麻醉住院医师的培训经验对急救时间的影响最小,使得住院医师的能力与这一操作指标的相关性变得困难。

L. F. Miles, Janeway Granche, C. Hoffman, M. Green
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引用次数: 2

摘要

引言麻醉住院医师根据主观和客观指标被认为是合格的。知识获取和程序技能往往难以准确衡量。检查围手术期效率的有形指标可以为可靠的评估提供来源。方法对病例日志数据库进行回顾性分析,得出3072例住院5年以上的外科病例。调查的主要变量是从手术完成到离开手术室的时间。记录的其他变量包括一周中的哪一天、主治麻醉师姓名、主治外科医生姓名、患者年龄、性别、美国麻醉师协会身体状况(ASA PS)分类以及住院患者与日间手术状态。结果在控制手术持续时间、住院状态、ASA PS、外科医生和主治麻醉师后,住院培训时间具有较高的统计学意义。在完全调整的模型中,一年的住院培训与28秒的出现时间减少有关。手术时间增加1小时与34秒的出现时间增加有关。结论尽管麻醉住院医师训练时间和苏醒时间之间存在统计学上显著的相关性,但由于实际节省的时间相对较少,临床意义可能较低。我们提醒使用围手术期指标(如出现时间)评估麻醉住院医师能力的价值,直到这些指标经过重大验证。
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Anesthesia Resident Training Experience Minimally Impacts Emergence Time, Making Correlation of Resident Competency With This Operational Metric Difficult.
Introduction Anesthesia residents are deemed competent based on subjective and objective metrics. Knowledge acquisition and procedural skill is often difficult to accurately measure. Inspecting tangible metrics of perioperative efficiency may provide a source for reliable evaluation. Methods Retrospective case-log database review yielded 3072 surgical cases involving residents over 5 years. Primary variable investigated was the time from surgery completion to exit from operating room. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status (ASA PS) classification, and inpatient versus day surgery status. Results After controlling for procedure duration time, inpatient status, ASA PS, surgeon, and attending anesthesiologist, resident training time had high statistical significance. In the fully adjusted model, 1 year of resident training was associated with a reduction in emergence time by 28 seconds. A 1-hour increase in procedure time was associated with an increase in emergence time of 34 seconds. Conclusions Although a statistically significant correlation between anesthesia resident training time and emergence time was demonstrated, the clinical significance is likely low given the relatively small amount of actual time saved. We caution the value of using perioperative metrics (e.g., emergence time) for evaluating anesthesia resident competency, until such metrics have undergone significant validation.
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