外科手术中的日常交接:系统性回顾以及干预措施和结果的新分类法。

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-03-01 DOI:10.1093/bjsopen/zrae011
Jessica M Ryan, Fiachra McHugh, Anastasija Simiceva, Walter Eppich, Dara O Kavanagh, Deborah A McNamara
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引用次数: 0

摘要

背景:质量差的交接班会给患者带来不良后果;然而,目前缺乏支持安全外科交接班的证据。本系统性综述旨在总结可用于改善轮班结束时手术交接的干预措施。此外,还介绍了一种新的干预措施和结果分类法以及一种经过修改的质量评估工具:方法:检索了 Ovid MEDLINE®、PubMed、Embase 和 Cochrane 数据库中截至 2023 年 4 月的文章。纳入了描述医生之间日常院内手术交接干预措施的比较研究。根据干预措施和结果对研究进行分组:共检索到 6139 条引文,41 项研究符合纳入标准。对照组和干预组的患者样本量分别为 11 946 人和 11 563 人。大多数研究为干预前/后队列研究(92.7%),大多数(73.2%)为 V 级证据。平均质量评估得分率为 53.4% (17.1)。对交接班干预措施和结果进行了分类,干预措施包括交接班工具、流程标准化措施、员工教育和使用记忆法。超过 25% 的研究将文件作为唯一的干预措施。总体而言,共评估了 55 项离散结果,分为四类,包括流程(27 项)、员工(14 项)、患者(12 项)和系统级(2 项)结果。在这些结果中,分别有51.8%、78.5%、58.3%(9761对9312名患者)和100%的结果得到显著改善:大多数出版物表明,高质量的手术交接可改善预后,而且许多干预措施似乎是有效的;但是,这些研究在方法上存在差异。这些新的分类标准和质量评估工具将有助于规范未来的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Daily handover in surgery: systematic review and a novel taxonomy of interventions and outcomes.

Background: Poor-quality handovers lead to adverse outcomes for patients; however, there is a lack of evidence to support safe surgical handovers. This systematic review aims to summarize the interventions available to improve end-of-shift surgical handover. A novel taxonomy of interventions and outcomes and a modified quality assessment tool are also described.

Methods: Ovid MEDLINE®, PubMed, Embase, and Cochrane databases were searched for articles up to April 2023. Comparative studies describing interventions for daily in-hospital surgical handovers between doctors were included. Studies were grouped according to their interventions and outcomes.

Results: In total, 6139 citations were retrieved, and 41 studies met the inclusion criteria. The total patient sample sizes in the control and intervention groups were 11 946 and 11 563 patients, respectively. Most studies were pre-/post-intervention cohort studies (92.7%), and most (73.2%) represented level V evidence. The mean quality assessment score was 53.4% (17.1). A taxonomy of handover interventions and outcomes was developed, with interventions including handover tools, process standardization measures, staff education, and the use of mnemonics. More than 25% of studies used a document as the only intervention. Overall, 55 discrete outcomes were assessed in four categories including process (n = 27), staff (n = 14), patient (n = 12) and system-level (n = 2) outcomes. Significant improvements were seen in 51.8%, 78.5%, 58.3% (n = 9761 versus 9312 patients) and 100% of these outcomes, respectively.

Conclusions: Most publications demonstrate that good-quality surgical handover improves outcomes and many interventions appear to be effective; however, studies are methodologically heterogeneous. These novel taxonomies and quality assessment tool will help standardize future studies.

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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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