Hilsden Richard, Moffat Bradley, Knowles Sarah, Parry Neil, Leslie Ken
Department of Surgery, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, London, ON N6A 5A5 Canada ; Schulich School of Medicine and Dentistry, Western University, London, ON Canada.
Department of Surgery, University of Western Ontario, London Health Sciences Centre, University Hospital, 339 Windermere Road, P.O. Box 5339, London, ON N6A 5A5 Canada ; Department of Critical Care, London, On Canada.
World J Emerg Surg. 2016 Feb 24;11:11. doi: 10.1186/s13017-016-0065-6. eCollection 2016.
Acute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons. Despite the recent emergence of this model of care, minimal research has been conducted on the quality of patient handover and no research has attempted to determine the rate of clinical agreement or disagreement among surgeons participating in these teams.
A prospective cohort study was carried out with our acute care surgical service at a tertiary care teaching hospital from January 2 to March 31 2012. At the conclusion of the daily morning handover, receiving surgeons were asked to indicate, on provided handover sheets, whether they agreed with the proposed management plan for each patient that was discussed. The specific aspects of care over which they disagreed were also described, and disagreements were classified a priori as major or minor. The primary outcome was the rate of disagreement over the handed over management plan.
Six staff surgeons agreed to participate and a total of 417 unique patients were handed over during the study period. For the primary outcome, a total of 41 disagreements were recorded for a disagreement rate of 9.8 %. 15 of the 41 disagreements were classified as major, for a major disagreement rate of 3.6 %. Consultant to consultant disagreements were classified as major disagreements 63 % of the time, whereas consultant to resident disagreements were classified as major 31 % of the time (P = 0.217). On average, the age of patients for which a clinical disagreement occurred were older; 63 vs. 57 (P < 0.05).
Despite the frequency of handovers in clinical practice, little research has been conducted to determine the rate of disagreement over patient management among surgeons participating working in academic centers. This study demonstrated that the rate of clinical disagreement is low among surgeons working in an tertiary care teaching hospital.
急性护理外科团队负责急诊手术患者，因此不同外科医生之间需要定期进行交接和协调。尽管这种护理模式最近才出现，但关于患者交接质量的研究极少，也没有研究试图确定参与这些团队的外科医生之间临床意见一致或不一致的发生率。
2012年1月2日至3月31日，在一家三级护理教学医院对我们的急性护理外科服务进行了一项前瞻性队列研究。在每日晨间交接结束时，要求接收的外科医生在提供的交接表上表明他们是否同意针对所讨论的每位患者提出的管理计划。还描述了他们不同意的具体护理方面，并将分歧预先分类为主要或次要。主要结局是对交接的管理计划的分歧率。
六位外科 staff 医生同意参与，研究期间共交接了417例不同的患者。对于主要结局，共记录了41例分歧，分歧率为9.8%。41例分歧中有15例被分类为主要分歧，主要分歧率为3.6%。顾问之间的分歧63%的时间被分类为主要分歧，而顾问与住院医生之间的分歧31%的时间被分类为主要分歧（P = 0.217）。发生临床分歧的患者平均年龄较大；63岁对57岁（P < 0.05）。
尽管临床实践中交接频繁，但很少有研究确定在学术中心工作的外科医生之间对患者管理的分歧率。本研究表明，在一家三级护理教学医院工作的外科医生中临床分歧率较低。
