Butler Marilyn W, Zarosinski Sandy, Rockstroh Dagmar
Pediatric National Surgical Quality Improvement Program, Randall Children's Hospital, 2801 N Gantenbein Avenue, Portland, OR, 97227, USA; Oregon Health and Science University, Portland, OR, USA.
Pediatric National Surgical Quality Improvement Program, Randall Children's Hospital, 2801 N Gantenbein Avenue, Portland, OR, 97227, USA.
J Pediatr Surg. 2018 Dec;53(12):2378-2382. doi: 10.1016/j.jpedsurg.2018.08.037. Epub 2018 Sep 4.
Inaccurate assignment of surgical wound class (SWC) remains a challenge in perioperative documentation. The purpose of our intervention was to increase the accuracy of SWC through a targeted training program directed toward pediatric surgeons and nurses.
A retrospective electronic medical record (EMR) chart review of 400 operations was performed according to NSQIP criteria during specified periods in 2014 and 2017, assessing SWC errors before and after a training program and posting of reference materials in operating rooms at a 165-bed children's hospital. After each operation, nurses confirmed SWC with the surgeon before recording the value in the EMR. Differences in proportions of misclassified SWC were evaluated with a chi-square test.
Following the educational program, misclassified SWC improved from 70/200 (35.0%) to 18/200 (9.0%), p < 0.001. Misclassified SWC for appendectomies improved from 46/95 (48.4%) to 12/108 (11.1%), p < 0.001.
Accurate SWC assignment in the EMR was improved by an educational program and posting of materials to aid assignment, as well as enhanced communication between surgeons and nurses at the conclusion of each operation. We present the first known attempt to list all pediatric surgery procedures according to SWC. Accurate SWC allows stratification of risks and more effective targeted interventions.
Level III.
手术伤口分类（SWC）的不准确赋值仍是围手术期文档记录中的一项挑战。我们干预措施的目的是通过针对小儿外科医生和护士的定向培训计划提高SWC的准确性。
根据NSQIP标准，在2014年和2017年的特定时间段内，对一家拥有165张床位的儿童医院的400例手术进行了回顾性电子病历（EMR）图表审查，评估培训计划前后以及在手术室张贴参考资料前后的SWC错误情况。每次手术后，护士在将值记录到EMR之前与外科医生确认SWC。使用卡方检验评估SWC错误分类比例的差异。
经过教育计划后，错误分类的SWC从70/200（35.0%）改善至18/200（9.0%），p < 0.001。阑尾切除术的错误分类SWC从46/95（48.4%）改善至12/108（11.1%），p < 0.001。
通过教育计划、张贴辅助赋值的材料以及在每次手术结束时加强外科医生和护士之间的沟通，提高了EMR中SWC赋值的准确性。我们首次尝试根据SWC列出所有小儿外科手术程序。准确的SWC可实现风险分层和更有效的靶向干预。
三级。
