Patients knowledge of the qualifications and roles of anaesthetists

Transcription

1 Anaesth Intensive Care 2007; 35: Patients knowledge of the qualifications and roles of anaesthetists A. R. BRAUN*, K. LESLIE, C. MORGAN, S. BUGLER Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia SUMMARY Patients knowledge of anaesthetists qualifications and roles remains inaccurate despite the efforts of professional bodies worldwide. However, patients have not been surveyed on this subject in Australia for more than 20 years. We therefore surveyed 200 patients attending the pre-admission clinic prior to elective non-cardiothoracic surgery in an Australian teaching hospital to determine current knowledge. Most (90.5%) patients stated that anaesthetists are medically qualified and 83.5% stated that they are medical specialists. Younger age, an English-speaking background and previous experience with surgery predicted knowledge of anaesthetists qualifications. Most patients believed that anaesthetists work in the operating theatre and are continually present during surgery, but few recognised their leading role in the care of patients during surgery or their other roles outside the operating theatre. Increased efforts are required to inform patients about the roles of anaesthetists in their care. Key Words: anaesthetists, patients, survey, roles, knowledge, attitudes In recent years, the general public has taken an increasing interest in medicine, particularly those aspects portrayed in television dramas and documentaries. At the same time, professional bodies have attempted to increase public awareness of the work undertaken by anaesthetists 1. Despite this, patients knowledge of the qualifications and roles of anaesthetists has been inaccurate and incomplete 1-3. Many patients have been unaware that their anaesthetist is medically qualified, let alone a medical specialist. In surveys performed in the last 25 years, the percentage of patients who correctly identified anaesthetists as medically qualified ranged from 63 to 90% 1-10, even when the interview was conducted postoperatively 4,5 or in private practice 5. In addition, the roles of the anaesthetist are unclear to patients, many of whom believe our work is complete after * M.B., B.S., Registrar in Anaesthesia, Department of Anaesthesia and Pain Management. M.B., B.S., M.D., M.Epi., F.A.N.Z.C.A., Head of Research, Department of Anaesthesia and Pain Management and Honorary Associate Professor, Department of Pharmacology, University of Melbourne. M.B., B.S., Honorary Research Fellow, Department of Anaesthesia and Pain Management. R.N., Research Nurse, Department of Anaesthesia and Pain Management. Address for correspondence: A/Prof K. Leslie, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Vic Reprints will not be available from the authors. Accepted for publication on February 15, Anaesthesia and Intensive Care, 35, No. 4, August 2007 induction of anaesthesia 11. For example, whilst 79% of patients in one study thought the anaesthetist was primarily responsible for their well-being during surgery, 30% had no idea when asked, During your anaesthetic, what does the anaesthetist do? 9. Finally, whilst anaesthetists fulfil many roles outside the operating theatre, these roles are very rarely ascribed to anaesthetists by patients 2,9. Patients have not been surveyed on this subject in Australia for more than 20 years 4,5. During that time, the roles of anaesthetists have expanded enormously and professional bodies in our region have made considerable efforts to increase the profile and understanding of our speciality. The purpose of this study therefore was to assess the knowledge of anaesthetists qualifications and the roles of the anaesthetist of patients awaiting elective surgery in an Australian teaching hospital. METHODS Following approval by the Human Research Ethics Committee at The Royal Melbourne Hospital, male and female patients awaiting elective, noncardiothoracic surgery, aged 18 years and over, and presenting to The Royal Melbourne Hospital Preadmission Clinic, were approached prior to review by nursing or medical staff and asked to participate in this survey. Those with inadequate English language comprehension due a language barrier, cognitive deficit or intellectual disability were excluded.

2 2 A. R. BRAUN, K. LESLIE ET AL In Australia, anaesthesia is practised exclusively by medically-qualified practitioners, most of whom are specialists or specialists-in-training (general practitioners deliver anaesthesia services in some rural areas and specific settings). At our hospital, all anaesthetists are specialists or specialists-in-training. The interviewers (A.B., C.M. and S.B.; two specialists-in-training and a research nurse) wore theatre attire, introduced themselves by their first name and surname and described themselves as working in anaesthesia research. The professional qualifications and roles of the interviewers were not revealed to the participants until after they completed the survey. After receiving verbal and printed information about the survey, consenting patients signed the consent form and completed the survey. The interviewers also recorded demographic data for each patient. When necessary, the interviewers provided assistance in completing the questionnaire, by reading the questions or writing down the patients answers. The project was completed in seven weeks in June-July 2006 after 200 consenting patients had completed the survey. Survey data were entered onto a database and frequency distributions were generated. Summary statistics are presented as mean (standard deviation) (normally distributed variables), median (interquartile range [IQR]) (skewed variables) or number (%) (counts). Patient age, educational status, non-english speaking background status and number of previous operations were selected a priori as potential predictors of knowledge of anaesthetists specialist qualifications and were assessed using logistic regression. Univariate predicators with P values <0.2 were included in multivariate models. Interactions were assessed (none were significant) and finally a parsimonious model was created. All analyses were performed using Stata 8.0 (Stata Corporation, TX, U.S.A.). A P value <0.05 was considered significant. RESULTS 208 patients were approached and 200 consenting patients completed the survey. Demographic details of these patients are presented in Table 1. These patients were typical of patients presenting for elective surgery in our hospital whose command of English is sufficient to participate in research projects without the aid of interpreters. Questions and patients responses about the qualifications and roles of the anaesthetist in theatre are presented in Table 2. Some 90.5% of patients recognised that anaesthetists are medically qualified and 83.5% realised they are medical specialists. Patients responses regarding the possible work locations of anaesthetists are presented in Table 3. The wording of the questions from the survey is presented verbatim in these tables. Most patients believed that anaesthetists work in the operating theatre and are continually present during surgery, but few recognised their leading role in the care of patients during surgery or their other roles outside the operating theatre. Age >70 years, non- English speaking background and no previous surgery were predictors of incorrect knowledge of Australian anaesthetists qualifications in the multivariate model (Table 4). TABLE 1 Demographic data (n=200) Characteristic % Age (years) (mean ±SD) (range) 55±17 (18-91) Gender (male) 58 Operation type General 32 Orthopaedic 17.5 Urological 13.5 Neurosurgical 12 Ear, nose and throat / head and neck / maxillofacial / ocular Plastics and reconstructive 12.5 Vascular 4.5 Assistance required to complete survey 43 Non-English speaking background 31 Italy 7 Greece 4.5 Baltic countries 4 Other European countries 6 Middle Eastern countries 5 Asia 4.5 Education Primary 15 Secondary 58.5 Post-secondary school Certificate / Diploma 12.5 University degree 14 Number of previous operations >

3 PATIENTS KNOWLEDGE OF THE QUALIFICATIONS AND ROLES OF ANAESTHETISTS 3 TABLE 2 The role of the anaesthetist (n=200) The following questions will ask you for your thoughts regarding the role of the anaesthetist in a typical Australian public hospital. Item % The anaesthetist is a (tick one only) Paramedic 4 General Practitioner 7 Specialist Medical Doctor 83.5 Nurse / Nurse Practitioner 5.5 The surgeon is a (tick one only) Nurse/Nurse Practitioner 0 Specialist Medical Doctor 94.5 General Practitioner 4 Vital signs are indicators of breathing, blood circulation (blood pressure, heart rate, electrocardiogram) and temperature. Who is the main person ensuring that vital signs remain stable during surgery? (Tick one only) Surgeon 6 Nurse/Nurse Practitioner 18.5 Anaesthetist 62.5 Cardiologist 11.5 Who is the main person in charge of treating a patient during an emergency in the operating theatre? (Tick one only) Paramedic 2.5 Cardiologist 8.5 Anaesthetist 13 Nurse/Nurse Practitioner 9.5 Surgeon 66.5 Who is the main person who decides if the patient requires a blood transfusion in the operating theatre? (Tick one only) Nurse/Nurse Practitioner 3.5 Anaesthetist 10 Haematologist 35.5 Surgeon 49.5 Where is the patient put to sleep for surgery? (Tick one only) Do not know 4.5 In the operating theatre 48 In the ward 3 In a room next to the operating theatre 44.5 How is the patient put to sleep? (Tick one only) Do not know 4.5 Tablets 2 Intravenous injection and anaesthetic gas 31 Intravenous injection 51 Anaesthetic gas 11.5 Item % How is the patient kept asleep during the operation? (Tick one only) Tablets 0.5 Intravenous injection 29.5 Anaesthetic gas 30 Do not know 16 Intravenous injection and anaesthetic gas 24 What does the anaesthetist do during the operation? (Tick one only) Do not know 12.5 Leaves the operating theatre 3 Stays in the operating theatre with the patient all the time Anaesthetises other patients in the operating theatre complex TABLE 3 Where else do anaesthetists work? Location Yes (%) No (%) Do not know (%) In the medical ward In any medical emergency anywhere in the hospital In the recovery room In hospital equipment maintenance In the preadmission clinic In an intensive care unit In the labour ward In a general practice In the surgical ward In the radiology department In the operating theatre In an ambulance In the chronic pain clinic In the cardiology department In the psychiatry department In hospital medical supply In the emergency department Immediately after the operation, who is responsible for ensuring that you recover in safety? (Tick one only) A Nurse/Nurse Practitioner 25.5 A Nurse supervised by a Surgeon 31 A Nurse supervised by an Anaesthetist

4 4 A. R. BRAUN, K. LESLIE ET AL TABLE 4 Predictors of knowledge of anaesthetists qualifications Predictor % correct Univariate OR (95% CI) P value Multivariate OR (95% CI) P value Age >70 years years ( ) ( ) years ( ) ( ) Education No university degree 82 0 University degree ( ) Background Non-English speaking 76 0 English-speaking ( ) ( ) Previous surgery ( ) ( ) OR=odds ratio. CI=confidence interval. DISCUSSION Most of the patients in our study (90.5%) identified anaesthetists as being medically qualified and 83.5% believed that anaesthetists were medical specialists. This contrasts with previous international and local studies in which the percentage of patients who correctly identified anaesthetists as medically qualified ranged from 63-90% 1-9. Our finding is an improvement on a previous study conducted in an Australian teaching hospital, which revealed that 66.2% of patients knew anaesthetists were medically qualified 4, but is similar to one conducted in an Australian private hospital (88.7%) 5. Considerably more patients considered surgeons to be medically qualified 4. In our study, only 1.5% of patients believed that surgeons were paramedics and none believed they had nursing qualifications. Most patients (80.5%) believed the anaesthetist stayed in the operating theatre caring for the one patient for the duration of their surgery, however the actual roles and responsibilities of the anaesthetist in theatre remain a mystery to patients. These results are similar to previous studies 3. Unfortunately for anaesthetists, many patients perceive that the surgeon performs the vital surgery and takes charge of emergency treatment, whilst the anaesthetist, if present, only bears witness to these feats. Patients views about the induction, maintenance and recovery phases of anaesthesia reflected the diverse ways in which anaesthesia may be provided. Most knew that induction and maintenance of anaesthesia are achieved using intravenous and inhaled agents, and that nurses (supervised by anaesthetists) are responsible for patient care during recovery. When Swinhoe et al asked in 1994, In what other areas of hospital care does an anaesthetist play a major role?, only 25% of patients could identify any other area outside theatre 9. This result is in keeping with other surveys 2,8-10 and with the results presented here. We demonstrated that most patients realise that anaesthetists work in theatre and attend emergencies around the hospital, but fewer realise that they work in the recovery room, labour ward, cardiology, radiology and psychiatry. Less than a third of patients suggested that anaesthetists work in the chronic pain clinic, despite the leading role of anaesthetists in pain medicine in our country. Interestingly, several non-anaesthetic roles were nominated as being performed by anaesthetists, with approximately up to 20% of patients suggesting that anaesthetists work in general practice, the ambulance service and equipment maintenance. Younger age, an English-speaking background and previous experience with surgery predicted accurate knowledge of the anaesthetist s qualifications in this study and previous work 3. These patients may be more likely to be exposed to information about anaesthesia in the media and in the hospital that they can understand. We speculate that if we had been able to include non-english speaking patients in our study (through the use of interpreters and translations), we may have demonstrated even less knowledge of the qualifications and roles of

5 PATIENTS KNOWLEDGE OF THE QUALIFICATIONS AND ROLES OF ANAESTHETISTS 5 anaesthetists in Australia. Increased efforts to provide information about anaesthesia to all patients are clearly required. This study has strengths and weaknesses. The study is of a relatively large size; we made a concerted attempt to blind the patients to the roles of the interviewers and to interview them prior to them receiving information at their preoperative visit; and we used multivariate analyses to explore the predictors of knowledge. However, the study was conducted in only one large metropolitan teaching hospital and the results therefore may not be generalisable to other settings, such as private practice. In addition, we were unable to include non-english speaking patients, as mentioned above. We modelled our questionnaire on previous research 9 so that we could make comparisons. However, some patients may have found some of the questions ambiguous (for example, the definition of an intraoperative emergency ). In conclusion, whilst the majority of patients regard the anaesthetist as a medical specialist, the actual roles of anaesthetists, both in and outside of the operating theatre remain poorly understood. Numerous advances in surgical diagnosis and treatment, critical care and pain medicine have depended upon the development of anaesthesia as a specialty. However, considering that the majority of our clinical practice is spent with amnesic or unconscious patients, it may not be surprising that patients knowledge of our specialty is poor. Further education for the public of the diverse roles and responsibilities of the anaesthetist would be invaluable in promoting the importance of our work. REFERENCES 1. Tanser S, Birt D. Who is watching over me? Was the public's perception of the anaesthetist changed by National Anaesthesia Day? J R Nav Med Serv 2000; 86: Tohmo H, Palve H, Illman H. The work, duties and prestige of Finnish anesthesiologists: patients view. Acta Anaesthesiol Scand 2003; 47: Ho R, Wong D. Anesthesiology: the misunderstood occupation! [Letter]. Can J Anaesth 2005; 52: Burrow B. The patient s view of anaesthesia in an Australian teaching hospital. Anaesth Intensive Care 1982; 10: Dodds C, Harding M, More D. Anaesthesia in an Australian private hospital: the consumer s view. Anaesth Intensive Care 1985; 13: Hume M, Kennedy B, Asbury A. Patient knowledge of anaesthesia and peri-operative care. Anaesthesia 1994; 49: Zvara D, Mathes D, Brooker R, McKinley A. Video as a patient teaching tool: does it add to the preoperative anesthetic visit? Anesth Analg 1996; 82: Hennessy N, Harrison D, Aitkenhead A. The effect of the anaesthetist s attire on patient attitudes. Anaesthesia 1993; 48: Swinhoe C, Groves E. Patients knowledge of anaesthetic practice and the role of anaesthetists. Anaesthesia 1994; 49: Keep P, Jenkins J. As others see us. The patient s view of the anaesthetist. Anaesthesia 1978; 33: Shevde K, Panagopoulos G. A survey of 800 patients knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg 1991; 73: Nietzsche F. Thus Spoke Zarathustra: A Book for All and None. New York, E. Stelger and Co., 1889.