Description of the Practice Pattern Characteristics of Anesthesia Care in Small, Medium and Large Teaching and Non-Teaching Medical Treatment Facilities in the Air Force

摘要

The purpose of this study was to investigate the practice pattern characteristics of anesthesia care in small, medium, and large teaching and non-teaching Medical Treatment Facilities (MTFs) in the Air Force. Data about anesthesia provider type, techniques and agents utilized, specialty services available, and military taskings affecting anesthesia providers (i.e. mobility exercises) were collected. The research was conducted utilizing a data collection tool distributed to the chief Certified Registered Nurse Anesthetists (CRNAs) at every Air Force MTF where anesthesia services were provided. A 73 percent return rate was obtained. Data demonstrated that 36 percent of the MTFs are staffed solely by CRNAs and the anesthesiologist to CRNA ratio is higher in large facilities. The most utilized technique in medium and large MTFs is general anesthesia with monitored anesthesia care (MAC) being the most used in small facilities. Fifty three percent of all MTFs provide obstetrical services with small MTFs administering twice as many intrathecal narcotics as labor epidurals. Most USAF MTFs provide pain management services with 50% of small facilities, staffed solely by CRNAs, having this service. The anesthetic agents most utilized include Fentanyl, Propofol, Versed, Desfiurane, Isoflurane, Lidocaine and Rocuronium; others, Bupivicaine, Cisatricurium and Remifentanyl are rarely used. Subarachniod block is the technique most utilized by all MTFs on a weekly and daily basis and Bier blocks are the most utilized upper extremity block. Most MTFs report having a mobility tasking with small facilities having more CRNAs than anesthesiologists assigned. Almost all facilities reported not performing cases with field anesthesia equipment. The information from this study can assist Air Force leaders in tailoring educational/residency programs, determine operational readiness, and to assess practice variations among various Air Force MTFs and civilian institutions.