Increasing Anesthesia Providers’ Understanding of Emergence Agitation in the Veteran Population

Abstract

Purpose. This quality improvement (QI) project aimed to increase knowledge of emergenceagitation (EA) and provide guidelines for recommended anesthetic medications amongst anesthesia providers at a veteran’s hospital in southern Arizona. Background. EA is a state of psychomotor excitement that can occur as a person awakens fromanesthesia and may involve confusion, thrashing, crying, shouting, and violence. Although this state is typically brief and self-limiting, it can lead to patient or staff harm, as well as other negative consequences. Current literature demonstrates that risk factors and screening techniques for EA have been identified, and modifications to anesthesia care for those at risk can reduce EA occurrence and severity. Combat veterans are at an increased risk of EA, and it is important for anesthesia providers who care for this population to understand the risks of EA and related anesthesia considerations. Methods. An educational presentation was developed using current literature about EA.Participants from a veterans facility in Southern Arizona were recruited to attend the presentation in person, and participants received a card-sized summary of recommendations for EA. A retrospective pre- and post-survey with six paired questions on paper was administered for participants to complete following the presentation. The survey was designed using a Likert scale to measure knowledge about EA. Each question was examined using a paired t-test to compare results before and after the educational presentation. Results. There were 19 anesthesia providers present for the presentation, and 18 (n = 18)participants completed the surveys for analysis. The mean pre-score of all survey questions was 3.80 (SD = 0.394), and the mean post-score was 4.46 (SD = 0.120). A significant improvement occurred as manifested by a p-value of 0.002 and a confidence interval of 95%. When assessing each of the 6 paired questions individually, five out of six pre- and post-scores significantly increased, and one paired question resulted in an insignificant increase which examined if providers adjust their anesthetic plan to reduce the risk of EA. Conclusions. An educational presentation on EA including a card-sized summary ofrecommendations is an effective way to increase knowledge of EA and provide guidelines for recommended anesthetic medications amongst anesthesia providers.