Influential Factor on Servicing Capability of Anesthesia Personnel Derived from The Study of Multicenter on Thai Anesthesia Manpower: SOMTAM

Abstract

Objectives: A variability of anesthesia personnel competency is the critical factor related to the service quality. Therefore, this research was conducted to study the factors affected the anesthesia personnel competencies in order to manage the appropriate services in Thailand. Methods: This is a cross – sectional, multi-center study, which is a subset and continuation from the research project titled Study of Multicenter on Thai Anesthesia Manpower; SOMTAM. It was conducted in the hospitals under the Ministry of Public Health from every Health services region, i.e., Mid-level referral centers, Standard level referral centers, Advanced level referral centers and Specialty level referral centers. We studied the personnel demography, patient factors, surgical factors and anesthesia factors that might affect the personnel competency level in the patient care by compiling from every anesthesia practices during a period of five official days and two public holidays from 16 June - 27 July 2019 by determining the competency level of 1 to 5 (novice to expert). The descriptive and logistic regression analysis were displayed using the odds ratio (OR); 95% confidence interval (95% CI) with statistically significant when p-value <0.05. Results: There were 3,774 patients from 18 hospitals involved (2,677 in develope set and 1,097 in test set). The level of personnel competency for the whole process of anesthesia was 3.57 ± 1.41, while in the Advanced center was 3.66 ± 0.35, Standard center was 3.78 ± 0.34, Mid-level center was 3.38 ±. 0.48 and Specialty center was 3.44 ± 0.34. The factors related to the personnel competency were the hospital level (OR 0.56; 0.4-0.9 in the Specialty center to OR 7.62; 4.9-11.9 in the Standard centers), ASA physical status (OR 1.17; 0.9-1.5 in ASA II to OR 1.97; 1.2-3.3 in ASA IV and V), the appropriateness of pre-anesthetic preparation (OR 1.5; 1.1 -1.9), the monitoring (OR 2.3; 1.5-3.6), the special techniques during anesthesia (OR 1.9; 1.2-3.1), the warming apparatus utilization (OR 1.6; 1.4-2.0) and the duration of patient care in post-anesthetic care unit (OR 1.1; 1.1-1.2) with the area under the receiver operating characteristic curve (AUC) of 0.73 in develope set and 0.77 in test set. Conclusion: The competency level of anesthesia personnel during pre-anesthetic, anesthetic and post-anesthetic period were unequal. The critical affected factors were the hospital level, anesthesia factors and patient factors.