Keller Patrick R, Schneeberger Steven, Drolet Brian C, Al Kassis Salam, Bennett Pearce F, Perdikis Galen
Departments of Plastic Surgery, and.
Ann Plast Surg. 2019 Jun;82(6S Suppl 5):S380-S385. doi: 10.1097/SAP.0000000000001818.
Facial trauma is common and carries significant morbidity and cost. Suboptimal interdisciplinary communication is associated with negative health outcomes. This study evaluates the clinical impact of implementation of American College of Surgeons Trauma Quality Improvement Program (TQIP) interdisciplinary communication guidelines between facial surgery and trauma teams.
Patients with facial trauma presenting to our level 1 trauma center between May and December 2017 were included (N = 812) and split into 3 groups, each anonymously representing a service that treats facial trauma. Services 1 and 2 were controls, and service 3 adopted TQIP communication guidelines. Mean and slope of time-to-operation (TTO) and mean length of stay were assessed 106 days before (n = 95) and 107 days after (n = 77) implementation.
For service 3, mean TTO decreased significantly from 6.2 to 2.9 days (P = 0.005) after implementation of the communication intervention. There was no significant difference in mean TTO preimplementation versus postimplementation in either control cohort, including service 1 (4.6 vs 4.9 days; P = 0.59) and service 2 (4.2 vs 4.5 days; P = 0.62). Average length of stay did not differ significantly between the preintervention versus postintervention in any service (service 1: 9.0 vs 8.3 days, P = 0.43; service 2: 4.6 vs 6.6 days, P = 0.85; service 3: 6.7 vs 6.4 days, P = 0.45).
Our study demonstrates that cost-free TQIP-guided improvement in interdisciplinary communication between the trauma service and a consulting surgical specialist decreases TTO for patients with operative facial trauma. Health care providers should develop strong well-defined communication channels between collaborating teams involved in patient care to optimize patient clinical outcomes.
面部创伤很常见，会带来严重的发病率和成本。跨学科沟通欠佳与不良健康结果相关。本研究评估了美国外科医师学会创伤质量改进计划（TQIP）跨学科沟通指南在面部外科和创伤团队之间实施的临床影响。
纳入2017年5月至12月在我们的一级创伤中心就诊的面部创伤患者（N = 812），并分为3组，每组匿名代表一个治疗面部创伤的科室。科室1和科室2为对照组，科室3采用TQIP沟通指南。在实施前106天（n = 95）和实施后107天（n = 77）评估手术时间（TTO）的均值和斜率以及平均住院时间。
对于科室3，实施沟通干预后，平均TTO从6.2天显著降至2.9天（P = 0.005）。在任何一个对照组中，实施前与实施后的平均TTO均无显著差异，包括科室1（4.6天对4.9天；P = 0.59）和科室2（4.2天对4.5天；P = 0.62）。在任何科室中，干预前与干预后的平均住院时间均无显著差异（科室1：9.0天对8.3天，P = 0.43；科室2：4.6天对6.6天，P = 0.85；科室3：6.7天对6.4天，P = 0.45）。
我们的研究表明，免费的TQIP指导下创伤科室与咨询外科专科医生之间跨学科沟通的改善可降低面部创伤手术患者的TTO。医疗保健提供者应在参与患者护理的协作团队之间建立强大且明确的沟通渠道，以优化患者的临床结局。
