A survey of human resources of the Anesthesiology in China: investigation of reform direction of human resources allocation of Chinese medical and health system based on the current status of human resources of the Anesthesiology

Objective To investigate the current status of the ten-year implementation of the World Health Organization (WHO) surgical safety checklist (SSC) in China. Methods A questionnaire was designed based on the three phases described by the checklist — the period before induction of anaesthesia, the period before skin incision, and the period before patient leaves operating room, taking into account some hotspots and disputes.The questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat platform.Answers were completed by mobile phones or desktop computers.Each WeChat ID number allowed only one answer for each individual participant. Results A total of 3 943 members red the questionnaire invitation, of which 2 121 members completed the questionnaire with an overall completion rate of 53.79%.For checks completed before induction of anesthesia, the percentage of members who routinely practiced checks before induction of anesthesia was 93.35%, the percentage of members who completed each and every element of the checklist was 60.16%, and the percentage of members who selected the element of the checklist the surgeon was not involved in the check was 14.05%.For checks practiced before skin incision, the percentage of members who routinely completed checks before skin incision was 78.22%, the percentage of members who completed each and every element of the checklist was 51.91%, and the percentage of members who selected the element of the checklist surgeons and anesthesiologists routinely stated their own professional key information was 18.24% and 18.81%, respectively.For checks practiced before the patient leaved the operating room, the percentage of members who routinely completed checks before removing the patient from the operating room was 64.26%, and the percentage of members who completed each and every element of the checklist was 44.18%.The percentage of members who was really serious about practicing the checklist was 56.20%.The percentage of members who believed that surgeons should participated in checks practiced before induction of anesthesia was 81.47%.If the member himself or a member of his family needed a surgery, the percentage of members who hoped to implement the checklist was 98.35%.The percentage of members who believed that practicing WHO SSC could reduce the complications of surgery and improve the anesthetic safety of patients was 94.34%. Conclusion The implementing rate of checks practiced before induction of anesthesia is high, while the implementing rates of checks completed before skin incision and before patient leaves operating room are sequentially reduced in China.Although there are some problems with the implementation of WHO SSC, most respondents believe that implementing SSC can improve the anesthetic safety of patients undergoing surgery. Key words: Anesthesia; Surgical safety checklist

Background: With the economy growth and medical reform, anaesthesia workforce and workload, as well as for other medical specialties in China changed dramatically, but the detail information have not been presented. A national off-line survey was designed to learn the current status for anaesthesiology, to analyze the related issues for medicine and to make suggestions for government to improve equity and quality of healthcare in China.Methods: From Mar 1 to Jun 30 in 2015, Chinese Society of Anaesthesiologits (CSA) released questionnaires containing hospital general information, anaesthesia-related information and surgical-related information to all the anaesthesiology departments in mainland China, except Hong Kong, Macao and Taiwan of China. Other relative data sources were searched from publications or website.Results: A total of 16280 questionnaires were released and 14076 copies (86.5%) were retrieved. There were 13489 copies (82.9%) identified as anaesthesia related data copies (ARDC) and 7026 copies (43.2%) identified as surgical related data copies (SRDC). In 2014, there were 77926 anaesthesiologists and its density was 5.7 per 100,000 population, 27.66 million inside operating room (OR) anaesthesia cases and 11.47 million outside OR anaesthesia cases were done. GDP per capita in each province was positively correlated with densities of physicians, anaesthesiologists and anaesthesia cases. One attending anaesthesiologist covered 634 inside OR and 263 outside OR anaesthesia cases in 2014. In SRDC, attending surgeons to attending anaesthesiologists ratio was 7.5 to 1. Each attending surgeon had 0.93 operation day per week and performed 86 operations in 2014. Generally, the higher-level and larger-sized hospitals had higher surgeons to anaesthesiologists ratio, higher surgeons to ORs ratio, less operation day per week for one surgeon, more operations and anesthesia cases done by one surgeon and one anaesthesiologist.Conclusions: China has the biggest number of anaesthesiologists in the world, but is still in shortage of anaesthesiologists. Economic level was positively correlated with anaesthesia workforce and anaesthesia service for all provinces in China. Significant misdistribution and imbalance in different provinces, sized hospitals and medical specialties were found in this survey. A national needs-based resident recruitment system along with the set-up of compulsory standardized resident training system should be taken into consideration and action. Citation: Lei Yang, Tao Zhu, Jia-Jin Li, Jin Liu. Anesthesia workforce and workload in china: A national survey. J Anesth Perioper Med 2017; 4: 67-75. doi: 10.24015/JAPM.2017.0006This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Objective To establish the information management system of performance in the operating room, and provide scientific convenient and effective methods for performance appraisal for nurses . Methods According to anesthesia information management system , performance appraisal software , and the seniority, position, level of nurses etc, we established the information management system of performance appraisal in the operating room .We compared the total annual leave days before and after the application of information management system , and used the self-designed questionnaire to investigate the satisfaction . Results The information management of performance strengthened the consciousness of nurses following the arrangement , decreased the time of leaving from work from 989 days to 312 days.The career satisfaction of nurses was up to 100%.And the satisfaction of patients increased from 76.69%to 98.23%.Besides, the average time of performance appraisal decreased from （5.84 ±0.27） d to （1.04 ±0.64） d.Conclusions Construction and application of information management system for performance appraisal of nursing staff in the operating room mobilize nurses ’ work and guarantee the quality of clinical care , which also improve the satisfaction among anesthetists , surgeons and patients .The information management system helps nurses with time management and improves the efficiency of performance appraisal . Key words: Operating room; Personnel management,hospital; Information technology

Objective To investigate the current situation of perioperative pain treatment and management using questionnaire survey. Methods A questionnaire was designed by ourselves and sent to anesthesiologists in each hospital all over China via the WeChat platform within 1 month.The system automatically recorded the situation of questionnaires. Results A total of 8 447 anesthesiologists involved in the investigation, the number of valid questionnaires retrieved was 6 778, anesthesiologists in the survey came from 847 hospitals in China, distributing across China 31 provinces and cities, and there were 526 tertiary hospitals(62.1%)and 321 hospitals under tertiary grade(37.9%). Among the medication for perioperative analgesia(not including medication for anesthesia), the following analgesics(applied alone or in combination)were used by anesthesiologists, and the application rate was as follows: opioids 79.74%, non-steroidal anti-inflammatory drugs 53.78%, paracetamol 25.76%, local analgesics for analgesia(for nerve blockade)25.44%, other drugs(such as ketamine, gabapentin)12.39%; combination of two or more drugs 63.65%.Six hundred forty-nine hospitals(76.6%)carried out therapy with analgesic pump after operation, and the constituent ratio of hospitals using patient-controlled analgesia(PCA)pump was 43.8%.Four hundred seventy-five hospitals(56.1%)established Acute Pain Service(APS), the organizing rate of APS was significantly higher in tertiary hospitals than in hospitals under tertiary grade(P<0.01), and the majority of APS personnel was anesthesiologists(72.4%). Conclusion Multimodal analgesia and PCA technique are not widely adopted and the requirement for non-steroidal anti-inflammatory drugs and nerve blockade is lower in perioperative pain treatment in China; analgesic pump is widely used after operation, but the application rate of PCA technique is not high; APS establishment is relatively weak in pain management and anesthesiologists play a leading role in APS. Key words: Questionnaires; Analgesia

Objective To evaluate the effect of the patient's preoperative visit to the operating room on the patient's apprehension before operation.Methods One hundred and Sixty patients aged 16-64 yr with fear visual analog scale (FVAS) score≥4 scheduled for elective surgery were randomly divided into 2 groups(n=80 each):control group and study group.In control group the anesthesiologists visited their patients the day before operation ns usual;while in study group the anesthesiologists brought their patients to the operating room,showed them the environment and anesthesia equipment and assured of the safety of the operation and anesthesia.The degree of fear was scored according to FVAS (O=no fear,1-3 mild,4-6 moderate,7-10 severe) and was evaluated on the 1st morning after admission(T1),the night before operation(T2)and before induction of anesthesia(T3).MAP and HR at T1-3 and blood glucose level at T1,3 were mensured and recorded.Results The patient's preoperative apprehension was significantly allayed by patient's preoperative visit to the operating room.The MAP,HR,incidence of moderate and severe fear at T2,3 and blood glucose level at T3 were significantly lower in study group than in control group.Conclusion Patient's preoperative visit to the operating room can allay precperative apprehension. Key words: Operating rooms; Environment; Fear

Background: Safety in anesthesia can be improved through monitoring and analysis of anesthetic complications. We conducted the present Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) incident reporting study to determine the current frequency distribution of incidents related to the anesthetic complications, factors contributing to the incidents, and corrective strategies. Objective: To describe the characteristics of the hospitals participating in this study and methods used. Methods: A multicenter prospective observational study was conducted in hospitals across Thailand in 2015. The participating hospitals were asked to anonymously report incidents of anesthesia-related adverse events and management. Three peer reviewers reviewed the completed record forms describing the incidents including possible mechanisms, contributing factors, appropriate management, and preventive strategies to achieve agreement by consensus. Results: Twenty-two hospitals across Thailand participated in this study. Fourteen (64%) were nonuniversity (service directed) hospitals, while 8 (36%) were university (academic teaching) hospitals. Most hospitals were involved in residency training and teaching medical students (77%), while just more than half (57%) were involved in training nurse anesthetists. The ratio of anesthesiologists to an operating room was 0.67:1 and the ratio of nurse anesthetists to an operating room was 2.03:1. Conclusion: A critical incident analysis of each reported adverse event is helpful for proposing a corrective or preventive strategy to ameliorate perioperative care and improve patient safety in the Thai health care system. Keywords: Adverse events, anesthesia, incident report, perioperative

Objective To investigate the development of painless bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China. Methods From December 2018 to February 2019, a self-designed electronic questionnaire was sent to related personnels in a department of anesthesiology in hospitals within the range of survey through the WeChat platform.The survey mainly included three aspects: basic information of hospital, development of bronchoscope diagnosis and treatment under general anesthesia and the specific management plan. Results Questionnaires were sent to 326 hospitals in total, and 261 hospitals responded with a response rate of 80.06%.Among the 261 hospitals involved in the survey, 34 hospitals responded that no related diseases were found, and thus the number of valid questionnaires was 227, and the rate of valid questionnaires was 87.0%.Among the 261 hospitals, 161 hospitals were tertiary hospitals, and 66 hospitals were secondary hospitals, with a constituent ratio of 70.9% to 29.1%.The average development rate of painless bronchoscopy was 34.8%, the highest rate was 54.0% in Beijing, and the lowest rate was 27.5% in Hebei province.The average development rate of painless bronchoscopy was significantly higher in tertiary hospitals than in secondary hospitals (P 0.05); the number of hospitals applying sevoflurane was larger as compared with that of hospitals applying desflurane(P 0.05). Conclusion At present, the development rate of painless bronchoscopy in China is lower, and the greatest difficulty in further development is the shortage of personnel.Bronchoscope diagnosis and treatment under laryngeal mask or under monitoring anesthesia is the most commonly used method in clinic, and general anesthesia under tracheal intubation is more suitable for highly difficult bronchoscope diagnosis and treatment.Opioids combined with propofol is the most commonly used anesthesia method. Key words: Bronchoscopy; Surveys and questionnaires

This study was designed to investigate the effects of work schedules on the health of hospital workers at the Assistance Publique-Hôpitaux de Paris (AP-HP). Out of 40 hospitals, 17 volunteered to participate in this study. The Standard Shiftwork Index and a questionnaire concerning physicians' work schedules were used. Ten thousand questionnaires were distributed anonymously to hospital workers between March and April 1999. Professional categories comprised head nurses, nurses, nursing auxiliaries, hospital agents, midwives and full time physicians. Departments included internal and geriatric medicine, general paediatrics, orthopaedic and general surgery, operating and emergency rooms, and anaesthesiology and intensive care units. 3250 questionnaires were returned. Demographics for the respondents were: 79.2% female, average age 38.1 +/- 9.1 years old. Eleven work schedules were identified. One fourth of the personnel had fixed morning work schedules. The highest level of job satisfaction was found in personnel working in paediatrics while dissatisfaction was strongest in the gerontology and, emergency room personnel. General Health Questionnaire (GHQ) scores were high for head nurses, operating room nurses and junior doctors as well as for personnel with rotating and flexible shifts. This study will be used to make recommendations concerning the reduction of working time for French hospital workers.

To evaluate the value of wavelet index (WLI) in general anesthesia through a comparison of WLI with bispectral index (BIS). A total of 53 patients scheduled for elective surgery with ASA (American Society of Anesthesiologists) I-II were selected to undergo general anesthesia. The monitoring probes of BIS, WLI and muscle relaxation were connected in awaking patients. The values of WLI and BIS were recorded at 10 min (T₁) entering OR (operating room), immediate before anesthesia induction (T₂), when the OAA/S (observer's assessment of alertness/sedation) score declined gradually to 5(T₃), 4(T₄), 3(T₅), 2(T₆), 1(T₇) after the infusion of propofol, after vecuronium given when the TOF value decreased to 100 (T₈), 75(T₉), 50 (T₁₀), 25 (T₁₁), 0 (T₁₂) after the injection of vecuronium, tracheal intubation (T₁₃), 1 min (T₁₄), 3 min (T₁₅) and 5 min (T₁₆) after the completion of tracheal intubation, immediate before initiating surgical procedure (T₁₇), beginning the operation (T₁₈), 1 min (T₁₉), 3 min (T₂₀), 5 min (T₂₁) post-operation, skin suturing (T₂₂), end of surgery (T₂₃), tracheal extubation (T₂₄), 1 min (T₂₅) and 5 min (T₂₆)cd post-extubation, immediate before exiting OR (T₂₇). The value of WLI at T₁₀-T₁₃, T₂₂-T₂₇ was more than BIS (P < 0.05). The Bland-Altman analysis showed that WLI was accepted comparing with BIS during the period of anesthesia. The bias was -2.99, 95% limits of agreement -29.97% to 21.56%. The correlation coefficients of OAA/S score with BIS and WLI were: r(BIS) = 0.884, r(WLI) = 0.757 (P = 0.000). WLI index is feasible for monitoring the depth of general anesthesia.

Background: The Royal College of Anesthesiologists of Thailand initiated registry and reporting of anesthesia service incidents and outcomes in 2005. Objectives: The Perianesthetic Anesthetic Adverse Events in Thailand (PAAd Thai) study aimed to investigate patient, surgical, and anesthetic profiles, and suggest strategies for prevention of adverse events. Methods: A prospective descriptive study was conducted in 22 hospitals across Thailand. Each hospital was invited to report, on an anonymous basis, any perianesthetic adverse incident during 12 months (between January 1 and December 31, 2015). A standardized incident report form was completed to determine the type of incident, and where, when, how, and why it occurred using closed and open-ended questionnaires. Data regarding main anesthetic techniques were also reported monthly. Descriptive statistics were used. Results: For 333,219 cases, 2,206 incident reports with 3,028 critical incidents were reported. The incidents commonly occurred in male patients (52.0%), aged 70 y (18.2%). The incidence of adverse events included cardiac arrest within 24 h (15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal intubation (8.5:10,000), difficult intubation (8.0:10,000), and malignant hyperthermia (1:200,000). General, cardiothoracic, neurological, and otorhinolaryngological surgical specialties posed a high risk of incidents. Operating and recovery rooms were common locations for incidents. Conclusion: In the past decade, there were dramatic reductions of perioperative cardiac arrests and difficult intubations. Common factors related to critical incidents were inexperience, emergency, inadequate preanesthetic evaluation, inappropriate decisions, lack of vigilance, and inexperienced assistants. Suggested corrective strategies are compliance with guidelines, additional training, and improvement of supervision and quality assurance. Keywords: Adverse events, anesthesia, incidents, incident report, patient safety

Objective To guide the perioperative qualified nursing care at operation room understanding the psychological needs before, during, and after operation of patients taking artificial total knee replacement. Methods 40 patients undertaking total knee arthroplasty at the second department of orthopedics at our hospital were selected as study objects. During preoperative visit, their psychological needs before, during, and after operation were investigated with self-designed questionnaire. Results The questionnaire recovery rate and effective rate both were 100.00%. A11 the 40 patients expected to be visited by the surgeon, anesthesiologist, and operating room nurses and wanted to know about the safety of the operation and the anesthesia before the operation; needed comfortable temperature, humidity, etc. and gentle operations by the doctors and nurses during the operation; and wanted to relieve their pain and discomfort in time and needed guidance in functional training and rehabilitation after the operation. In the 40 patients, the artificial total knee replacement surgery related knowledge demand score was (1.752 ± 0.596) and the score of psychological and emotional needs was (1.755 ± 0.603), with no statistical difference (t = 0.022 4, P > 0.05); but they were higher than the score of technology and environmental demands (1.468 ± 0.591) (t = 2.140 0 and 2.149 8, both P<0.05). Conclusions The patients have different needs in different stages of total knee arthroplasty surgery. The operation room nursing staff should pay attention to nursing care for patients’ perioperative psychological needs. According to the patients’ demands in different surgical stages, corresponding high-quality care should be taken. Key words: Artificial total knee replacement; Preoperative visit; Perioperative period; Psychological needs

IntroductionThe use of Regional Anesthesia techniques has gained increasing popularity. There are few data about conditions affecting education, attitudes and limitations for regional techniques use. The purpose of this study was to know the current practice of Regional Anesthesia in Portugal and to determine the factors affecting its application among the Portuguese Anesthesiologists. Methods The “Practice of Regional Anesthesia Questionnaire” was designed using a focus group, a Delphi process and a pilot test. The 32 items were divided into four scores: motivation, advantages, training and barriers. Groups of specialists in Anesthesia for more or less than 10 years, members of a Regional Anesthesia Society and paediatric experience were studied. The questionnaire link was sent by e-mail to Portuguese hospitals with training programs. Results190 Anesthesiologists answered the questionnaire. Younger anesthesiologists achieved higher scores on advantages. Members of a Regional Anesthesia Society were more motivated and exhibit more versatility in Regional Anesthesia. 52% of responders didn’t execute regional blocks in children due to inadequate training. The majority of the responders didn’t believe that Regional Anesthesia delays the starting times of surgeries or the time for discharge from a post-anesthesia care unit. Discussion and ConclusionMost Portuguese Anesthesiologists were motivated and interested in Regional Anesthesia. The main reported limitation was inadequate training. Training programs must be implemented so that regional techniques become a competency of every Anesthesiologist. This study may function as a benchmark for future assessment of the Regional Anesthesia practice and for evaluation of the implemented measures.

Objective To probe into the nursing experience of reasonable cooperation between op-eration room nurses and anesthesiologists. Methods Strengthening preoperative propaganda and psy-chological education,paying attention to the temperature and humidity in operation room,assisting the anesthesiologists to arrange patients'body position,giving cooperation of infusion and transfusion,actively involving in rescue work.Results Surgery patients got good care,anesthesia and surgery went along smoothly. Conclusions Smooth coordination between operation room nurses and anesthesiologists has great significance on the smooth going and satisfactory results of operation. Key words: Operating room nurses; Anesthesiologists; Cooperation

Objective To evaluate the effect of dexmedetomidine on the duration of non-hypoxic apnoea when used for induction of general anesthesia. Methods Eighty female patients, aged 18-64 yr, with body mass index of 18.5-24.9 kg/m2, of American Society of Anesthesiology physical status Ⅰ or Ⅱ, with Mallampati grade Ⅰ or Ⅱ, scheduled for elective surgery with general anesthesia requiring tracheal intubation, were divided into 2 groups (n=40 each) by a random number table method: dexmedetomidine group (group D) and conventional group (group C). Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min in group D, and the normal saline 40 ml was intravenously infused in group C. In two groups, pure oxygen 8 L/min was inhaled via the closed mask, 3 min later fentanyl 3 μg/kg, etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg were intravenously injected in turn, assisted ventilation was not performed in this period.The anesthesia machine was immediately connected to perform mechanical ventilation when SpO2 was reduced to 92% after tracheal intubation.Arterial blood samples were collected for blood gas analysis, and PaO2 was recorded at the time of entering the operation room, immediately before inhaling pure oxygen, at the beginning of injecting fentanyl, and when SpO2 was decreased to 92%.The development of adverse cardiovascular events during the trial, and duration of non-hypoxic apnoea were recorded. Results Compared with group C, the incidence of adverse cardiovascular events was significantly decreased, and the duration of non-hypoxic apnoea was prolonged, and no significant change was found in PaO2 at the time of entering the operation room, immediately before inhaling pure oxygen, at the beginning of injecting fentanyl, and when SpO2 was decreased to 92% in group D (P<0.05). Conclusion Dexmedetomidine can prolong the duration of non-hypoxic apnoea and raise the safety of endotracheal intubation during general anesthesia induction when used for induction of general anesthesia. Key words: Dexmedetomidine; Anesthesia, general; Duration of non-hypoxic apnoea

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