Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?
Forceps delivery volumes in teaching and nonteaching hospitals: are volumes sufficient for physicians to acquire and maintain competence?
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DOI：
10.1097/acm.0000000000000048
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Cram P
中科院分区：
文献类型：
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作者：
Kyser KL;Lu X;Santillan D;Santillan M;Caughey AB;Wilson MC;Cram P
在过去二十年中，手术分娩中使用产钳的情况有所下降，这引起了人们对教学医院是否有能力向学员提供使用产钳的充分经验的质疑。作者检查：(1)教学医院和非教学医院的手术分娩数量；(2)教学医院是否有足够数量的产钳供医生获得和保持能力。作者使用来自9个州的住院病人数据来确定2008年所有因分娩住院的妇女。他们把医院分为三类：主要教学类、次要教学类和非教学类。他们计算了每家医院的产生量（全手术、剖宫产、真空、产钳、两种或两种以上方法），并比较了各医院类别的数据。样本包括835家医院的1,344,305例分娩。主要教学医院、次要教学医院和非教学医院平均剖宫产量分别为969.8、757.8和406.9。平均真空容积为301.0、304.2、190.4，平均产钳容积为25.2、15.3、8.9。2008年，31家医院（占所有医院的3.7%）没有进行真空抽吸，320家医院（38.3%）没有进行产钳分娩。2008年，13家（23%）大教学医院和44家（44%）小教学医院的产钳数量不超过5个。低产钳量可能妨碍许多受训者获得足够的经验和熟练程度。这些发现突出了许多专业面临的更广泛的挑战，即确保受训人员和执业医生获得并保持不经常执行的高技术程序的能力。
The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined: (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures.