Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Denver, Aurora, CO.
Surgery. 2018 Apr;163(4):832-838. doi: 10.1016/j.surg.2017.11.017. Epub 2018 Jan 10.
The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement.
Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed.
Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings.
A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges.
Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field.
我们研究的目的是描述医疗保健提供者对导致急诊普通外科发病率和死亡率不成比例的因素的印象，以确定改善医疗质量的目标。
急诊普通外科的特点是成本负担高，发病率和死亡率不成比例。导致这些观察到的差异的因素尚未得到全面理解，也没有正式制定质量改进的目标。
采用扎根理论方法，通过目的基础抽样招募急诊普通外科医生参与半结构式访谈和焦点小组。要求参与者确定影响急诊普通外科手术结果的因素，定义急诊普通外科患者的有效护理，并描述手术室团队结构。访谈进行到主题饱和为止。在案例内和跨案例对转录本进行迭代编码和分析，以确定新出现的主题。成员检查用于确定研究结果的可信度。
共有来自 5 家学术医院的 40 名参与者参加了个人访谈（n=25 [9 名麻醉师，12 名外科医生，4 名护士]）或焦点小组（n=2 [15 名护士]）。急诊普通外科的特点是具有极高的可变性，可以细分为患者变异性（急性生理学和合并症）和系统变异性（手术室资源和劳动力）。多学科沟通被确定为急诊普通外科变异性的调节剂；然而，护理人员通常被排除在早期沟通交流之外。
急诊普通外科的关键变异性可能会影响结果。患者变异性和系统变异性，重点是多学科沟通，代表了该领域质量改进的潜在领域。
