Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, MI.
J Surg Res. 2013 Nov;185(1):190-7. doi: 10.1016/j.jss.2013.05.051. Epub 2013 Jun 5.
This investigation aimed to document surgical capacity at public medical centers in a middle-income Latin American country using the Surgeons OverSeas (SOS) Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) survey tool.
We applied the PIPES tool at six urban and 25 rural facilities in Santa Cruz, Bolivia. Outcome measures included the availability of items in five domains (Personnel, Infrastructure, Procedures, Equipment, and Supplies) and the PIPES index. PIPES indices were calculated by summing scores from each domain, dividing by the total number of survey items, and multiplying by 10.
Thirty-one of the 32 public facilities that provide surgical care in Santa Cruz were assessed. Santa Cruz had at least 7.8 surgeons and 2.8 anesthesiologists per 100,000 population. However, these providers were unequally distributed, such that nine rural sites had no anesthesiologist. Few rural facilities had blood banking (4/25), anesthesia machines (11/25), postoperative care (11/25), or intensive care units (1/25). PIPES indices ranged from 5.7-13.2, and were significantly higher in urban (median 12.6) than rural (median 7.8) areas (P < 0.01).
This investigation is novel in its application of a Spanish-language version of the PIPES tool in a middle-income Latin American country. These data document substantially greater surgical capacity in Santa Cruz than has been reported for Sierra Leone or Rwanda, consistent with Bolivia's development status. Unfortunately, surgeons are limited in rural areas by deficits in anesthesia and perioperative services. These results are currently being used to target local quality improvement initiatives.
本研究旨在使用海外外科医生(SOS)人员、基础设施、程序、设备和用品(PIPES)调查工具,记录中美洲一个中等收入国家的公立医疗中心的外科手术能力。
我们在玻利维亚圣克鲁斯的六个城市和 25 个农村地区应用了 PIPES 工具。结果衡量标准包括五个领域(人员、基础设施、程序、设备和用品)和 PIPES 指数的物品供应情况。PIPES 指数通过将每个领域的得分相加、除以调查项目总数并乘以 10 来计算。
评估了圣克鲁斯提供外科护理的 32 家公立医疗机构中的 31 家。圣克鲁斯每 10 万人拥有至少 7.8 名外科医生和 2.8 名麻醉师。然而,这些提供者的分布不均,9 个农村地点没有麻醉师。很少有农村设施有血库(25 个中的 4 个)、麻醉机(25 个中的 11 个)、术后护理(25 个中的 11 个)或重症监护病房(25 个中的 1 个)。PIPES 指数范围为 5.7-13.2,城市(中位数 12.6)明显高于农村(中位数 7.8)地区(P <0.01)。
本研究在中美洲中等收入国家应用西班牙语版 PIPES 工具,这是一种新颖的方法。这些数据记录表明,与塞拉利昂或卢旺达相比,圣克鲁斯的外科手术能力大大增强,这与玻利维亚的发展状况一致。不幸的是,由于麻醉和围手术期服务的不足,外科医生在农村地区受到限制。这些结果目前正被用于针对当地质量改进举措。