Chai Jia Xin, Chong Shin Yuet
SingHealth Anaesthesiology Residency Programme, Singapore.
Department of Anaesthesiology, Singapore General Hospital, Singapore.
Singapore Med J. 2018 May;59(5):271-278. doi: 10.11622/smedj.2017033. Epub 2017 Apr 28.
Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore.
A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure.
Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively.
Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.
生产压力是指要求人员将生产置于安全之上的压力。我们评估了新加坡麻醉医生中生产压力的普遍程度。
对当地麻醉医生进行了随机在线调查。询问了他们对工作环境中生产压力的态度、涉及不安全行为情况的发生频率，以及对外部和内部压力源强度的评分。
从人口统计学角度来看，我们的受访者与新加坡所有麻醉医生大致相似，并且在各三级医院中分布较为均匀。近一半（44.5%）的人目睹过生产压力，有同事被迫以不安全的方式进行麻醉。此类事件包括外科医生要求对未充分优化的患者进行择期手术的压力、采用外科医生想要的麻醉技术的压力、必须寻找手术室以完成外科医生手术安排的压力，以及在手术时间方面受到误导。超过一半（52.3%）的人因工作量过大而在临床判断上出现失误。择期手术工作量繁重与在缺乏适当支持的情况下仍继续为患者进行手术、改变操作以避免延误手术开始以及寻找手术室以完成外科医生手术安排显著相关（p < 0.05），并且与被迫为麻醉医生原本会取消的患者进行手术相关（p < 0.01）。避免延误手术开始和减少患者之间周转时间的需求分别是排名最高的内部和外部压力。
生产压力在新加坡麻醉医生中普遍存在，并且与工作量繁重相关。
