Persad Amit R, Mercure-Cyr Rosalie, Spiess Michael, Woo Allan, Tymchak Zane, Wu Adam, Hnenny Luke, Fourney Daryl R
Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
Division of Orthopedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
Eur Spine J. 2022 Dec;31(12):3330-3336. doi: 10.1007/s00586-022-07423-4. Epub 2022 Oct 20.
"After-hours" non-elective spine surgery is associated with increased morbidity. Decision-making may be enhanced by collaborative input from experienced local colleagues. At our center, we implemented routine use of a cross-platform messaging system (CPMS; WhatsApp Inc., Mountain View, California) to facilitate quality care discussions and collaborative surgical decision-making between spine surgeons prior to booking cases with the operating room. Our aim is to determine whether encrypted text messaging for shared decision-making between spine surgeons affects the number or type of after-hours spine procedures.
We retrospectively compared the number, type and length of after-hours spine surgery over three time periods: (A) June 1, 2016-May 31, 2017 (baseline control); (B) June 1, 2017-May 31, 2018 (implementation of retrospective quality care spine rounds); and (C) June 1, 2018-May 31, 2019 (implementation of CPMS). A qualitative analysis of the CPMS transcripts was also performed to assess the rate of between-surgeon agreement for timing and type of procedure.
The mean number of after-hours spine surgeries/month over the three study periods (A, B, C) was 10.83, 9.75 and 7.58 (p = 0.014); length of surgery was 41.82, 33.14 and 25.37 h/month (p = 0.001). Group agreement with the attending spine surgeon plan was 74.3% overall and was highest for the most urgent and least urgent types of indications.
Prospective (i.e., prior to booking surgery) quality care discussion for joint decision-making among spine surgeons using CPMS may reduce both the number and complexity of after-hours procedures.
“非工作时间”的非选择性脊柱手术与发病率增加相关。经验丰富的当地同事的协作意见可能会改善决策。在我们中心，我们实施了常规使用跨平台消息系统（CPMS；WhatsApp公司，加利福尼亚州山景城），以促进脊柱外科医生在向手术室预订病例之前进行高质量护理讨论和协作手术决策。我们的目的是确定脊柱外科医生之间用于共同决策的加密短信是否会影响非工作时间脊柱手术的数量或类型。
我们回顾性比较了三个时间段的非工作时间脊柱手术的数量、类型和时长：（A）2016年6月1日至2017年5月31日（基线对照）；（B）2017年6月1日至2018年5月31日（实施回顾性高质量护理脊柱查房）；以及（C）2018年6月1日至2019年5月31日（实施CPMS）。还对CPMS记录进行了定性分析，以评估外科医生之间在手术时间和类型方面的一致率。
在三个研究时间段（A、B、C）中，每月非工作时间脊柱手术的平均数量分别为10.83、9.75和7.58（p = 0.014）；手术时长分别为41.82、33.14和25.37小时/月（p = 0.001）。总体上与脊柱主治医生计划的组内一致率为74.3%，在最紧急和最不紧急的指征类型中最高。
使用CPMS在脊柱外科医生之间进行前瞻性（即手术预订前）高质量护理共同决策讨论，可能会减少非工作时间手术的数量和复杂性。
