The Influence of a Night-Float Call System on the Incidence of Unintentional Dural Puncture: A Retrospective Impact Study

Anesth Analg. 2015 May;120(5):1095-1098. doi: 10.1213/ANE.0000000000000706.

Abstract

Background: Resident night-float systems have been associated with adverse outcomes. We hypothesized that an obstetric anesthesia night float would increase the incidence of unintentional dural punctures.

Methods: The July to December incidence of unintentional dural puncture before (control group) and with night float (night-float group) was compared retrospectively. The incidence of unintentional dural puncture by day of week and trainee level was evaluated.

Results: The unintentional dural puncture rate of control group was 0.73% (20 of 2758) vs 1.49% (39 of 2612) in the night-float group (P = 0.008; relative risk = 2.06; 95% confidence interval = 1.23-3.74). The proportion of unintentional dural punctures attributed to clinical anesthesia-1 residents in the night-float and control groups was 28.2% (11 of 39) and 5.0% (1 of 20), respectively (relative risk = 5.64; 95% confidence interval = 1.07-152; P = 0.044).

Conclusions: Implementation of night float increased the incidence of unintentional dural puncture.

MeSH terms

  • After-Hours Care*
  • Anesthesia Department, Hospital*
  • Anesthesia, Epidural / adverse effects*
  • Anesthesia, Epidural / methods
  • Anesthesia, Obstetrical / adverse effects*
  • Anesthesia, Obstetrical / methods
  • Clinical Competence
  • Dura Mater / injuries*
  • Humans
  • Injections, Epidural
  • Internship and Residency*
  • Personnel Staffing and Scheduling*
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Workforce