title: Evaluation of high-risk obstetric patients: a survey of US academic centers.
abstract: OBJECTIVE
  Obstetric anesthesiologists commonly care for high-risk obstetric patients. However, it is unclear how obstetricians refer these patients for anesthetic evaluation and whether obstetric anesthesia clinics (OACs) are used. Our study aims were to determine the availability and characteristics of OACs at US academic obstetric centers and to evaluate how high-risk patients are referred for anesthetic evaluation.
  
  
  METHODS
  This is a survey study design.
  
  
  METHODS
  University of Virginia Center for Survey Research.
  
  
  METHODS
  A survey questionnaire was constructed and electronically mailed to obstetric anesthesia directors based at hospitals with accredited anesthesia residency programs.
  
  
  METHODS
  One hundred thirteen obstetric anesthesia directors were contacted. We asked questions about the presence and operational characteristics of OACs. These characteristics were compared between hospitals with high, medium, and low annual delivery volumes. We also inquired about how high-risk patients are referred for anesthetic evaluation. Frequencies were compared using Fisher test, with P< .05 considered as statistically significant.
  
  
  RESULTS
  The survey response rate was 58% (n = 65). Overall, only 25 (38%) respondents indicated that their hospital operated an OAC. The proportion of hospitals with an OAC and OAC operational hours did not significantly vary according to hospital delivery volume. Among hospitals with an OAC, 24% respondents indicated that obstetricians always refer high-risk patients to the OAC. Nearly half of respondents (44%) indicated that high-risk patients usually or sometimes receive their first anesthetic evaluation during the delivery hospitalization.
  
  
  CONCLUSIONS
  Our findings suggest that, among US academic centers, OACs are uncommon and the referral of high-risk patients for antenatal anesthetic evaluation is inconsistent. These findings suggest that more structured referral processes are needed to ensure that high-risk women receive anesthetic evaluation before labor or delivery.
authors.affiliation: Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), 300 Pasteur Dr, Stanford, CA 94305. Electronic address: ajbut@stanford.edu.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Butwick
authors.affiliation: University of Virginia School of Medicine, Department of Anesthesia, PO Box 800710, Charlottesville, VA 22908. Electronic address: mt9y@virginia.edu.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tiouririne
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D009774:Obstetrics / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States
keywords: High-risk parturients; Obstetric anesthesia clinic; Prenatal assessment