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绘制择期手术中的患者教育接触情况图谱:一项队列研究和横断面调查。

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey.

机构信息

Victor Horsely Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK

Wellcome / EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.

出版信息

BMJ Open Qual. 2024 May 27;13(2):e002810. doi: 10.1136/bmjoq-2024-002810.

Abstract

OBJECTIVE

Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.

DESIGN

A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey.

SETTING

A single surgical centre in the UK.

PARTICIPANTS

Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded.

INTERVENTIONS

Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire.

RESULTS

There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery.

CONCLUSIONS

Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.

摘要

目的

制定患者了解拟议手术的过程图,并确定患者用于自我教育的资源。

设计

采用混合方法设计,结合半结构化利益相关者访谈、使用电子医疗记录(EHR)对回顾性队列进行定量验证以及横断面患者调查。

地点

英国的一个单一外科中心。

参与者

对 14 名脊柱多学科团队成员进行了访谈,以制定过程图。该过程图使用 2022 年 1 月至 6 月期间接受择期脊柱手术的 50 名患者的 EHR 进行了验证。手术后,从 25 份患者调查中收集反馈意见,以确定他们使用哪些资源来了解他们的脊柱手术。排除年龄在 18 岁以下或接受急诊手术的患者。

干预措施

择期脊柱手术和术后在病房或随访诊所提供的患者问卷。

主要和次要结果

主要结果是过程图上出现的研究队列的百分比。如果>80%的患者出现,则定义关键时间点。次要结果是使用患者问卷中列出的教育资源的研究队列的百分比。

结果

该队列共发生 342 次就诊,确定了 16 个离散事件类别。初始外科诊所(88%)、麻醉术前评估(96%)和手术入院(100%)被确定为关键时间点。调查发现,患者最常从他们的外科医生那里获得口头信息(100%),其次是他们的外科医生的书面信息(52%)和互联网(40%),以了解他们的手术。

结论

过程映射是展示患者路径的有效方法。初始外科诊所、麻醉术前评估和手术入院是患者接受信息的关键时间点。这对未来指导患者教育干预措施在关键时间点集中注意力具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb27/11131119/5d10b9a7e85c/bmjoq-2024-002810f01.jpg

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