Parikh Rajiv P, Snyder-Warwick Alison, Naidoo Sybill, Skolnick Gary B, Patel Kamlesh B
St. Louis, Mo.
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
Plast Reconstr Surg. 2017 Nov;140(5):736e-745e. doi: 10.1097/PRS.0000000000003771.
The Accreditation Council for Graduate Medical Education and Plastic Surgery Milestone Project has identified practice-based learning and improvement, which involves systematically analyzing current practices and implementing changes, as a core competency in residency education. In surgical care, complication reporting is an essential component of practice-based learning and improvement as complications are analyzed in morbidity and mortality conference for quality improvement. Unfortunately, current methods for capturing a comprehensive profile of complications may significantly underestimate the true occurrence of complications. Therefore, the objectives of this study are to evaluate an intervention for complication reporting and compare this to current practice, in a plastic surgery training program.
This is a preintervention and postintervention study evaluating resident reporting of complications on a plastic surgery service. The intervention was an online event reporting system developed by department leadership and patient safety experts. The cohorts consisted of all patients undergoing surgery during two separate 3-month blocks bridged by an implementation period. A trained reviewer recorded complications, and this served as the reference standard. Fisher's exact test was used for binary comparisons.
There were 32 complications detected in 219 patients from June to August of 2015 and 35 complications in 202 patients from October to December of 2015. The proportion of complications reported in the preintervention group was nine of 32 (28.1 percent). After the intervention, this significantly increased to 32 of 35 (91.4 percent) (p < 0.001).
An intervention using an event reporting system, supported by departmental leadership, led to significant improvements in complication reporting by plastic surgery residents.
毕业后医学教育认证委员会和整形外科学里程碑项目已将基于实践的学习与改进确定为住院医师教育的一项核心能力，该能力包括系统分析当前实践并实施变革。在外科护理中，并发症报告是基于实践的学习与改进的重要组成部分，因为在发病率和死亡率会议上会对并发症进行分析以提高质量。不幸的是，目前用于全面了解并发症情况的方法可能会严重低估并发症的实际发生率。因此，本研究的目的是在一个整形外科学培训项目中评估一种并发症报告干预措施，并将其与当前实践进行比较。
这是一项干预前和干预后的研究，评估整形外科学服务中住院医师对并发症的报告情况。干预措施是由科室领导和患者安全专家开发的在线事件报告系统。研究队列包括在两个单独的3个月时间段内接受手术的所有患者，中间有一个实施期。一名经过培训的审核员记录并发症情况，并将其作为参考标准。采用Fisher精确检验进行二元比较。
2015年6月至8月，219例患者中检测到32例并发症；2015年10月至12月，202例患者中检测到35例并发症。干预前组报告的并发症比例为32例中的9例（28.1%）。干预后，这一比例显著提高到35例中的32例（91.4%）（p<0.001）。
在科室领导支持下使用事件报告系统的干预措施，使整形外科学住院医师的并发症报告有了显著改善。
