Differences in anaesthesiologist–surgeon seniority and patient safety: a single-centre mixed-methods study

IF 9.1 1区 医学 Q1 ANESTHESIOLOGY
Xiaohan Xu , Xuerong Yu , Yuelun Zhang , Hongling Chu , Huan Zhang , Xue Zhang , Shuang Ma , Lingeer Wu , Quexuan Cui , Le Shen , Yuguang Huang
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Abstract

Background

Junior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist–surgeon seniority might impact patient safety.

Methods

This was a sequential explanatory, mixed-methods evaluation conducted at a general hospital, comprising a retrospective case-control study followed by semi-structured interviews. In the quantitative phase, the case group included surgical patients who experienced anaesthesia-related adverse events. The control group was randomly selected from surgical patients without adverse events, matched to the case group by surgeon, surgery, and surgery year. The exposure was the differences in work experience between anaesthesiologists and surgeons. For the qualitative phase, participants were recruited from attending anaesthesiologists using a theoretical sampling strategy, and a grounded theory analysis was performed.

Results

The quantitative study included 390 patients in the case group and 1560 patients in the control group. After controlling for confounders, we did not find a significant association between differences in anaesthesiologist–surgeon seniority and odds of anaesthesia-related adverse events (adjusted odds ratio 1.00, 95% confidence interval 0.98–1.01, P=0.634). In cases of disagreements among surgeons, anaesthesiologists primarily based clinical decisions on the potential impact on patient safety. Junior anaesthesiologists faced challenges when rejecting surgeons. Nevertheless, they received robust support from anaesthesiology colleagues.

Conclusions

The capacity of anaesthesiologists to uphold patient safety was not significantly affected by their seniority levels relative to surgeons.
麻醉师-外科医生资历和患者安全的差异:一项单中心混合方法研究。
背景:初级麻醉师往往发现很难获得外科医生的信任,可能是因为他们的经验有限和不熟悉外科医生。因此,在处理与资深外科医生的分歧时,他们可能会面临压力。我们调查了麻醉师-外科医生资历的差异是否以及如何影响患者安全。方法:这是在一家综合医院进行的顺序解释性混合方法评估,包括回顾性病例对照研究和半结构化访谈。在定量阶段,病例组包括经历麻醉相关不良事件的手术患者。对照组从无不良事件的手术患者中随机选择,按外科医生、手术方式和手术年份与病例组匹配。暴露是麻醉师和外科医生工作经验的差异。在定性阶段,参与者使用理论抽样策略从主治麻醉师中招募,并进行扎实的理论分析。结果:定量研究纳入病例组390例,对照组1560例。在控制混杂因素后,我们没有发现麻醉师-外科医生资历差异与麻醉相关不良事件发生率之间存在显著关联(校正优势比1.00,95%可信区间0.98-1.01,P=0.634)。在外科医生意见分歧的情况下,麻醉师主要根据对患者安全的潜在影响作出临床决定。初级麻醉师在拒绝外科医生时面临挑战。然而,他们得到了麻醉学同事的大力支持。结论:麻醉医师维护患者安全的能力不受其相对于外科医生的资历的显著影响。
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来源期刊
CiteScore
13.50
自引率
7.10%
发文量
488
审稿时长
27 days
期刊介绍: The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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