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Process Change and Anesthesia Trainee Instruction Improve Obstetric Anesthesia Care in a Serbian Obstetric Hospital: A Report of an On-going International Collaboration
Abstract Number: SAT-12
Abstract Type: Original Research
Introduction: In Serbia, the use of neuraxial analgesia for labor (NAL) and for cesarean delivery (NACD) is low. The Department of Anesthesiology at Clinical Center Vojvodine (CCV) requested a multi-year collaboration with Kybele Inc. in 2012 to help train physicians in the use of NAL and NACD. Despite annual didactic courses, frequent communication between host and Kybele, and annual week-long clinical instruction visits through 2015, use of NAL and NACD plateaued in 2014 and NA experience among trainees did not increase. In January 2016, one author (CP) conducted a 4 month visit, focusing on resident instruction. In August 2016, CCV leadership mandated an evening clinical shift for one attending and trainees; daytime staffing was unchanged. We report on the effects of these 2 interventions on NAL, NACD, and resident education.
Methods: The Institutional Review Board approved data gathering for this quality improvement analysis. CP conducted a 4 month visit from early January 2016 through April 30 2016, focusing on clinical resident education; a Kybele team visit overlapped. Data on NAL and NACD in 2014, 2015 was compared to that collected during the 7 month interval prior to and 5 month period after the above staffing change. Data on resident experience with NAL and NACD in 2015 was compared to 2016. Student’s T test and chi square test with adjustments for multiple comparisons were used where appropriate.
Results (Table 1): The percentage of NACD plateaued at approximately 25% during 2014 and 2015, but rose to over 50% in the last 5 months of 2016. The percentage of NAL declined 1/2016 – 7/2016, but more than doubled after. Trainee experience in NAL and NACD increased; some trainees reported over 25 experiences in both during a rotation. One author (BP) and 3 other CCV attendings adopted the method of resident instruction modeled by CP during their clinical work, particularly after the change in evening staffing.
Discussion: Goals for the Kybele – CCV collaboration are to increase NAL/NACD and improve education. In 2015, improvement plateaued. The drop in NAL in 1-7/2016 followed external nationwide mandates for NAL. The change in staffing hours improved staff utilization for NAL. The intensive 4 month trainee instruction demonstrated a model for CCV attendings to better utilize trainees for clinical care. Patient service increased and trainee education was enhanced. Better resident training may improve future obstetric anesthesia care in Serbia.