麻醉医师围手术期夜间工作：关键问题的定性研究和建议。
Peri-operative night-time work of anaesthesiologists: A qualitative study of critical issues and proposals.
机构信息
From the Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo (MI, AG, AC), Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo (MI, AG, AC), Division of Anaesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age 'Gaetano Barresi', University of Messina, Policlinico 'G. Martino', Messina, Italy (AN), Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier Cedex 5, Montpellier, France (IL), Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA (AC), Outcomes Research Consortium, Cleveland, OH, USA (AC), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AA), Institute of Clinical Medicine, University of Copenhagen (AA), Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany (PK), Consorcio Hospital General Universitario de Valencia, Valencia. Methodology research Department, Universidad Europea de Valencia, Spain (CSRG), Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India (SNM), Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands (MJS), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MJS), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK (MJS), Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome (FB), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and surgery. University of Perugia, Italy (EDR) and General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel (SE).
出版信息
Eur J Anaesthesiol. 2024 Jan 1;41(1):34-42. doi: 10.1097/EJA.0000000000001930. Epub 2023 Nov 15.
BACKGROUND
Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking.
OBJECTIVES
This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks.
DESIGN
Qualitative analysis of responses to two open-ended questions.
SETTING
Online platform questionnaire promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC).
PARTICIPANTS
The survey sample consisted of an international cohort of anaesthesiologists.
MAIN OUTCOME MEASURES
We identified and classified recurrent themes in the responses to questions addressing perceptions regarding (Q1) peri-operative night-time working conditions, which may affect patient safety and (Q2) potential solutions.
RESULTS
We analysed 2112 and 2113 responses to Q1 and Q2, respectively. The most frequently reported themes in relation to Q1 were a perceived reduction in professional performance accompanied by concerns regarding the possible consequences of work with fatigue (27%), and poor working conditions at night-time (35%). The most frequently proposed solutions in response to Q2 were a reduction of working hours and avoidance of 24-h shifts (21%), an increase in human resources (14%) and performance of only urgent or emergency surgeries at night (14%).
CONCLUSION
Overall, the surveyed anaesthesiologists believe that workload-to-staff imbalance and excessive working hours were potential bases for increased peri-operative risk for their patients, partly because of fatigue-related medical errors during night-time work. The performance of nonemergency elective surgical cases at night and lack of facilities were among the reported issues and potential targets for improvement measures. Further studies should investigate whether countermeasures can improve patient safety as well as the quality of life of anaesthesia professionals. Regulations to improve homogeneity, safety, and quality of anaesthesia practice at night seem to be urgently needed.
背景
缺乏围手术期夜间工作条件对患者安全影响的麻醉医师意见的定性数据。
目的
本研究旨在深入了解麻醉医师对夜间工作条件对围手术期患者安全的影响的看法，以及可能采取哪些行动来减轻感知到的风险。
设计
对两个开放式问题的回应进行定性分析。
设置
由欧洲麻醉学会和重症监护学会（ESAIC）在线平台问卷推广。
参与者
调查样本由国际麻醉医师队列组成。
主要观察指标
我们确定并分类了回答以下两个问题的回复中反复出现的主题：（Q1）可能影响患者安全的围手术期夜间工作条件的看法，以及（Q2）潜在的解决方案。
结果
我们分别分析了 Q1 和 Q2 的 2112 和 2113 个回复。与 Q1 相关的报告最多的主题是专业表现下降，同时对疲劳工作的潜在后果感到担忧（27%），以及夜间工作条件差（35%）。针对 Q2 提出的最常见的解决方案是减少工作时间和避免 24 小时轮班（21%），增加人力资源（14%）和仅在夜间进行紧急或紧急手术（14%）。
结论
总体而言，接受调查的麻醉医师认为工作量与人员配备失衡和工作时间过长是增加围手术期风险的潜在基础，部分原因是夜间疲劳相关的医疗错误。夜间进行非紧急择期手术和缺乏设施是报告的问题和潜在改进措施的目标之一。进一步的研究应该调查对策是否可以提高患者安全性以及麻醉专业人员的生活质量。似乎迫切需要改善夜间麻醉实践的同质化、安全性和质量的法规。
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