ORIGINAL ARTICLE
Obstetric recovery practice: a survey of UK obstetric anaesthetists

https://doi.org/10.1016/j.ijoa.2004.12.009Get rights and content

Background:

The 1998 guidelines for obstetric anaesthesia services state: “postoperative care of the obstetric patient should be in accordance with that of any postoperative patient.” We sought to discover whether this standard of care was provided.

Method:

A questionnaire designed to investigate recovery room practice was sent to 251 UK obstetric units. The survey took place between January and June 2003.

Results:

The response rate was 78%. A total of 123 units (63%) had a dedicated obstetric recovery area. Midwives were exclusively responsible for postoperative parturient care in 113 units (58%) between 0900 and 1700 h and in 124 units (64%) after 1700 h. Dedicated recovery nurses were available in 59 units (30%) during the day, in contrast to 36 units (19%) after 1700 h. The level of background training ranged from no training (39%) to locally organised courses (32%), rotation through surgical areas (21%) and nationally organised English National Board courses (8%).

Conclusion:

The survey demonstrates that current obstetric recovery room practice does not always adhere to the recommended Association of Anaesthetists of Great Britain and Ireland guidelines. The provision of dedicated recovery staff or a cohort of specifically trained midwives may help to improve existing standards.

Introduction

In September 1998 the Association of Anaesthetists of Great Britain and Ireland (AAGBI) in conjunction with the Obstetric Anaesthetists’ Association (OAA) issued guidelines for obstetric anaesthesia services. Within this document it was stated that “the postoperative care of the obstetric patient should be in accordance with the care of any postoperative patient ” and that “midwifery staff deputed to look after postoperative patients should be specifically trained in monitoring, care of the airway and resuscitative procedures.1

The objective of this survey was to compare the existing standards of obstetric recovery services with the recommended standards of recovery, as documented in the AAGBI guidelines.[2], [3]

Section snippets

Methods

A questionnaire (Appendix) that had been approved and partly modified by the audit subcommittee of the OAA was sent out to the lead anaesthetists of 251 obstetric units within the United Kingdom. The list was supplied by the OAA secretariat. The questionnaire was designed to investigate recovery room facilities, recovery room staffing and the level of background training. A letter accompanying the questionnaire explained that answers should be based on unit policies and not individual practice.

Results

Of the 251 questionnaires sent, 195 (78%) were returned. One unit on the mailing list had closed, and four other hospitals had amalgamated into two. Some respondents didn’t complete all parts of the questionnaire and consequently the denominator varies in the analysis of the results.

The demographic data from the first part of the questionnaire are shown in Table 1. The annual delivery rate was not significantly correlated with the caesarean section rate, percentage of caesarean sections

Discussion

A fully equipped and staffed recovery area is paramount to the safety of patients recovering from the immediate effects of anaesthesia. In addition, it provides the ideal setting for detection and treatment of early postoperative complications. In accordance with the guidelines for obstetric anaesthesia services published by the Association of Anaesthetists of Great Britain and Ireland in September 1998, obstetric patients should receive the same standard of postoperative care as that of the

Conclusion

Our results have demonstrated that at the time the survey was conducted, the standards of obstetric recovery services did not always match those recommended by the AAGBI guidelines. Shortfalls in the provision of obstetric recovery areas, together with inappropriate staffing and often inadequate background training have been identified as the key areas for concern. Ideally, the provision of dedicated recovery staff or a cohort of specifically trained midwifery staff would help to improve

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