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Where should electroconvulsive treatment facilities be located?

Because electroconvulsive therapy (ECT) at Community-General Hospital, Syracuse, N.Y., was provided under the direction of psychiatrists, the facilities and equipment had always been located in the psychiatry department. Anesthesiologists and other professionals needed from other departments were enlisted as needed. In 1990, sentiment began to grow, both in the anesthesiology department and elsewhere, for location of the service in the surgical/recovery suite. However, nothing like a consensus existed.

To aid in the decision-making process, the Professional Affairs Department conducted a survey of 1,680 hospital-based members of the College. In addition to asking whether the hospital provided electroconvulsive therapy, the questionnaire asked who provided anesthetic services, where ECT facilities and equipment were located, where actual therapy was provided, and the preferred location for ECT. Responses were returned by 707 physician executives, 42 percent of the sample.

Respondents split on provision of ECT--50.5 percent do and 49.5 percent do not. All the following percentages are based on those who provide such services. Anesthesiologists are responsible totally or in part for anesthetic services in 91.6 percent of the institutions. Where responsibility is shared, psychiatrists are the most frequent partner.

Facilities and equipment for ECT are located solely in the surgical/recovery suite for 52.9 percent of the hospitals. The psychiatry department was the location for 35.9 percent of the respondents. In addition, 4.2 percent of the hospitals had facilities and equipment in both areas. Unspecified locations or no answer accounted for 8.1 percent of the responses. (Total responses exceed 100 percent because of a small number of respondents indicating multiple categories.)

The current location of ECT followed a similar pattern. The psychiatry department was the choice for 35.9 percent of the respondents, the surgical/recovery suite for 55.5 percent, and a combination of the two for 2.8 percent. Unspecified locations or no answer accounted for 5.9 percent.

Only slight changes were noted when those surveyed were asked for their preferences on the location of ECT. The surgical/recovery suite was the choice of 56.0 percent of the respondents, and psychiatry was preferred by 33.1 percent. Only 1.7 percent listed both areas. Other locations and no answer accounted for 9.2 percent of the respondents.

Obviously, a majority of the institutions have located ECT in the surgical/recovery area and prefer this location. It is likely that this is true because the provision of most anesthetic services is by anesthesiologists, who are based in the area. The results of this survey have influenced Community-General Hospital to relocate its ECT to the surgical/recovery suite. All of the involved parties were involved in the decision and participated in the planning for the shift, which was successfully completed earlier this year.

Peter S. Koenig is Director, Medical Administrative Services, Community-General Hospital, Syracuse, N.Y.
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Author:Koenig, Peter S.
Publication:Physician Executive
Date:Nov 1, 1991
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