Paoletti X, Marty J
Department of Epidemiology, Biostatistics and Clinical Research, University Hospital Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France.
Br J Anaesth. 2007 Apr;98(4):462-9. doi: 10.1093/bja/aem003. Epub 2007 Feb 16.
Numerous hospitals implement a ratio of one anaesthetist supervising non-medically-qualified anaesthetist practitioners in two or more operating theatres. However, the risk of requiring anaesthetists simultaneously in several theatres due to concurrent critical periods has not been evaluated. It was examined in this simulation study.
Using a Monte Carlo stochastic simulation model, we calculated the risk of a staffing failure (no anaesthetist available when one is needed), in different scenarios of scheduling, staffing ratio, and number of theatres.
With a staffing ratio of 0.5 for a two-theatre suite, the simulated risk that at least one failure occurring during a working day varied from 87% if only short operations were performed to 40% if only long operations performed (65% for a 50:50 mixture of short and long operations). Staffing-failure risk was particularly high during the first hour of the workday, and decreased as the number of theatres increased. The decrease was greater for simulations with only long operations than those with only short operations (the risk for 10 theatres declined to 12% and 74%, respectively). With a staffing ratio of 0.33, the staffing-failure risk was markedly higher than for a 0.5 ratio. The availability of a floater for the whole suite to intervene during failure strongly lowered this risk.
Scheduling one anaesthetist for two or three theatres exposes patients and staff to high risk of failure. Adequate planning of long and short operations and the presence of a floating anaesthetist are efficient means to optimize site activity and assure safety.
许多医院实行一名麻醉医生在两个或更多手术室监督非医学资质麻醉医生从业者的比例。然而，由于同时出现关键时期而需要麻醉医生同时在多个手术室的风险尚未得到评估。本模拟研究对此进行了考察。
我们使用蒙特卡洛随机模拟模型，计算了在不同排班、人员配备比例和手术室数量的情况下人员配备失败（需要麻醉医生时无麻醉医生可用）的风险。
对于有两个手术室的套间，人员配备比例为0.5时，模拟得出的在工作日期间至少发生一次失败的风险，若只进行短手术则为87%，若只进行长手术则为40%（长短手术各占50%的混合情况为65%）。人员配备失败风险在工作日的第一个小时特别高，并随着手术室数量的增加而降低。对于仅进行长手术的模拟，这种降低幅度大于仅进行短手术的模拟（10个手术室时风险分别降至12%和74%）。人员配备比例为0.33时，人员配备失败风险明显高于比例为0.5时。有一名全套间的流动麻醉医生在出现失败时进行干预，可大大降低这种风险。
为两个或三个手术室安排一名麻醉医生会使患者和工作人员面临较高的失败风险。对长短手术进行充分规划以及配备流动麻醉医生是优化手术安排并确保安全的有效手段。
