Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
BJS Open. 2022 Jul 7;6(4). doi: 10.1093/bjsopen/zrac092.
Emergency laparotomy is associated with high morbidity and mortality. The early identification of high-risk patients allows for timely perioperative care and appropriate resource allocation. The aim of this study was to develop a nationwide surgical trainee-led quality improvement (QI) programme to increase the use of perioperative risk scoring in emergency laparotomy.
The programme was structured using the active implementation framework in 15 state-funded Irish hospitals to guide the staged implementation of perioperative risk scoring. The primary outcome was a recorded preoperative risk score for patients undergoing an emergency laparotomy at each site.
The rate of patients undergoing emergency laparotomy receiving a perioperative risk score increased from 0-11 per cent during the exploratory phase to 35-100 per cent during the full implementation phase. Crucial factors for implementing changes included an experienced central team providing implementation support, collaborator engagement, and effective communication and social relationships.
A trainee-led QI programme increased the use of perioperative risk assessment in patients undergoing emergency laparotomy, with the potential to improve patient outcomes and care delivery.
急诊剖腹手术与较高的发病率和死亡率相关。早期识别高危患者有助于及时进行围手术期护理和适当的资源分配。本研究的目的是开发一项全国性的外科实习生主导的质量改进（QI）计划，以增加在急诊剖腹手术中使用围手术期风险评分。
该计划使用主动实施框架在 15 家由国家资助的爱尔兰医院中进行结构化，以指导围手术期风险评分的分阶段实施。主要结果是记录每个站点接受急诊剖腹手术的患者的术前风险评分。
接受围手术期风险评分的急诊剖腹手术患者比例从探索阶段的 0-11%增加到全面实施阶段的 35-100%。实施变革的关键因素包括经验丰富的中央团队提供实施支持、合作者的参与以及有效的沟通和社交关系。
实习生主导的 QI 计划增加了在接受急诊剖腹手术的患者中进行围手术期风险评估的使用，有可能改善患者的预后和护理效果。
