Obstetric Anesthesia: A National Survey
Why the study?
What are the characteristics of obstetric anesthesia that inhibit participation by anesthesia personnel, and how does staffing vary by hospital delivery volume?
Population
Heads of obstetric and anesthesia services in 1,200 hospitals in the United States
Design
Cross-sectional
Authors
Discussion
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Member takes
Implication
Smaller obstetric units' anesthesia understaffing signals potential safety gaps; cross-sectional data leaves open optimal volume-based staffing thresholds.
Key Points
- To assess the state of obstetric anesthesia services in the United States and identify institutional factors that discourage anesthesia personnel from entering or practicing in this subspecialty.
- Administered a nationwide questionnaire survey to the directors of obstetric and anesthesia services across 1,200 hospitals in the United States.
- Assessed perceived operational barriers to participation, specialist availability, provider presence during general anesthesia for cesarean section, and personnel assignments for neonatal resuscitation stratified by hospital delivery volume.
- Identified primary disincentives to participation, including scheduling unpredictability in labor and delivery, obstetricians dictating anesthetic management, elevated malpractice liability, and insufficient clinical volume.
- Anesthesiologists provided or directed general anesthesia for cesarean delivery in only 44% of hospitals with <500 annual deliveries, compared to 86% of hospitals with >1,500 annual deliveries.
- Non-specialized personnel ('others') performed newborn resuscitation in 24% of cesarean and 43% of vaginal deliveries in units with <500 births annually, compared to 4% and 2% in units with >1,500 births annually.
Structured PICO
What are the characteristics of obstetric anesthesia that inhibit participation by anesthesia personnel, and how does staffing vary by hospital delivery volume?
P
Population
Heads of obstetric and anesthesia services in 1,200 hospitals in the United States
I
Intervention
Questionnaire assessing obstetric anesthesia and reasons for lack of anesthesia personnel involvement
O
Outcome
Assessment of obstetric anesthesia staffing, availability of personnel, and reasons inhibiting participation
Smaller obstetric units in the US are significantly more under-staffed with anesthesia personnel compared to larger units, with multiple factors inhibiting greater participation by anesthesiologists.
Cite This Study
Gibbs et al. (1986) studied this question.