    Franklin Dexter
    Division of Management Consulting and Department of Anesthesia, University of Iowa, Iowa City 52242, USA
    Anesth Analg 101:465-73, table of contents. 2005
    ..Conversely, if inappropriate statistical methods are used, administrators may claim success at reducing cancellation rates when, in fact, the problem remains unresolved, affecting patients and clinicians...
  35. ncbi request reprint Estimating the incidence of prolonged turnover times and delays by time of day
    Franklin Dexter
    Division of Management Consulting, Department of Anesthesia, The University of Iowa, Iowa City, IA 52242, USA
    Anesthesiology 102:1242-8; discussion 6A. 2005
    ..Prolonged turnover times cause frustration and can thereby reduce professional satisfaction and the workload surgeons bring to a hospital...
  36. ncbi request reprint Strategies to reduce delays in admission into a postanesthesia care unit from operating rooms
    Franklin Dexter
    Division of Management Consulting, University of Iowa, Iowa City 52242, USA
    J Perianesth Nurs 20:92-102. 2005
    ..Such interventions should be considered only if statistical analysis, performed by using computer simulation, has established that reducing PACU length of stay will reduce delays in admission at a manager's facility...
  37. ncbi request reprint Making management decisions on the day of surgery based on operating room efficiency and patient waiting times
    Franklin Dexter
    Department of Anesthesia and Health Management and Policy, The University of Iowa, Iowa City, USA
    Anesthesiology 101:1444-53. 2004
    ..Future studies should focus on using real-time display of data to reduce patient waiting...
  38. ncbi request reprint Impact of reducing turnover times on staffing costs
    Franklin Dexter
    Anesth Analg 98:872. 2004
  39. ncbi request reprint Use of operating room information system data to predict the impact of reducing turnover times on staffing costs
    Franklin Dexter
    Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City 52242, USA
    Anesth Analg 97:1119-26, table of contents. 2003
    ....
  40. ncbi request reprint The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital
    Catherine McIntosh
    Department of Anaesthesia, John Hunter Hospital, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
    Anesth Analg 103:1499-516. 2006
    ..Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care...