Controversy between anesthesiologists and obstetricians on the labour ward: the Delphi method is used as a consensus-building technique
Controversy between anesthesiologists and obstetricians on the labour ward: the Delphi method is used as a consensus-building technique
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DOI：
10.1007/s12630-014-0294-7
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发表时间：
2015-03-01
影响因子：
4.2
通讯作者：
Carvalho, Jose C. A.
中科院分区：
文献类型：
--
作者：
Nhathien Nguyen-Lu;Downey, Kristi;Carvalho, Jose C. A.
产科医生和麻醉师可能会对医学证据做出不同的解释，这可能会产生冲突并影响患者的护理。我们试图找出最重要的有争议的话题，涉及产科医生和麻醉师在分娩病房，有可能影响病人的outcome.We进行了一项共识的研究，德尔菲技术的基础上。由产科麻醉师和产科医生组成的专家小组回答了一系列四个平行的顺序问卷，其中穿插着反馈。第一轮由开放式问卷组成：患者管理中的哪些主题会引起麻醉师和产科医生之间可能干扰患者结局的不同意见，为什么？第二轮寻求对主题达成一致，第三轮寻求对主题及其基本原因进行排名，这些主题至少获得60%的同意。最后一轮让每个学科都能了解另一个学科所收集的争议。10名麻醉师和10名产科医生参加了这项研究。麻醉医生发现的争议性话题是产科医生的两倍（分别为6对3）。产科医生同意麻醉师确定的所有主题，但仅同意18个（28%）支持它们的原因中的5个。麻醉师同意产科医生提出的所有主题，但同意只有三个（50%）的理由来支持他们。产科医生和麻醉师都确定了几个有争议的话题，可能会影响临床实践的生产病房。这些信息可以作为制定教育计划和战略的基础，以改善两个学科之间的沟通。
Obstetricians and anesthesiologists may interpret medical evidence differently, which could potentially generate conflict and compromise patient care. We sought to identify the most important controversial topics involving obstetricians and anesthesiologists on the labour ward that had the potential to affect patient outcome.We conducted a consensus-building study based on the Delphi technique. A panel of experts comprised of obstetric anesthesiologists and obstetricians responded to a series of four parallel sequential questionnaires interspersed with feedback. The first round consisted of an open questionnaire: Which topics in patient management would rouse a difference of opinion between anesthesiologists and obstetricians that may interfere with patient outcome, and why? The second round sought agreement on the topics, and the third round sought to rank the topics, and their underlying reasons, that scored at least 60% agreement. The final round allowed each discipline insight into the controversies gathered by the other discipline.Ten anesthesiologists and ten obstetricians participated in the study. Anesthesiologists identified twice as many controversial topics as the obstetricians (six vs three, respectively). The obstetricians agreed with all topics identified by the anesthesiologists, but agreed with only five of the 18 (28%) reasons to support them. Anesthesiologists agreed with all topics raised by the obstetricians, but agreed with only three of the six (50%) reasons to support them.Both the obstetricians and the anesthesiologists identified several controversial topics that may influence clinical practice on the labour ward. This information could serve as the basis to develop educational programs and strategies to improve communication between the two disciplines.