Department of Anesthesia, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
Hum Resour Health. 2020 Mar 17;18(1):20. doi: 10.1186/s12960-020-0458-1.
The mounting pressure on the Australian healthcare system is driving a continual exploration of areas to improve patient care and access and to maximize utilization of our workforce. We hypothesized that there would be support by anesthetists employed at our hospital for the design, development, and potential implementation of an anesthesia-led nurse practitioner (NP) model for low-risk colonoscopy patients.
We conducted a cross-sectional, mixed methods study to ascertain the attitudes and acceptability of anesthetists towards a proposed anesthesia-led NP model for low-risk colonoscopy patients. An online survey using commercial software and theoretical questions pertaining to participants' attitudes towards an anesthesia-led NP model was e-mailed to consultant anesthetists. Participants were also invited to participate in a voluntary 20-min face-to-face interview.
A total of 60 survey responses were received from a pool of 100 anesthetists (response rate = 60%, accounting for 8.04% margin of error). Despite the theoretical benefits of improved patient access to colonoscopy services, most anesthetists were not willing to participate in the supervision and training of NPs. The predominant themes underlying their lack of support for the program were a perception that patient safety would be compromised compared to the current model of anesthesia-led care, the model does not meet the Australian and New Zealand College of Anesthetists guidelines for procedural sedation and analgesia, and the program may be a public liability prone to litigation in the event of an adverse outcome. Concerns about consumer acceptance and cost-effectiveness were also raised. Finally, participants thought the model should be pilot tested to better understand consumer attitudes, logistical feasibility, patient and proceduralist attitudes, clinical governance, and, importantly, patient safety.
Most anesthetists working in a single-center university hospital did not support an anesthesia-led NP model for low-risk colonoscopy patients. Patient safety, violations of the current Australian and New Zealand College of Anesthetists guidelines on procedural sedation, and logistical feasibility were significant barriers to the acceptance of the model.
Australian and New Zealand Clinical Trials Registry, 12619001036101.
澳大利亚医疗体系面临的压力不断增大，这促使人们持续探索能够改善患者护理和就诊体验并充分利用现有劳动力的各个领域。我们假设，医院内的麻醉师会支持为低风险结肠镜检查患者设计、开发并可能实施的麻醉主导型护士从业者（NP）模式。
我们开展了一项横断面混合方法研究，旨在确定麻醉师对拟议的低风险结肠镜检查患者麻醉主导型 NP 模式的态度和接受程度。使用商业软件向顾问麻醉师发送了一份在线调查，其中包含与参与者对麻醉主导型 NP 模式的态度相关的理论问题。还邀请参与者参加 20 分钟的面对面访谈。
在 100 名麻醉师中，共收到 60 份调查回复（回复率为 60%，误差幅度为 8.04%）。尽管该模式在改善患者接受结肠镜检查服务方面具有理论上的优势，但大多数麻醉师不愿参与 NP 的监督和培训。他们不支持该计划的主要原因是，他们认为与当前的麻醉主导型护理模式相比，该模式会危及患者安全；该模式不符合澳大利亚和新西兰麻醉师学院关于程序镇静和镇痛的指南；该计划可能存在风险，一旦出现不良后果，可能会引发诉讼。他们还提出了对消费者接受度和成本效益的担忧。最后，参与者认为应进行试点测试，以更好地了解消费者的态度、实施的可行性、患者和程序执行者的态度、临床治理，以及重要的是患者安全。
在单一中心大学医院工作的大多数麻醉师不支持为低风险结肠镜检查患者实施麻醉主导型 NP 模式。患者安全、违反澳大利亚和新西兰麻醉师学院关于程序镇静的现行指南以及后勤可行性是该模式难以被接受的主要障碍。
澳大利亚和新西兰临床试验注册中心，12619001036101。
