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Lost in Translation. Controversies between Anesthesiologists and Obstetricians on the Labor ward: A Delphi Technique-based Consensus.
Abstract Number: T 33
Abstract Type: Original Research
The practice of maternity care is characterized by close co-operation of several healthcare disciplines – anesthesiologists, obstetricians and nurses in caring for the same patient. Each discipline may interpret medical evidence in different ways, which may potentially compromise patient outcome. Major enquiries into maternity services continue to identify that ineffective communication is associated with poor maternal and neonatal outcome. The purpose of this study was to identify the most important controversial topics between obstetricians and anesthesiologists with a potential to affect patient outcome.
After REB approval, a consensus-building study based on the Delphi technique  was conducted at our institution. A selected panel of experts comprised of obstetric anesthesiologists and obstetricians, responded to a series of 4 parallel sequential questionnaires interspersed by feedback. Two of the 3 investigators were blinded to whom the responses were from. The 1st round was an open question: what are the topics in patient management, and the reasons why, whereby a difference in opinion exists between anesthesiologists and obstetricians that may interfere with patient outcome? The 2nd round sought agreement on the topics gained from the 1st round. The 3rd round sought the ranking of topics and reasons that scored ≥60% consensus, in order of importance. The final round allowed the opposite discipline insight into the controversies gathered by the other discipline and sought topics of mutual agreement.
10 anesthesiologists and 10 obstetricians participated in the study. Topics and reasons that achieved 60% agreement in each group of specialists are presented in Table 1. Anesthesiologists agreed with all topics, and 50% of the reasons raised by obstetricians. The obstetricians had ≥60% agreement with the topics identified by anesthesiologists, but only 28% agreement of the reasons as to why the differences exist.
Although both disciplines initially identified different topics, once presented with the counterpart view, both parties were in agreement. However, there was significant disagreement on the underlying reasons for the controversies. This information may serve as the basis to develop education, training programs and strategies to improve communication between the two disciplines and therefore patient care.
1.Women and Birth 2011;24:72-79
2.Management Science 1963;9:458-467