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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Multiple Measures of Anesthesia Workload During Teaching and Nonteaching Cases

Matthew B. Weinger, MD^*,,, Swapna B. Reddy, BS, and Jason M. Slagle, MS Section Editor

*Department of Anesthesiology, University of California-San Diego; San Diego Center for Patient Safety; and Anesthesia Ergonomics Research Laboratory, Veterans Affairs San Diego Healthcare System, California

Address correspondence to Matthew B. Weinger, MD, Veterans Affairs Medical Center (125A), 3350 La Jolla Village Dr., San Diego, CA 92161-5008. Address e-mail to mweinger{at}ucsd.edu

In this study, we sought to examine several measures of anesthesia provider workload during different phases of anesthesia care and during teaching and nonteaching cases. Clinical work was assessed in real-time during 24 general anesthetics performed by consenting anesthesia providers. Workload was measured using physiological (provider heart rate), psychological (self-assessment and observer rating), and procedural (response latency to an alarm light and workload density) techniques. Clinicians’ heart rates, observer and self-reported workload scores, and nonteaching workload density were consistently increased during anesthetic induction and emergence compared with maintenance. In nonteaching cases, workload density correlated with heart rate and with psychological workload. Workload density during teaching cases did not decrease during the induction and was significantly greater than during nonteaching cases. Alarm-light response latency (a measure of clinical vigilance) was significantly prolonged during the teaching compared with nonteaching cases. These results suggest that intraoperative teaching increases the workload of the clinician instructor and may reduce vigilance during anesthesia care. Additionally, multiple workload measures may provide a more comprehensive profile of the work demands of clinical cases.

IMPLICATIONS: Psychological, physiological, and procedural workload measures during routine general anesthesia cases documented the increased work demands of induction and emergence. Intraoperative teaching increased workload and decreased vigilance, suggesting the need for caution when educating during patient care.

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