Imperial College London, UK (Research and Audit Federation of Trainees).
Manchester University NHS Foundation Trust, Manchester, UK (British Society of Allergy and Clinical Immunology).
Br J Anaesth. 2018 Jul;121(1):134-145. doi: 10.1016/j.bja.2018.04.010. Epub 2018 May 21.
UK national anaesthetic activity was studied in 2013 but weekend working was not examined. Understanding changes since 2013 in workload and manpower distribution, including weekends, would be of value in workforce planning.
We performed an observational survey of NHS hospitals' anaesthetic practice in October 2016 as part of the 6th National Audit Project of the Royal College of Anaesthetists (NAP6). All cases cared for by an anaesthetist during the study period were included. Patient characteristics and details of anaesthetic conduct were collected by local anaesthetists.
Responses were received from 342/356 (96%) hospitals. In total, 15 942 cases were reported, equating to an annual anaesthetic workload of ≈3.13 million cases. Approximately 95% (9888/10 452) of elective and 72% (3184/4392) of emergency work was performed on weekdays and 89% (14 145/15 942) of activity was led by senior (consultant or career grade) anaesthetists and 1.1% (180/15942) by those with <2 yr anaesthetic experience. During weekends case urgency increased, the proportion of healthy patients reduced and case mix changed. Cases led by senior anaesthetists fell to 80% (947/1177) on Saturday and 66% (342/791) on Sunday. Senior involvement in obstetric anaesthetic activity was 69% (628/911) during the week and 45% (182/402) at weekends, compared with 93% (791/847) in emergency orthopaedic procedures during the week and 89% (285/321) at weekends. Since 2013, the proportion of obese patients, elective weekend working, and depth of anaesthesia monitoring has increased [12% (1464/12 213) vs 2.8%], but neuromuscular monitoring has not [37% (2032/5532) vs 38% of paralysed cases].
Senior clinicians deliver most UK anaesthesia care, including at weekends. Our findings are important for any planned workforce reorganisation to rationalise 7-day working.
2013 年对英国全国麻醉活动进行了研究，但未对周末工作进行检查。了解自 2013 年以来工作量和人力分配的变化，包括周末的情况，对于劳动力规划很有价值。
我们在 2016 年 10 月作为皇家麻醉师学院（NAP6）第 6 次全国审计项目的一部分，对国民保健制度医院的麻醉实践进行了观察性调查。在此期间，所有由麻醉师照顾的患者均包括在内。当地麻醉师收集患者特征和麻醉实施的详细信息。
收到了 356 家（342 家，96%）医院的回复。共报告了 15942 例，相当于每年约 313 万例麻醉工作量。大约 95%（9888/10452）的择期手术和 72%（3184/4392）的急诊手术在工作日进行，89%（14145/15942）的手术由高级（顾问或职业）麻醉师主导，1.1%（180/15942）的手术由麻醉经验不足 2 年的麻醉师主导。周末时，病例紧急程度增加，健康患者比例下降，病例组合发生变化。高级麻醉师主导的病例数降至周六的 80%（947/1177）和周日的 66%（342/791）。在产科麻醉活动中，周内高级麻醉师的参与率为 69%（628/911），周末为 45%（182/402），而在周内紧急骨科手术中为 93%（791/847），周末为 89%（285/321）。自 2013 年以来，肥胖患者的比例、周末择期手术和麻醉深度监测有所增加[12%（1464/12213）比 2.8%]，但神经肌肉监测没有增加[37%（2032/5532）比 38%的麻痹病例]。
高级临床医生提供了英国大部分的麻醉服务，包括周末。我们的发现对于任何计划中的劳动力重组以实现 7 天工作制的合理化都很重要。
