Body S C, Fanikos J, DePeiro D, Philip J H, Segal B S
Department of Anesthesia, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Anesthesiology. 1999 Apr;90(4):1171-5. doi: 10.1097/00000542-199904000-00033.
Cost reduction has become an important fiscal aim of many hospitals and anesthetic departments, despite its inherent limitations. Volatile anesthetic agents are some of the few drugs that are amenable to such treatment because fresh gas flow rate (FGFR) can be independent of patient volatile anesthetic agent requirement.
FGFR and drug use were recorded at the temporal midpoint of 2,031 general anesthetics during a 2-month preintervention period. Staff and residents were provided with their preintervention individual mean FGFR, their peer group mean, and educational material regarding volatile agent costs and low-flow anesthesia. FGFR and drug use were remeasured over a 2-month period (postintervention) immediately after this information (N = 2,242) and again 5 months later (delayed follow-up), for a further 2-month period (N = 2,056).
For all cases, FGFR decreased from 2.4+/-1.1 to 1.8+/-1.0 l/min (26% reduction) after the intervention and increased to 1.9+/-1.1 l/min (5% increase of preintervention FGFR) at the time of delayed follow-up. Use of more expensive volatile agents (desflurane and sevoflurane) increased during the study period (P < 0.01). In a subgroup of 44 staff members with more than five cases in all study periods, 42 members decreased their mean FGFR after intervention. At delayed follow-up, 30 members had increased their FGFR above postintervention FGFR but below their initial FGFR. After accounting for other predictors of FGFR, the effectiveness of the intervention was significantly reduced at follow-up (28% reduction), but retained a significant effect compared to preintervention FGFR (19% reduction).
Although individual feedback and education regarding volatile agent use was effective at reducing FGFR, effectiveness was reduced without continued feedback. Use of more expensive volatile agents was not reduced by education regarding drug cost, and actually increased.
尽管成本降低存在固有局限性，但已成为许多医院和麻醉科的一项重要财政目标。挥发性麻醉剂是少数几种适合此类处理的药物，因为新鲜气体流速（FGFR）可以独立于患者对挥发性麻醉剂的需求。
在为期2个月的干预前期，记录了2031例全身麻醉患者在时间中点的FGFR和药物使用情况。向工作人员和住院医生提供了他们干预前的个人平均FGFR、同组平均水平，以及有关挥发性麻醉剂成本和低流量麻醉的教育资料。在提供这些信息后，立即在为期2个月的时间段内（干预后）重新测量FGFR和药物使用情况（N = 2242），并在5个月后再次进行为期2个月的延迟随访测量（N = 2056）。
对于所有病例，干预后FGFR从2.4±1.1降至1.8±1.0升/分钟（降低26%），在延迟随访时升至1.9±1.1升/分钟（较干预前FGFR增加5%）。在研究期间，使用更昂贵的挥发性麻醉剂（地氟烷和七氟烷）有所增加（P < 0.01）。在所有研究期间有超过5例病例的44名工作人员亚组中，42名成员在干预后降低了他们的平均FGFR。在延迟随访时，30名成员的FGFR高于干预后的FGFR，但低于其初始FGFR。在考虑了FGFR的其他预测因素后，干预的有效性在随访时显著降低（降低28%），但与干预前FGFR相比仍有显著效果（降低19%）。
尽管关于挥发性麻醉剂使用的个人反馈和教育在降低FGFR方面有效，但如果没有持续反馈，有效性会降低。关于药物成本的教育并没有减少更昂贵挥发性麻醉剂的使用，实际上反而增加了。
