产科麻醉劳动力调查：30年更新

Obstetric Anesthesia Workforce Survey: A 30-Year Update.

作者信息

Traynor Andrea J, Aragon Meredith, Ghosh Debashis, Choi Ray S, Dingmann Colleen, Vu Tran Zung, Bucklin Brenda A

机构信息

From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, California; †University of Colorado School of Medicine, Aurora, Colorado; and ‡Division of Biostatistics, University of Colorado School of Public Health, Aurora, Colorado.

出版信息

Anesth Analg. 2016 Jun;122(6):1939-46. doi: 10.1213/ANE.0000000000001204.

DOI:10.1213/ANE.0000000000001204

PMID:27088993

Abstract

BACKGROUND

Obstetric Anesthesia Workforce Surveys were conducted in 1981, 1992, and 2001, and the 10-year update was conducted in 2012. Anesthesia providers from US hospitals were surveyed to identify the methods used to provide obstetric anesthesia. Our primary hypothesis was that the provision of obstetric anesthesia services has changed in the past 10 years.

METHODS

A sample of hospitals was generated based on the number of births per year and US census region. Strata were defined as follows: I ≥ 1500 annual births (n = 341), II ≥ 500 to 1499 annual births (n = 438), and III < 500 annual births (n = 414). Contact email information for the anesthesia provider in charge of obstetric services was obtained by phone call. Electronic questionnaires were sent through email.

RESULTS

Administration of neuraxial (referred to as "regional" in previous surveys) labor analgesia was available 24 hours per day in all stratum I hospitals responding to the survey. Respondents across all strata reported high rates of in-house coverage, with 86.3% (95% confidence interval [CI] = 82.7%-90%) of stratum I providers reporting that they provided in-house anesthesiology services for obstetrics. The use of patient-controlled epidural analgesia in stratum I hospitals was reported to be 35% in 2001 and 77.6% (95% CI = 73.2%-82.1%) in this survey. Independent Certified Registered Nurse Anesthetists were reported to provide obstetric anesthesia services in 68% (95% CI = 57.9%-77.0%) of stratum III hospitals. Although 76% (95% CI = 71.2%-80.3%) of responding stratum I hospitals allow postpartum tubal ligations, 14% report inadequate staffing to provide anesthesia either always or at off-hours.

CONCLUSIONS

Since 2001, there have been significant changes in how responding hospitals provide obstetric anesthesia care and staff the labor and delivery ward. Obstetric anesthesia surveys, updated every 10 years, continue to provide information about changes in obstetric anesthesia practice.

摘要

背景

1981年、1992年和2001年进行了产科麻醉劳动力调查，并于2012年进行了10年更新调查。对美国医院的麻醉服务提供者进行了调查，以确定提供产科麻醉的方法。我们的主要假设是，在过去10年里，产科麻醉服务的提供方式发生了变化。

方法

根据每年的出生人数和美国人口普查区域生成医院样本。分层定义如下：I组为每年出生人数≥1500例（n = 341），II组为每年出生人数≥500至1499例（n = 438），III组为每年出生人数<500例（n = 414）。通过电话获取负责产科服务的麻醉服务提供者的联系电子邮件信息。通过电子邮件发送电子问卷。

结果

在回复调查的所有I组医院中，均提供每天24小时的椎管内（在之前的调查中称为“区域”）分娩镇痛。所有分层的受访者报告称内部覆盖率很高，I组中有86.3%（95%置信区间[CI]=82.7%-90%）的提供者报告他们为产科提供内部麻醉服务。据报告，I组医院中患者自控硬膜外镇痛的使用率在2001年为35%，在本次调查中为77.6%（95%CI = 73.2%-82.1%）。据报告，在III组医院中，68%（95%CI = 57.9%-77.0%）的产科麻醉服务由独立的注册护士麻醉师提供。尽管76%（95%CI = 71.2%-80.3%）回复调查的I组医院允许产后输卵管结扎，但14%的医院报告称人员配备不足，无法随时或在非工作时间提供麻醉服务。