Angarita Fernando A, Dueck Andrew D, Azouz Solomon M
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; The Division of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Surgery. 2015 Jul;158(1):289-99. doi: 10.1016/j.surg.2015.02.014. Epub 2015 Apr 11.
Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents.
An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies.
Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy.
Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions.
术后电解质失衡的管理往往受传统观念驱动。为确定可改进之处，我们评估了外科医生和住院医师术后电解质管理的实践模式。
在多伦多大学的主治外科医生和外科住院医师中开展了一项在线调查。该调查按照制定自填式问卷的系统方法设计。问题涉及工作量、假设临床场景中的决策制定以及改进策略。
在分发的232份调查问卷中，156份完成（回复率：67%）。大多数人表示，在多伦多大学附属的13家医院中，低年资住院医师负责管理电解质。监督主要由高年资住院医师进行（75%）。13%的人报告管理未受监督。约59%的住院医师不知道主治外科医生评估患者电解质的频率。尽管大多数住院医师（53.7%）报告他们从未得到过电解质替代方面的工具或培训，但他们认为自己有中等或极高的信心。住院医师和主治外科医生在假设临床场景的管理上存在差异。大多数（50.5%）受访者认为电解质替代方案是最合适的改进策略。
电解质替代是外科医生工作量的一个重要组成部分。尽管报告称电解质管理方面的正规培训有限，但住院医师认为自己有能力；然而，他们的实践差异很大，且往往与药物指导建议不同。优化外科病房术后电解质的管理需要建立一个能提高知识、培训并限制不必要干预的框架。
