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Background: The US Centers for Medicare and Medicaid Services provide guidelines for the coverage of anaesthesia residents and certified registered nurse anaesthetists (CRNAs) by anaesthesiologists. We tested the hypothesis that changes in the anaesthesia staffing model increase billing compliance., Methods: We analysed 13 926 anaesthesia cases performed between September 2019 and November 2019 (baseline), and between September 2020 and November 2020 (after change in staff model) at a US academic medical centre using an estimation tool. The intervention was assignment of additional 12-h weekday CRNAs plus an additional anaesthesiologist who covered weekdays after 17:00, weekends, and holidays. The proportion of cases with billing compliant coverage (covered either by solo anaesthesiologist or anaesthesiologist covering two or fewer residents or four or fewer CRNAs) was analysed using logistic and segmented regression analyses., Results: The change in staff model was associated with a decrease in non-optimal anaesthesia staff assignments from 4.2% to 1.2% of anaesthesia cases (adjusted odds ratio 0.25; 95% confidence interval [CI] 0.20-0.32; P<0.001) and an increase in billable anaesthesia units of 0.6 per anaesthesia case (95% CI 0.4-0.8; P<0.001). An increased revenue margin associated with optimal staffing levels would only be achieved with salary levels at the 25th percentile of relevant benchmark compensation levels. Total staff overtime for all anaesthesia providers decreased (adjusted absolute difference -4.1 total overtime hours per day; 95% CI -7.0 to -1.3; P=0.004)., Conclusions: Implementation of a change in anaesthesia staffing model was associated with improved billing compliance, higher billable anaesthesia units, and reduced overtime. The effects of the anaesthesia staff model on revenue and financial margin can be determined using our web-based margin-cost estimation tool., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Study Objective: To estimate the incidence of postoperative oxygenation impairment after lung resection in the era of lung-protective management, and to identify perioperative factors associated with that impairment., Design: Registry-based retrospective cohort study., Setting: Two large academic hospitals in the United States., Patients: 3081 ASA I-IV patients undergoing lung resection., Measurements: 79 pre- and intraoperative variables, selected for inclusion based on a causal inference framework. The primary outcome of impaired oxygenation, an early marker of lung injury, was defined as at least one of the following within seven postoperative days: (1) SpO 2  < 92%; (2) imputed PaO 2 /FiO 2  < 300 mmHg [(1) or (2) occurring at least twice within 24 h]; (3) intensive oxygen therapy (mechanical ventilation or > 50% oxygen or high-flow oxygen)., Main Results: Oxygenation was impaired within seven postoperative days in 70.8% of patients (26.6% with PaO 2 /FiO 2  < 200 mmHg or intensive oxygen therapy). In multivariable analysis, each additional cmH 2 O of intraoperative median driving pressure was associated with a 7% higher risk of impaired oxygenation (OR 1.07; 95%CI 1.04 to 1.10). Higher median intraoperative FiO 2 (OR 1.23; 95%CI 1.14 to 1.31 per 0.1) and PEEP (OR 1.12; 95%CI 1.04 to 1.21 per 1 cm H 2 O) were also associated with increased risk. History of COPD (OR 2.55; 95%CI 1.95 to 3.35) and intraoperative albuterol administration (OR 2.07; 95%CI 1.17 to 3.67) also showed reliable effects., Conclusions: Impaired postoperative oxygenation is common after lung resection and is associated with potentially modifiable pre- and intraoperative respiratory factors., Competing Interests: Declaration of competing interest No relevant conflicts of interest to report for any authors., (Copyright © 2023. Published by Elsevier Inc.)

The criminalization hypothesis assumes that deinstitutionalization coupled with inadequate police training has led to the increased arrest of people with mental illness. Arrest is viewed as a means to manage the troublesome behavior that often results from mental illness. Supporting research has emphasized the contributing role that illness plays in the arrest decision. This assumption largely ignores an extant criminal justice literature on the factors that influence arrest. On the basis of a review of this criminal justice literature, beginning with Bittner's 1967 seminal work, a framework is proposed that incorporates three contexts -- manipulative, temporal, and scenic -- surrounding the police encounter and the relationship of these contexts to mental illness. These three "horizons" incorporate the characteristics of the community, the offender, and the incident, all of which are recognized as influential in shaping police discretion. The scenic horizon is indicative of the features of the community. The temporal horizon includes police knowledge that stretches beyond the specific incident and officer characteristics. The manipulative horizon involves the current incident from the standpoint of the officer and includes considerations of safety for the community as well as the immediate concerns of the officer. Implications of this framework are then explored with respect to both police and mental health service mandates.