Browne W, Siu L W L, Monagle J P
Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
Anaesth Intensive Care. 2011 Sep;39(5):936-40. doi: 10.1177/0310057X1103900521.
Operating room efficiency is an important concern in hospitals today both in the public and private sectors. Currently, a paucity of literature exists to evaluate the impact of anaesthetic training on operating room efficiency in the Australian health system. At Monash Medical Centre, Clayton, private consultant operating sessions and public teaching operating sessions use the same operating theatres, nursing and technical staff. Consultant anaesthetists and obstetricians perform all tasks during private sessions, whereas anaesthetic and obstetric trainees perform many tasks during public sessions. In this prospective observational study, total case time, anaesthesia controlled time and the surgical time were measured for elective caesarean section under spinal anaesthesia in 59 patients (private consultant n = 29, public teaching n = 30). Increases in total case time (24 minutes, P < 0.001), anaesthesia controlled time (5.2 minutes, P < 0.015) and surgical time (19.25 minutes, P < 0.001) were observed in the public teaching group compared with the private consultant group. The participation of anesthetic trainees in caesarean sections results in a modest increase in anaesthetic controlled time of approximately five minutes per case or 16 minutes in an operative session with three cases scheduled. Elimination of anaesthetic 'training' time does not allow scheduling of an extra elective caesarean section. Reduced operating theatre throughput is unlikely to be a consequence of training specialist anaesthetists in this clinical setting.
手术室效率是当今公共和私营部门医院都非常关注的一个重要问题。目前，在澳大利亚医疗系统中，评估麻醉培训对手术室效率影响的文献较少。在克莱顿的莫纳什医疗中心，私人顾问手术时段和公共教学手术时段使用相同的手术室、护理和技术人员。在私人手术时段，顾问麻醉师和产科医生执行所有任务，而在公共手术时段，麻醉和产科实习生执行许多任务。在这项前瞻性观察研究中，对59例接受脊髓麻醉的择期剖宫产患者（私人顾问组n = 29，公共教学组n = 30）的总手术时间、麻醉控制时间和手术时间进行了测量。与私人顾问组相比，公共教学组的总手术时间（增加24分钟，P < 0.001）、麻醉控制时间（增加5.2分钟，P < 0.015）和手术时间（增加19.25分钟，P < 0.001）均有所增加。麻醉实习生参与剖宫产手术导致麻醉控制时间适度增加，每例约增加5分钟，或在安排了3例手术的手术时段增加16分钟。消除麻醉“培训”时间并不能安排额外的择期剖宫产手术。在这种临床环境中，手术室吞吐量降低不太可能是培训专科麻醉师的结果。
