Dickerson Elliot C, Alam Hasan B, Brown Richard K J, Stojanovska Jadranka, Davenport Matthew S
Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.
Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan.
J Am Coll Radiol. 2016 Aug;13(8):943-9. doi: 10.1016/j.jacr.2016.02.005. Epub 2016 Mar 22.
The aim of this study was to determine if direct in-person communication between an acute care surgical team and radiologists alters surgical decision making.
Informed consent was waived for this institutional review board-exempt, HIPAA-compliant, prospective quality improvement study. From January 29, 2015 to December 10, 2015, semiweekly rounds lasting approximately 60 min were held between the on-call acute care surgery team (attending surgeon, chief resident, and residents) and one of three expert abdominal radiologists. A comprehensive imaging review was performed of recent and comparison examinations for cases selected by the surgeons in which medical and/or surgical decision making was pending. All reviewed examinations had available finalized reports known to the surgical team. RADPEER interradiologist concordance scores were assigned to all reviewed examinations. The impression and plan of the attending surgeon were recorded before and after each in-person review.
One hundred patients were reviewed with 11 attending surgeons. The in-person meetings led to changes in surgeons' diagnostic impressions in 43% (43 of 100) and changes in medical and/or surgical planning in 43% (43 of 100; 20 acute changes, 23 nonacute changes, 19 changes in operative management) of cases. There were major discrepancies (RADPEER score ≥3) between the impression of the reviewing radiologist and the written report in 11% of cases (11 of 100).
Targeted in-person collaboration between radiologists and acute care surgeons is associated with substantial and frequent changes in patient management, even when the original written report contains all necessary data. The primary mechanism seems to be promotion of a shared mental model that facilitates the exchange of complex information.
本研究旨在确定急性护理手术团队与放射科医生之间的直接面对面沟通是否会改变手术决策。
对于这项获得机构审查委员会豁免、符合《健康保险流通与责任法案》（HIPAA）的前瞻性质量改进研究，豁免了知情同意。2015年1月29日至2015年12月10日期间，值班的急性护理手术团队（主治医生、总住院医师和住院医师）与三位腹部放射科专家之一每两周进行一次持续约60分钟的查房。对手术医生选择的、医疗和/或手术决策待定的病例进行近期检查和对照检查的全面影像学评估。所有评估的检查都有手术团队已知的最终确定报告。对所有评估的检查给出放射科医生之间的RADPEER一致性评分。在每次面对面评估前后记录主治医生的印象和计划。
11位主治医生对100例患者进行了评估。面对面会议导致43%（100例中的43例）的手术医生诊断印象发生改变，43%（100例中的43例；20例急性改变、23例非急性改变、19例手术管理改变）的病例在医疗和/或手术计划方面发生改变。11%（100例中的11例）的病例中，审查放射科医生的印象与书面报告之间存在重大差异（RADPEER评分≥3）。
放射科医生与急性护理手术医生之间有针对性的面对面协作与患者管理方面大量且频繁的改变相关，即使原始书面报告包含所有必要数据。主要机制似乎是促进了有助于复杂信息交流的共享心理模型。
