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Barriers to collaborative anesthetic care between Anesthesiologists and Nurses on Labour and Delivery: A multicenter study using the Delphi method.
Abstract Number: T-34
Abstract Type: Original Research
Introduction: The practice of obstetrical anesthesia relies on the collaborative efforts between anesthesiologists and nurses. Teamwork, however, remains a challenge in health care (1). While the reasons for this are varied (1,2), it is known that interventions to improve inter-professional collaboration may improve patient care (3). We sought to identify barriers to collaborative care between anesthesiologists and nurses in a busy Canadian tertiary labor and delivery (L&D) unit and to validate these findings in other units across Canada and the United States.
Methods: This double-blind cross-sectional consensus building study was based on the Delphi technique(4)and carried out in two phases. The first phase was completed at our institution where a panel of obstetric anesthesiologists and nurses responded to four parallel sequential rounds of questionnaires. Round 1 comprised of a set of three open-ended questions: “What are the barriers to collaborative care between anesthesiologists and nurses that affect patient care during the provision of anesthetic care on the L&D unit? What are the reasons they exist? What are some interventions that may address them?" Round 2 sought consensus (defined as >70% of agreement) on the responses within each professional group and these would proceed to Round 3. Round 3 (cross-over) sought consensus (>70% of agreement) on items submitted by the opposite profession. In Round 4 (ranking), both groups were asked to rank the top ten barriers to collaboration out of a list originated at the completion of Round 3. The second phase of the study will be a multicenter (10 L&D units across Canada and the United States) validation inquiry seeking consensus on the top ten barriers found in the first phase.
Results: For the first phase, 22 anesthesia providers and 18 nurses were recruited. During Round 1, the open-ended questions revealed 56 and 30 barriers/corresponding reasons/suggested interventions from the anesthesia and nursing group, respectively. Identified barriers included themes such as professionalism, availability, dissonance, role clarity, team coordination, communication environment, organizational structure and knowledge gaps. Preliminary findings from Round 2 are presented in Table 1, with final results expected by the SOAP conference.
References: 1)Nurs Inq 2008 15: 1-2; 2) Medsurg Nurs 2008 17: 35; 3) Cochrane Database Syst Rev 2009: 3; 4) J Adv Nurs 2003 41: 376-82