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Patterns of obstetric anesthesia staffing and out-of-hours coverage at US academic obstetric centers.
Abstract Number: F-61
Abstract Type: Original Research
There has been limited examination of obstetric anesthesia staffing for labor and delivery (L&D) units in the United States, especially within academic obstetric centers (1). It is also unclear whether institution-specific delivery volumes influence the type and degree of daytime, out-of-hours and weekend obstetric anesthesia coverage. We examined current patterns of obstetric anesthesia staffing at academic obstetric centers, including whether anesthesia coverage varies according to institution-specific delivery volumes.
We identified US academic hospitals with ACGME accredited anesthesia residency programs (www.acgme.org) 115 obstetric anesthesia directors were invited to complete an online survey, which contained questions about annual delivery volume and daytime/out of hours coverage by attending anesthesiologists. Hospitals were categorized into three groups based on tertiles of delivery volume. Data are presented as median [IQR] and n (%); data were analyzed using Fisher’s test for categorical data.
We contacted 113 obstetric anesthesia directors; 65 directors completed the survey (response rate=58%). Delivery volumes in low volume, medium volume and high volume L&D units were 1800 [1500-2000], 3000 [2500-3500], and 4500 [3950-7000] deliveries per year respectively (Table). The majority of the units (46/65 (70%)) had daytime coverage with one anesthesia attending. The number of daytime attendings significantly differed according to the delivery volume of each hospital. We also observed significant differences in the type of weekend daytime attending-level coverage according to hospital volume. We observed a non-significant trend towards higher volume hospitals having in-house dedicated attending midweek out-of-hours coverage or weekend nighttime coverage compared to lower volume hospitals.
This survey suggests that annual delivery volume may influence the degree of obstetric anesthesia daytime and out-of-hours coverage at US academic centers. High volume units are more likely to have a dedicated daytime in-house coverage compared to low volume institutions. As we could not assess maternal outcomes in this study, future research is needed to determine whether rates of obstetric morbidity are influenced by the type and quality of daytime and out-of-hours obstetric anesthesia coverage
References: (1) Anesthesiology 2005; 103:645-53