Rotimi O, Beatson K, Aderombi A, Lam W, Bajomo O, Kukreja N
General Surgery Department, Windmill Road, Medway Maritime Hospital, Gillingham, Kent, ME7 5NY, United Kingdom.
Ann Med Surg (Lond). 2020 Nov;59:229-233. doi: 10.1016/j.amsu.2020.10.011. Epub 2020 Oct 9.
During the COVID-19 pandemic, surgical practice may deviate with operative and non-operative management considered. Appropriate discussion of options with patients is paramount to quality surgical care. Intercollegiate and EAES guidelines recommend discussing and documenting risk of COVID-19 exposure in the consent process for patients undergoing surgery.
Closed-loop audit of consent forms for patients undergoing emergency and elective surgical procedures. Interventions implemented included education of wider surgical teams. Data was collected during a one-week period for each cycle and analysed using Chi-squared test.
In cycle 1, 6/17 (35.3%) case notes documented discussion of COVID-19 risk. Following intervention, compliance improved to 23/29 (79.3%) cases in cycle 2 and 33/45 (73.3%) cases in cycle 3.
Pre-intervention, our consenting practice was non-compliant. Our interventions led to significant and sustained improvements in practice. We recommend provision of wider surgical team education to facilitate good consenting practice.
在新冠疫情期间,手术操作可能会因所考虑的手术及非手术管理方式而有所不同。与患者恰当讨论各种选择对于高质量的手术治疗至关重要。校际及欧洲内镜外科学会(EAES)指南建议,在为接受手术的患者进行知情同意过程中,讨论并记录新冠病毒暴露风险。
对接受急诊和择期手术的患者的知情同意书进行闭环审核。实施的干预措施包括对更广泛的手术团队进行培训。每个周期在一周内收集数据,并使用卡方检验进行分析。
在第1周期,17份病例中有6份(35.3%)记录了对新冠病毒风险的讨论。干预后,第2周期的合规率提高到29份病例中的23份(79.3%),第3周期为45份病例中的33份(73.3%)。
干预前,我们的知情同意操作不符合要求。我们的干预措施使实际操作有了显著且持续的改善。我们建议对更广泛的手术团队进行培训,以促进良好的知情同意操作。