Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Liver Transpl. 2012 Jun;18(6):737-43. doi: 10.1002/lt.23427.
Investigators at a single institution have shown that the organization of the anesthesia team influences patient outcomes after liver transplant surgery. Little is known about how liver transplant anesthesiologists are organized to deliver care throughout the United States. Therefore, we collected quantitative survey data from adult liver transplant programs in good standing with national governing agencies so that we could describe team structure and duties. Information was collected from 2 surveys in a series of quantitative surveys conducted by the Liver Transplant Anesthesia Consortium. All data related to duties, criteria for team membership, interactions/communication with the multidisciplinary team, and service availability were collected and summarized. Thirty-four of 119 registered transplant centers were excluded (21 pediatric centers and 13 centers not certified by national governing agencies). Private practice sites (26) were later excluded because of a poor response rate. There were minimal changes in the compositions of the programs between the 2 surveys. All academic programs had distinct liver transplant anesthesia teams. Most had set criteria for membership and protocols outlining the preoperative evaluation, attended selection committees, and were always available for transplant surgery. Fewer were involved in postoperative care or were available for patients needing subsequent surgery. Most trends were associated with the center volume. In conclusion, some of the variance in team structure and responsibilities is probably related to resources available at the site of practice. However, similarities in specific duties across all teams suggest some degree of self-initiated specialization.
一家机构的研究人员表明，麻醉团队的组织方式会影响肝移植手术后患者的预后。在美国，肝移植麻醉师如何组织起来提供护理服务还知之甚少。因此，我们从与国家管理机构保持良好关系的成人肝移植项目中收集了定量调查数据，以便描述团队结构和职责。这些信息是从肝移植麻醉联盟进行的一系列定量调查的 2 项调查中收集的。收集并总结了与职责、团队成员标准、与多学科团队的互动/沟通以及服务可用性相关的所有数据。在 119 个注册移植中心中，有 34 个（21 个儿科中心和 13 个未获得国家管理机构认证的中心）被排除在外。由于回复率低，私人执业场所（26 个）后来也被排除在外。两次调查之间，项目的组成基本没有变化。所有学术项目都有明确的肝移植麻醉团队。大多数团队都有明确的成员标准和协议，概述了术前评估、参加选拔委员会，并随时为移植手术提供服务。参与术后护理或为需要后续手术的患者提供服务的团队较少。大多数趋势都与中心的容量有关。总之，团队结构和职责的一些差异可能与实践场所的可用资源有关。然而，所有团队在特定职责上的相似之处表明存在一定程度的自我发起的专业化。
