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Re: Consequences of running more operating theatres than anaesthetists to staff them: a stochastic s
- Kenwyn James, Owen Boswell, David Sparkes (1 May 2007)
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Kenwyn James, SpR Anaesthetics Southampton, UK, Owen Boswell, David Sparkes
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Editor – we read with interest the article by Paoletti and Marty predicting the high risk of anaesthetist unavailability when anaesthetists supervise two or more theatres and the reduction in this risk when a floating anaesthetist is present.[1] We question the authors’ claim that this increased staffing ratio has a beneficial effect on patient safety. Anaesthetist unavailability is likely to have different outcomes depending on the critical period they are unable to attend. A delay in induction, or recovery, of a few minutes is unlikely to result in patient harm, particularly as the simulation considered elective procedures. The significance of failing to attend a crisis depends on whether an anaesthetist is required for reasons of protocol or insufficient clinical skills on the part of the non-medically- qualified anaesthetist. Supervising more than one case has been common practice for many years in the USA and parts of Europe. Clinical experience suggests that such staffing ratios do not disadvantage patients. Work in the USA has shown risk adjusted mortality rates to be similar for Certified Registered Nurse Anaesthetists (CRNAs) working alone and those working under the supervision of an anaesthetist.[2] Over a 6 year period in an American university hospital it was found that decreased staffing ratios reduced the rate of patient injury, suggesting improved patient safety.[3] Critical incidents, however, increased. This suggests critical incidents are not necessarily a valid indicator of anaesthesia safety outcome. We feel, therefore, that the simulations described do not provide sufficient evidence to warrant the introduction of floating anaesthetists. K. James O. Boswell D. Sparkes Southampton, UK 1. Paoletti X, Marty J. Consequences of running more operating theatres than anaesthetists to staff them: a stochastic simulation study. Br J Anaesthesia 2007; 98: 462-9 2. Pine MP, Holt KD, You-Bei L. Surgical mortality and type of anaesthesia provider. AANA Journal 2003; 71:109-16 3. Posner KL, Freund PR. Trends in quality of anaesthesia care associated with changing staff patterns, productivity and concurrency of case supervision in a teaching hospital. Anaesthesiology 1999; 91:839-47 Conflict of Interest:None declared |
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