手术室麻醉亚专科与麻醉住院医师和护士麻醉师的监督质量显著提高无关。

Operating Room Anesthesia Subspecialization Is Not Associated With Significantly Greater Quality of Supervision of Anesthesia Residents and Nurse Anesthetists.

机构信息

From the *Division of Management Consulting, Department of Anesthesia; †Department of Management Sciences, University of Iowa, Iowa City, Iowa; ‡Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, Florida; and §Department of Anesthesia, University of Iowa, Iowa City, Iowa.

出版信息

Anesth Analg. 2017 Apr;124(4):1253-1260. doi: 10.1213/ANE.0000000000001671.

DOI:10.1213/ANE.0000000000001671

PMID:28098571

Abstract

BACKGROUND

Supervision of anesthesia residents and nurse anesthetists is a major responsibility of faculty anesthesiologists. The quality of their supervision can be assessed quantitatively by the anesthesia residents and nurse anesthetists. Supervision scores are an independent measure of the contribution of the anesthesiologist to patient care. We evaluated the association between quality of supervision and level of specialization of anesthesiologists.

METHODS

We used two 6-month periods, one with no feedback to anesthesiologists of the residents' and nurse anesthetists' evaluations, and the other with feedback. Supervision scores provided by residents and nurse anesthetists were considered separately. Sample sizes among the 4 combinations ranged from n = 51 to n = 62 University of Iowa faculty. For each supervising anesthesiologist and 6-month period, we calculated the proportion of anesthetic cases attributable to each anesthesia Current Procedural Terminology code. The sum of the square of the proportions, a measurement of diversity, is known as the Herfindahl index. The inverse of this index represents the effective number of common procedures. The diversity (degree of specialization) of each faculty anesthesiologist was measured attributing each case to: (1) the anesthesiologist who supervised for the longest total period of time, (2) the anesthesiologist who started the case, or (3) the anesthesiologist who started the case, limited to cases started during "regular hours" (defined as nonholiday Monday to Friday, 07:00 AM to 02:59 PM). Inferential analysis was performed using bivariate-weighted least-squares regression.

RESULTS

The point estimates of all 12 slopes were in the direction of greater specialization of practice of the evaluated faculty anesthesiologist being associated with significantly lower supervision scores. Among supervision scores provided by nurse anesthetists, the association was statistically significant for the third of the 6-month periods under the first and second ways of attributing the cases (uncorrected P < .0001). However, the slopes of the relationships were all small (eg, 0.109 ± 0.025 [SE] units on the 4-point supervision scale for a change of 10 common procedures). Among supervision scores provided by anesthesia residents, the association was statistically significant during the first period for all 3 ways of attributing the case (uncorrected P < .0001). However, again, the slopes were small (eg, 0.127 ± 0.027 units for a change of 10 common procedures).

CONCLUSIONS

Greater clinical specialization of faculty anesthesiologists was not associated with meaningful improvements in quality of clinical supervision.

摘要

背景

监督麻醉住院医师和注册护士麻醉师是麻醉科医师的主要职责。他们的监督质量可以由麻醉住院医师和注册护士麻醉师进行定量评估。监督评分是麻醉师对患者护理贡献的独立衡量标准。我们评估了监督质量与麻醉师专业化程度之间的关系。

方法

我们使用了两个 6 个月的时间段，一个时间段没有向麻醉师反馈居民和护士麻醉师的评估结果，另一个时间段有反馈。分别考虑了居民和护士麻醉师提供的监督评分。在这 4 种组合中，样本量从 n = 51 到 n = 62 个爱荷华大学的教员不等。对于每位监督麻醉师和每个 6 个月的时间段，我们计算了归因于每个麻醉术当前程序术语（Current Procedural Terminology，CPT）代码的麻醉病例比例。该比例的平方和的度量称为赫芬达尔指数。该指数的倒数表示常见程序的有效数量。每位教员麻醉师的多样性（专业化程度）通过以下方式衡量：（1）监督时间最长的麻醉师，（2）开始该病例的麻醉师，或（3）开始该病例的麻醉师，仅限于在“常规时间”（定义为非节假日周一至周五，上午 7:00 至下午 2:59）开始的病例。使用双变量加权最小二乘法回归进行推断分析。

结果

所有 12 个斜率的点估计值均朝评估的教员麻醉师的实践专业化程度更高的方向发展，与监督评分显著降低有关。在护士麻醉师提供的监督评分中，在以第三种方式分配病例的情况下（未经校正的 P <.0001），前两个 6 个月中的三个时间段具有统计学意义。但是，关系的斜率都很小（例如，CPT 评分 4 分制下，每改变 10 个常见程序，就有 0.109 ± 0.025 [SE] 个单位）。在麻醉住院医师提供的监督评分中，在所有三种分配病例的情况下，第一个时间段均具有统计学意义（未经校正的 P <.0001）。但是，同样，斜率也很小（例如，改变 10 个常见程序时，就有 0.127 ± 0.027 个单位）。