某军队创伤中心实施的急诊普通外科流程改进计划回顾。
Review of an emergency general surgery process improvement program at a verified military trauma center.
机构信息
Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
Naval Medical Research Center, Silver Spring, MD, USA.
出版信息
Surg Endosc. 2018 Oct;32(10):4321-4328. doi: 10.1007/s00464-018-6303-0. Epub 2018 Jul 2.
INTRODUCTION
Decreasing combat-based admissions to our military facility have made it difficult to maintain a robust trauma process improvement (PI) program. Since emergency general surgery (EGS) and trauma patients share similarities, we merged the care of our EGS and trauma patients into one acute care surgery (ACS) team. An EGS PI program was developed based on trauma PI principles to facilitate continued identification of opportunities for improvement despite our decline in trauma admissions. Analysis of the first 18 months of combined ACS PI data is presented.
METHODS
EGS registry inclusion criteria was based on published Association for the Surgery of Trauma's recommendations. Program components and PI categories were based on our existing trauma PI program. Dedicated coordinators actively reviewed and cataloged patient care and outcomes. Deviations from standard practice patterns, unplanned interventions, and other complications were abstracted, categorized, and evaluated through levels of review similar to accepted trauma PI principles. Data for the first six quarters were collated and trends were analyzed.
RESULTS
Over 18 months, 696 EGS patients met registry inclusion criteria, with 468 patients (67%) undergoing operative intervention. Over the same time, 353 trauma patients were admitted with 158 undergoing operative intervention (56.4%). Of the 696 EGS patients and 353 trauma patients, 226 (32%) and 243 (69%) PI events were identified, respectively. Common events included unplanned therapies, re-admissions, and unplanned ICU admissions. Based on analysis of all events, four new areas for improvement initiatives were identified. Results of these initiatives included implementation of a multi-disciplinary EGS PI committee, consensus protocols, and departmental and hospital-wide actions.
CONCLUSION
In an 18-month period, integration of our EGS patients into a novel, combined ACS PI program facilitated recognition of an additional 226 PI events and provided a substrate for continued improvements in patient care.
简介
我们军事设施中的战斗相关入院人数减少，这使得维持一个强大的创伤流程改进（PI）计划变得困难。由于急诊普通外科（EGS）和创伤患者有相似之处，我们将 EGS 和创伤患者的护理合并到一个急性护理外科（ACS）团队中。根据创伤 PI 原则，制定了 EGS PI 计划，以促进在我们创伤入院人数下降的情况下，继续发现改进机会。本文介绍了合并后的 ACS PI 数据的前 18 个月的分析结果。
方法
EGS 登记标准基于创伤外科学会（ASS）发布的建议。计划组成部分和 PI 类别基于我们现有的创伤 PI 计划。专门的协调员积极审查和记录患者的护理和结果。通过与公认的创伤 PI 原则类似的审查水平，对偏离标准实践模式、非计划干预和其他并发症进行提取、分类和评估。前六个季度的数据被整理并分析了趋势。
结果
在 18 个月的时间里，696 名 EGS 患者符合登记标准，其中 468 名患者（67%）接受了手术干预。在同一时期，353 名创伤患者入院，其中 158 名患者（56.4%）接受了手术干预。在 696 名 EGS 患者和 353 名创伤患者中，分别确定了 226 例（32%）和 243 例（69%）PI 事件。常见的事件包括非计划治疗、再次入院和非计划 ICU 入院。根据所有事件的分析，确定了四个新的改进措施领域。这些措施的结果包括实施多学科 EGS PI 委员会、共识协议以及部门和医院范围内的行动。
结论
在 18 个月的时间里，将我们的 EGS 患者纳入新的、合并的 ACS PI 计划，有助于发现另外 226 例 PI 事件，并为患者护理的持续改进提供了基础。
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