Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
JAMA Surg. 2013 Jan;148(1):29-35. doi: 10.1001/jamasurgery.2013.403.
To examine surgeons' experiences of conflict with intensivists and nurses about goals of care for their postoperative patients.
Cross-sectional incentivized US mail-based survey.
Private and academic surgical practices.
A total of 2100 vascular, neurologic, and cardiothoracic surgeons.
Surgeon-reported rates of conflict with intensivists and nurses about goals of care for patients with poor postsurgical outcomes.
The adjusted response rate was 55.6%. Forty-three percent of surgeons reported sometimes or always experiencing conflict about postoperative goals of care with intensivists, and 43% reported conflict with nurses. Younger surgeons reported higher rates of conflict than older surgeons with both intensivists (57% vs 32%; P = .001) and nurses (48% vs 33%; P = .001). Surgeons practicing in closed intensive care units reported more frequent conflict than those practicing in open intensive care units (60% vs 41%; P = .005). On multivariate analysis, the odds of reporting conflict with intensivists were 2.5 times higher for surgeons with fewer years of experience compared with their older colleagues (odds ratio, 2.5; 95% CI, 1.6-3.8) and 70% higher for reporting conflict with nurses (odds ratio, 1.7; 95% CI, 1.1-2.6). The odds of reporting conflict with intensivists about goals of postoperative care were 40% lower for surgeons who primarily managed their intensive care unit patients than for those who worked in a closed unit (odds ratio, 0.60; 95% CI, 0.40-0.96).
Surgeons regularly experience conflict with critical care clinicians about goals of care for patients with poor postoperative outcomes. Higher rates of conflict are associated with less experience and working in a closed intensive care unit.
探讨外科医生与重症监护医师和护士在术后患者治疗目标方面发生冲突的经历。
横断面激励性美国邮件调查。
私人和学术外科实践。
共 2100 名血管、神经和心胸外科医生。
外科医生报告的与重症监护医师和护士在术后治疗目标方面发生冲突的发生率，这些患者的术后结局较差。
调整后的应答率为 55.6%。43%的外科医生报告说，他们有时或经常与重症监护医师就术后治疗目标发生冲突，43%的外科医生报告说与护士发生冲突。与重症监护医师（57%比 32%；P =.001）和护士（48%比 33%；P =.001）相比，年轻的外科医生比年长的外科医生报告冲突的频率更高。在封闭的重症监护病房工作的外科医生比在开放的重症监护病房工作的外科医生报告更多的冲突（60%比 41%；P =.005）。多变量分析显示，与经验更丰富的同事相比，经验较少的外科医生报告与重症监护医师发生冲突的可能性高 2.5 倍（比值比，2.5；95%置信区间，1.6-3.8），报告与护士发生冲突的可能性高 70%（比值比，1.7；95%置信区间，1.1-2.6）。与主要管理重症监护病房患者的外科医生相比，在封闭病房工作的外科医生报告与重症监护医师就术后治疗目标发生冲突的可能性低 40%（比值比，0.60；95%置信区间，0.40-0.96）。
外科医生经常与重症监护临床医生就术后结局较差的患者的治疗目标发生冲突。更高的冲突率与经验不足和在封闭的重症监护病房工作有关。
