Dexter Franklin, Hindman Bradley J, Bayman Emine O, Mueller Rashmi N
Anesthesia, University of Iowa, Iowa City, USA.
Biostatistics/Anesthesia, University of Iowa, Iowa City, USA.
Cureus. 2024 Mar 1;16(3):e55346. doi: 10.7759/cureus.55346. eCollection 2024 Mar.
Although safety climate, teamwork, and other non-technical skills in operating rooms probably influence clinical outcomes, direct associations have not been shown, at least partially due to sample size considerations. We report data from a retrospective cohort of anesthesia evaluations that can simplify the design of prospective observational studies in this area. Associations between non-technical skills in anesthesia, specifically anesthesiologists' quality of clinical supervision and nurse anesthetists' work habits, and patient and operational factors were examined.
Eight fiscal years of evaluations and surgical cases from one hospital were included. Clinical supervision by anesthesiologists was evaluated daily using a nine-item scale. Work habits of nurse anesthetists were evaluated daily using a six-item scale. The dependent variables for both groups of staff were binary, whether all items were given the maximum score or not. Associations were tested with patient and operational variables for the entire day.
There were 40,718 evaluations of faculty anesthesiologists by trainees, 53,772 evaluations of nurse anesthetists by anesthesiologists, and 296,449 cases that raters and ratees started together. Cohen's d values were small (≤0.10) for all independent variables, suggesting a lack of any clinically meaningful association between patient and operational factors and evaluations given the maximum scores. For supervision quality, the day's count of orthopedic cases was a significant predictor of scores (P = 0.0011). However, the resulting absolute marginal change in the percentage of supervision scores equal to the maximum was only 0.8% (99% confidence interval: 0.2% to 1.4%), i.e., too small to be of clinical or managerial importance. Neurosurgical cases may have been a significant predictor of work habits (P = 0.0054). However, the resulting marginal change in the percentage of work habits scores equal to the maximum, an increase of 0.8% (99% confidence interval: 0.1% to 1.6%), which was again too small to be important.
When evaluating the effect of assigning anesthesiologists and nurse anesthetists with different clinical performance quality on clinical outcomes, supervision quality and work habits scores may be included as independent variables without concern that their effects are confounded by association with the patient or case characteristics. Clinical supervision and work habits are measures of non-technical skills. Hence, these findings suggest that non-technical performance can be judged by observing the typical small sample size of cases. Then, associations can be tested with administrative data for a far greater number of patients because there is unlikely to be a confounding association between patient and case characteristics and the clinicians' non-technical performance.
尽管手术室中的安全氛围、团队协作及其他非技术技能可能会影响临床结果，但尚未发现直接关联，至少部分原因是样本量的考虑。我们报告了一项麻醉评估回顾性队列研究的数据，这些数据可简化该领域前瞻性观察性研究的设计。研究了麻醉领域非技术技能之间的关联，特别是麻醉医生的临床监督质量和麻醉护士的工作习惯，以及患者和手术因素。
纳入了一家医院八个财政年度的评估和手术病例。每天使用一个包含九个项目的量表评估麻醉医生的临床监督情况。每天使用一个包含六个项目的量表评估麻醉护士的工作习惯。两组工作人员的因变量均为二元变量，即所有项目是否都获得了最高分。对全天的患者和手术变量进行关联测试。
实习生对麻醉医生进行了40,718次评估，麻醉医生对麻醉护士进行了53,772次评估，评估者和被评估者共同参与了296,449例病例。所有自变量的科恩d值都很小（≤0.10），这表明在患者和手术因素与获得最高分的评估之间缺乏任何具有临床意义的关联。对于监督质量，当天骨科病例的数量是评分的一个显著预测因素（P = 0.0011）。然而，监督评分中等于最高分的百分比的绝对边际变化仅为0.8%（99%置信区间：0.2%至1.4%），即太小而不具有临床或管理重要性。神经外科病例可能是工作习惯的一个显著预测因素（P = 0.0054）。然而，工作习惯评分中等于最高分的百分比的边际变化，增加了0.8%（99%置信区间：0.1%至1.6%），同样太小而不重要。
在评估分配具有不同临床绩效质量的麻醉医生和麻醉护士对临床结果的影响时，监督质量和工作习惯评分可作为自变量纳入，而无需担心它们的影响会因与患者或病例特征的关联而混淆。临床监督和工作习惯是非技术技能的衡量指标。因此，这些发现表明，可以通过观察典型的小样本病例来判断非技术表现。然后，可以使用大量患者的管理数据来测试关联，因为患者和病例特征与临床医生的非技术表现之间不太可能存在混淆关联。
