Rural Health Academic Centre, University of Otago, Ashburton 7700, New Zealand
Rural Remote Health. 2021 Jan;21(1):6320. doi: 10.22605/RRH6320. Epub 2021 Jan 7.
Rural hospitals in New Zealand provide broad generalist clinical services, including procedural sedation and analgesia (PSA). This study was designed to explore patterns of procedural sedation use including indications, equipment, medications, logistical and medical staff support available by rural hospitals, and whether current professional guidelines support rural sedation practice.
Through the New Zealand Rural Hospital Research Network, 17 rural hospitals were enrolled in an online survey during February 2018. The electronic survey consisted of 31 questions, regarding general information, staffing level and procedural sedation practice. Further questions sought information on clinical documentation and training guidelines.
Most participating sites represented larger rural hospitals and were distributed equally throughout New Zealand. All performed procedural sedation. The distance of rural hospitals to their referral hospitals varied, with the closest being 65 km and the furthest at 326 km away. This study found that staffing and equipment available for rural procedural sedation varied, with the majority of rural hospitals having access to only one doctor out of hours, and only half having access to two doctors within daytime hours. A majority of the respondents felt that a minimum safe level for procedural sedation in their rural hospital required only a single doctor. Procedural sedation is frequently performed in rural hospitals in New Zealand, with the majority of respondents performing PSA at least once a week or more. Ketamine is the preferred PSA agent. A wide variety of procedures are undertaken including orthopaedic and injury treatments, abscess incision and drainage, and cardioversions. Patient transfer to another centre for the purpose of PSA is infrequent, occurring a few times a month or less for all hospitals.
This exploratory survey of rural hospital PSA practice demonstrated that PSA is a commonly performed procedure for a variety of indications. Staffing, equipment and techniques available for rural PSA vary according to institution. There is no current professional framework that suitably defines minimum standards for rural PSA practice, and specific training resources are limited. Providing procedural sedation and analgesia is an essential rural hospital service which is patient and whānau (Māori-language word for extended family) centred, saves patient transfers, and should be supported by a safe, pragmatic and realistic framework of tools, recommendations and training for rural practitioners.
新西兰的农村医院提供广泛的通科临床服务，包括程序镇静和镇痛（PSA）。本研究旨在探讨程序镇静的使用模式，包括农村医院的适应证、设备、药物、后勤和医务人员支持情况，以及当前的专业指南是否支持农村镇静实践。
通过新西兰农村医院研究网络，17 家农村医院于 2018 年 2 月参与了一项在线调查。电子调查问卷由 31 个问题组成，涉及一般信息、人员配备水平和程序镇静实践。进一步的问题是关于临床记录和培训指南的信息。
大多数参与的医院代表较大的农村医院，分布在新西兰各地。所有医院都进行了程序镇静。农村医院与转诊医院的距离各不相同，最近的为 65 公里，最远的为 326 公里。本研究发现，农村程序镇静的人员配备和设备各不相同，大多数农村医院只有一名医生在非工作时间值班，只有一半的医院在白天有两名医生值班。大多数受访者认为，他们的农村医院进行程序镇静的最低安全水平只需要一名医生。在新西兰，程序镇静经常在农村医院进行，大多数受访者每周至少进行一次 PSA 或更多次。氯胺酮是首选的 PSA 药物。进行的各种程序包括骨科和损伤治疗、脓肿切开引流和电复律。为了进行 PSA，将患者转至另一个中心的情况很少见，所有医院每月发生几次或更少。
这项对农村医院 PSA 实践的探索性调查表明，PSA 是一种常用于多种适应证的常见程序。根据机构的不同，农村 PSA 的人员配备、设备和技术各不相同。目前没有适合定义农村 PSA 实践最低标准的专业框架，具体的培训资源也有限。提供程序镇静和镇痛是农村医院的一项基本服务，以患者和家庭为中心，节省了患者的转院，应该得到一个安全、务实和现实的工具、建议和培训框架的支持，以满足农村从业者的需求。
