Continuity of Care in the Training Environment: Anesthesiology Residency in the Ambulatory Surgery Setting

Anesthesiology residents acquire clinical skills and acumen primarily from experience providing anesthesia for procedural cases, with prior preparation maximizing learning. Ambulatory surgery and associated management styles create fluid anesthesiology staffing-reducing predictability for learners and disrupting continuity of care. This prospective, observational study aimed to quantify anesthesia personnel changes in the operating rooms of a single teaching hospital. For a 5-week period, Monday through Friday, we recorded the surgical schedule on the prior evening. After the day of surgery, tracking software provided a list of cases performed. We completed electronic health record review for each case, recorded the actual anesthesiology personnel involved, and compared that to the personnel originally scheduled. We also recorded the occurrence of any permanent transitions of care within a case, the type of operation, and the anesthesia start and end times. Anesthesia providers included 47 residents and 32 attending physicians. The study period included 1285 scheduled cases, 55% (n = 711) of which were started and finished by the originally scheduled resident and attending physician. Including canceled cases (126 of 1285, 10%) and added cases (207 of 1366, 15%), residents started anesthetics on patients and with attending physicians assigned to them from the day before 54% of the time. Transitions of care occurred in 19% (260 of 1366) of the cases. Anesthesiology residents prepare for many procedures that do not eventuate and frequently start other cases without prior opportunity for preparation and study. Transitions of care further reduce continuity of care and fragment supervision.