Dexter Franklin, Ledolter Johannes, Smith Thomas C, Griffiths David, Hindman Bradley J
From the Division of Management Consulting, Department of Anesthesia, Department of Management Sciences, and Department of Anesthesia, University of Iowa, Iowa City, Iowa.
Anesth Analg. 2014 Sep;119(3):670-678. doi: 10.1213/ANE.0000000000000345.
At many U.S. healthcare facilities, supervision of anesthesiology residents and/or Certified Registered Nurse Anesthetists (CRNAs) is a major daily responsibility of anesthesiologists. Our department implemented a daily process by which the supervision provided by each anesthesiologist working in operating rooms was evaluated by the anesthesiology resident(s) and CRNA(s) with whom they worked the previous day.
Requests for evaluation were sent daily via e-mail to each resident and CRNA after working in an operating room. Supervision scores were analyzed after 6 months, and aligned with the cases' American Society of Anesthesiologists Relative Value Guide units.
(1) Mean monthly evaluation completion rates exceeded 85% (residents P = 0.0001, CRNAs P = 0.0005). (2) Pairwise by anesthesiologist, residents and CRNAs mean supervision scores were correlated (P < 0.0001), but residents assigned greater scores than did CRNAs (P < 0.0001). The pairwise differences between residents and CRNAs were heterogeneous among anesthesiologists (P < 0.0001). (3) Anesthesiologist supervision scores provided by residents were: (a) greater when a resident had more units of work that day with the rated anesthesiologist (P < 0.0001), and (b) less when the anesthesiologist had more units of work that same day with other providers (P < 0.0001). However, the relationships were unimportantly small, Kendall τb = +0.083 ± 0.014 (SE) and τb = -0.057 ± 0.014, respectively. The correlations were even less among the CRNAs, τb = -0.029 ± 0.013 and τb = -0.004 ± 0.012, respectively. (4) There also was unimportantly small association between a resident's or CRNA's mean score for an anesthesiologist and the number of days worked together (τb = -0.069 ± 0.023 and τb = +0.038 ± 0.020, respectively).
Although the attributes that residents and CRNA perceive as constituting "supervision" significantly share commonalities, supervision scores should be analyzed separately for residents and CRNAs. Although mean supervision scores differ markedly among anesthesiologists, supervision scores are influenced negligibly by staff assignments (e.g., how busy the anesthesiologist is with other operating rooms).
在美国的许多医疗保健机构，监督麻醉科住院医师和/或注册护士麻醉师（CRNA）是麻醉医生日常的主要职责。我们科室实施了一个日常流程，即由前一天与麻醉医生一起工作的麻醉科住院医师和CRNA对在手术室工作的每位麻醉医生提供的监督进行评估。
每天在手术室工作结束后，通过电子邮件向每位住院医师和CRNA发送评估请求。6个月后对监督评分进行分析，并与病例的美国麻醉医师协会相对价值指南单位进行比对。
（1）平均每月评估完成率超过85%（住院医师P = 0.0001，CRNA P = 0.0005）。（2）按麻醉医生两两比较，住院医师和CRNA的平均监督评分具有相关性（P < 0.0001），但住院医师给出的评分高于CRNA（P < 0.0001）。住院医师和CRNA之间的两两差异在麻醉医生中具有异质性（P < 0.0001）。（3）住院医师给出的麻醉医生监督评分情况如下：（a）当住院医师当天与被评分的麻醉医生的工作量单位更多时，评分更高（P < 0.0001），（b）当麻醉医生当天与其他提供者的工作量单位更多时，评分更低（P < 0.0001）。然而，这些关系的影响极小，肯德尔τb分别为+0.083±0.014（标准误）和τb = -0.057±0.014。CRNA之间的相关性更小，τb分别为-0.029±0.013和τb = -0.004±0.012。（4）住院医师或CRNA对麻醉医生的平均评分与共同工作天数之间也存在极小的关联（τb分别为-0.069±0.023和τb = +0.038±0.020）。
尽管住院医师和CRNA认为构成“监督”的属性有显著的共同之处，但应分别对住院医师和CRNA的监督评分进行分析。尽管不同麻醉医生的平均监督评分存在显著差异，但监督评分受人员分配（例如麻醉医生在其他手术室的繁忙程度）的影响极小。
