[Interdisciplinary complications conference--also a (simple) kind of quality assurance].

D Heim, U Stricker, M Negri
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引用次数: 2

Abstract

Documentation of complications is a "must" today. Several societies have been formed and several systems of documentation exist to fulfill these requirements. But there are also very simple tools for quality management in every hospital. Since 1995 all surgical/orthopedic interventions have been prospectively recorded at the hospital of Frutigen. Every other month a list of all operations and their complications is put together by the two surgeons-in-chief. This list is then presented at the so-called interdisciplinary complications-conference. This meeting is open to all employees of the hospital and to all medical doctors of the region. From the 1st January 1995 to the 31st December 2001 7396 surgical interventions were performed on in- or outpatients. 134 complications (1.8%) occurred. These were: 49/7396 infections (0.7%), 14/1395 re-osteosyntheses (1%), 21/7396 hematomas requiring evacuation (0.3%), 8/7396 disturbances in wound healing (0.1%) and 42 other, postoperative complications. Postoperative infection occurred most frequently after appendectomies 10/251 (4%), the rate after internal fixation was 0.6% (9/1395). Hematomas were encountered most frequently after total joint replacement (hip and knee) 4/180 (2.2%), followed by inguinal hernias 4/287 (1.4%). The rate of re-osteosynthesis was highest after internal fixation of proximal humerus fractures 5/58 (8.6%). This systematic documentation of complications allows an analysis of the operative/perioperative management. By introducing specific measures (compression-bandage after operations of inguinal hernias and total hip prosthesis, new implant with rotational stability for proximal humerus fractures) an attempt can be made to reduce the rate of the most frequent complications. The public presentation of the complications at the meeting makes it possible to communicate good and bad results to the whole staff including the general practitioners, and the interdisciplinary mode of discussion permits the inclusion of not only the surgical but also all other possible aspects of the treatment of the patients.

[跨学科并发症会议——也是一种(简单的)质量保证]。
如今,并发症的记录是“必须的”。为了满足这些要求,已经成立了若干协会,并存在若干文件系统。但是每个医院也有非常简单的质量管理工具。自1995年以来,所有外科/矫形手术都在Frutigen医院进行了前瞻性记录。每隔一个月,两位首席外科医生就会列出所有手术及其并发症的清单。这份清单随后将在所谓的跨学科并发症会议上公布。这次会议对医院的所有雇员和该地区的所有医生开放。从1995年1月1日至2001年12月31日,对住院或门诊病人进行了7396次手术干预。发生并发症134例(1.8%)。其中:49/7396例感染(0.7%),14/1395例再成骨(1%),21/7396例血肿需要引流(0.3%),8/7396例伤口愈合障碍(0.1%)和42例其他术后并发症。术后感染发生率最高的是阑尾切除术后10/251(4%),内固定术后发生率为0.6%(9/1395)。全髋关节置换术后血肿发生率最高,为4/180(2.2%),腹股沟疝发生率次之,为4/287(1.4%)。肱骨近端骨折5/58(8.6%)内固定后复位率最高。这种系统的并发症记录可以分析手术/围手术期的处理。通过引入特定的措施(腹股沟疝手术后的压迫绷带和全髋关节假体,肱骨近端骨折旋转稳定的新植入物),可以尝试减少最常见的并发症的发生率。在会议上公开介绍并发症,可以向包括全科医生在内的全体工作人员传达好结果和坏结果,跨学科的讨论模式允许不仅包括手术,还包括患者治疗的所有其他可能方面。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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