A critical evaluation of the anaesthetic services in the province of Gauteng outside the greater Johannesburg area

Green-Thompson, Lionel Patrick
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The purpose of this study was to evaluate the anaesthetic services in the province of Gauteng outside of the greater Johannesburg area in two parts: Part 1: assessing the level of training in anaesthesia of those doctors who deliver the anaesthetic service in the area described and Part 2: reviewing the records of anaesthetics delivered in a two week period. Part 1 of the study was conducted using a questionnaire at three academic and five non academic hospitals. The questionnaire was administered to all doctors delivering anaesthesia at these hospitals and achieved a response rate of 50% and 69,2% at the academic and non academic hospitals respectively. Part 2 of the study reviewed the records of anaesthetic procedures performed over a two week period using the theatre registers as a primary data source and then a formal record retrieval for additional data. The findings of part one showed that the majority (n=15, 83.33%) of practitioners at the non academic hospitals did not have a postgraduate qualification in anaesthesia while this applied to a smaller (n=22, 39.29%) proportion at the academic hospitals. There are significantly fewer doctors with postgraduate qualifications in anaesthesia at the non academic hospitals studied. Similarly 45% of the doctors at the non academic hospitals felt that their training was inadequate for the anaesthetics they were expected to perform. The findings of part two showed that a wide range of procedures were performed for patients of all ages. There were significant differences in the distribution of major and minor cases between the regional and district hospitals. While the selection of anaesthetic was appropriate in all cases, there was a higher than accepted rate of general anaesthesia for caesarean sections. However, there was no significant difference in the length of hospital stay following either a spinal or a general anaesthetic for Caesarean Sections. Most of the cases reviewed took shorter than an hour to be completed and most patients were discharged within a week of surgery. In only 27 (5%) of the procedures reviewed could a complete anaesthetic record be retrieved.
M.Med. (Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2011