Hedwig Schroeck MD (is Associate Professor of Anesthesiology, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.), Michaela A. Whitty MPH (is Manager of Perioperative Inventory and Logistics, Dartmouth Health, Lebanon, New Hampshire.), Bridget Hatton MPH (formerly with the Dartmouth Institute of Health Policy, Hanover, New Hampshire, is DrPH Student, Johns Hopkins Bloomberg School of Public Health, Baltimore.), Pablo Martinez-Camblor PhD (is Assistant Professor of Anesthesiology, and Biomedical Data Science, Geisel School of Medicine at Dartmouth College.), Louise Wen MD (is Clinical Assistant Professor, Geisel School of Medicine at Dartmouth College, and Anesthesiologist, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center.), Andreas H. Taenzer MD (is Professor of Anesthesiology, and Pediatrics, Geisel School of Medicine at Dartmouth College. Please address correspondence to Hedwig Schroeck)
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Abstract
Background
An increasing number of procedures are performed in non-operating room anesthesia (NORA) settings, including magnetic resonance imaging (MRI) suites. Patient care in NORA is accomplished by interprofessional ad hoc teams (anesthesia clinicians, imaging technologists, and others), who do not regularly work together otherwise. The authors aimed to explore team relations and role perceptions during crisis situations in MRI settings among such ad hoc teams.
Methods
This mixed methods study used a convergent parallel design: The Relational Coordination Index (RCI) and a survey about role perceptions were administered to anesthesia and non-anesthesia personnel working in MRI settings, and semistructured interviews were conducted among a purposive sample. After descriptive statistics and thematic analysis, the authors integrated quantitative and qualitative findings to identify and describe overlapping and mismatched perceptions between the two groups.
Results
A total of 67 surveys (response rate 74.4%) and 17 interviews were analyzed. RCI ratings revealed moderate relational coordination between the anesthesia and non-anesthesia groups. Anesthesia and non-anesthesia respondents agreed that the anesthesia clinician assumes leadership during crisis management while non-anesthesia personnel assist. There were nuanced differences in expectations about the role of non-anesthesia personnel in calling for help, understanding specific equipment needs, and performing patient care actions. Many anesthesia clinicians felt unsure about crisis-relevant skills of their non-anesthesia colleagues. MRI technologists emphasized attention to magnetic safety as integral to their role, which was infrequently mentioned by anesthesia personnel.
Conclusion
Nuanced mismatches in role expectations within the interprofessional care team exist, which may hinder effective crisis management in MRI settings.
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