Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献_第9页

Bridging generational gaps in Surgery: A narrative review on values, well-being, and training preferences 弥合外科手术的代沟：关于价值观、幸福感和培训偏好的叙述回顾。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-07-08 DOI: 10.1016/j.surge.2025.07.003

Floortje Huizing , Vincent Q. Sier , Annelot D. Sark , Heleen S. Snijders , Joost R. van der Vorst , Roderick F. Schmitz , Abbey Schepers , Joris J. Blok , Future Surgeon Initiative

Background and purpose

Intergenerational differences in surgery create both challenges and opportunities. While differening perspectives and expectations may deter younger generations from pursuing surgical careers, it is crucial to balance these with the core values that define the surgical profession. This narrative review was conducted to better understand how the profession needs to evolve.

Methods

A structured literature search on generational changes in surgery was conducted using PubMed and Google Scholar. Relevant search terms were employed, covering (i) surgeons/surgery, (ii) generation/cohort and (ii) culture/identity/behaviour. After independent title and abstract screening by three authors, consensus was reached to include relevant studies published in English up to November 2023.

Main findings

Full-text evaluation led to an inclusion of 50 studies, reviewed for returning themes. Identified themes included: generations (n = 9), work engagement (n = 8), work-life balance (n = 7), training and education (n = 4) and attractiveness of the profession (n = 8). An additional 14 relevant studies were included based on reference lists and external sources.

Conclusions

This review summarizes key factors contributing to surgical well-being and generational dynamics. Awareness of these factors is increasing. While generational differences exist, many distinctions may be attributed to life phases, lifestyles or systemic changes in the past decades. Addressing these topics daily can foster intergenerational dialogue and a supportive environment for future surgeons.

背景与目的：手术的代际差异既带来挑战，也带来机遇。虽然不同的观点和期望可能会阻止年轻一代追求外科职业，但平衡这些与定义外科职业的核心价值观至关重要。进行这种叙述性审查是为了更好地了解该专业需要如何发展。方法：使用PubMed和谷歌Scholar对外科代际变化进行结构化文献检索。使用相关的搜寻词，包括(i)外科医生/外科手术、（ii）世代/群组及（ii）文化/身份/行为。经过三位作者独立的题目和摘要筛选，我们达成共识，纳入2023年11月之前发表的相关英文研究。主要发现：全文评价纳入了50项研究，对返回主题进行了审查。确定的主题包括：世代（n = 9）、工作投入（n = 8）、工作与生活平衡（n = 7）、培训与教育（n = 4）和职业吸引力（n = 8）。根据参考文献清单和外部来源，另外列入了14项相关研究。结论：本综述总结了影响手术健康和代际动态的关键因素。对这些因素的认识正在增加。虽然存在代际差异，但许多差异可能归因于过去几十年的生活阶段、生活方式或系统变化。每天处理这些话题可以促进代际对话，并为未来的外科医生提供支持环境。

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引用次数: 0

Enhancing medical student learning in the operating theatre: the need for integrated preparation 加强医学生在手术室的学习：综合准备的必要性。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-06-30 DOI: 10.1016/j.surge.2025.06.003

Lachlan Dick, Sannah Ali, Katie Hughes

引用次数: 0

Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study 以利多卡因和硝苯地平为基础的保守治疗急性痔疮疾病的比较疗效：一项回顾性队列研究。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-06-28 DOI: 10.1016/j.surge.2025.06.002

Michele Schiano di Visconte

Background

Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition that significantly impacts patients' quality of life and healthcare systems. Despite the availability of various conservative treatments, comparative efficacy data remains limited. This retrospective study evaluates two treatment regimens for AHD, focusing on symptom relief, patient-reported outcomes, and treatment tolerability.

Methods

Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed. Patients were divided into two groups: Group A treated with oral diosmin/hesperidin, bromelain, and topical lidocaine, and Group B treated with oral diosmin/hesperidin, bromelain, and topical nifedipine. Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21.

Results

Both groups showed significant improvements in symptoms during the study period. Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, p < 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p < 0.001). Improvements in SHS-HD scores were more rapid for Group A, with scores on day 7 showing a significant difference (Group A: 7.58 ± 2.58 vs. Group B: 12.27 ± 4.21, p < 0.001). Both regimens were well tolerated, with no significant adverse events.

Conclusions

The combination of oral diosmin/hesperidin, bromelain, and lidocaine provides superior initial symptom relief compared with nifedipine-based regimens. Lidocaine is the preferred topical agent for rapid pain management in AHD patients. Further studies are required to confirm these results.

背景：急性痔疮病（AHD）是一种常见的肛肠疾病，严重影响患者的生活质量和医疗保健系统。尽管有各种保守治疗方法，但相对疗效数据仍然有限。本回顾性研究评估了AHD的两种治疗方案，重点关注症状缓解、患者报告的结果和治疗耐受性。方法：回顾2022年10月至2024年10月在某三级保健中心治疗的123例AHD患者的病历。患者分为两组：A组口服地奥司明/橙皮苷、菠萝碱，外用利多卡因；B组口服地奥司明/橙皮苷、菠萝碱，外用硝苯地平。在基线和第7、14和21天使用痔疮疾病症状评分（HDSS）、疼痛视觉模拟量表（VAS）和痔疮疾病短期健康量表（SHS-HD）对症状进行评估。结果：两组患者在研究期间症状均有明显改善。A组疼痛减轻更快（VAS日：0.17±0.52 vs. 2.20±1.11,p）结论：与硝苯地平为主的方案相比，口服地奥司明/橙皮苷、菠萝酶和利多卡因联合使用可更好地缓解初始症状。利多卡因是AHD患者快速止痛的首选外用药物。需要进一步的研究来证实这些结果。

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引用次数: 0

Venous thromboembolism (VTE) prevention in the trauma patient: A national survey of practice 创伤患者静脉血栓栓塞（VTE）预防：一项全国实践调查。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-06-27 DOI: 10.1016/j.surge.2025.06.001

Bibi Ayesha Bassa , Michele Fernandes , Elizabeth Little , Kaitlin Alexander , Frank Lyons , Valeria Lima Passos , Fionnuala Ni Ainle , Etimbuk Umana

Aim

Due to complex injury patterns, the safe timing of venous thromboembolism (VTE) prophylaxis in trauma patients is challenging. The purpose of this study was to characterize current thromboprophylaxis practice in trauma patients amongst trauma providers in Ireland.

Methods

We conducted a national, cross-sectional survey of trauma providers. The survey was sponsored by the Irish Network for VTE Research (INViTE) and disseminated through the national trauma and VTE office. The survey was a 35-item questionnaire and collected information regarding non-pharmacologic prophylaxis practice, preferred pharmacologic agent and dose, timing to initiation of prophylaxis in high-risk patients and selection of patients for extended thromboprophylaxis post discharge.

Results

A total of 116 trauma providers responded (estimated response rate among surgical specialities 11 %). Majority of respondents (72/116; 65 %) were consultant doctors or fellows. Thirty-seven percent of respondents (43/116) reported having a VTE guideline for trauma patients at their institution. Majority of respondents (115/116; 99 %) reported using some form of mechanical prophylaxis. The most common pharmacologic dosing regimen reported was enoxaparin 40 mg 24-hourly (44/116; 38 %). Forty-four percent of respondents (51/116) indicated adjusting doses in patients with obesity. A high degree of variability in initial timing of prophylaxis following traumatic brain injury, solid organ injury, and spinal column injuries was observed.

Conclusion

There is variable VTE prevention practice among trauma providers in Ireland. A standardized, national approach to VTE prevention in trauma care is needed.

目的：由于复杂的损伤模式，创伤患者静脉血栓栓塞（VTE）预防的安全时机是具有挑战性的。本研究的目的是表征目前的血栓预防实践的创伤患者之间的创伤提供者在爱尔兰。方法：我们对创伤提供者进行了全国性的横断面调查。这项调查由爱尔兰静脉血栓栓塞研究网络（INViTE）赞助，并通过国家创伤和静脉血栓栓塞办公室进行传播。该调查是一份35项问卷，收集了有关非药物预防实践、首选药物和剂量、高危患者开始预防的时间以及出院后延长血栓预防的患者选择的信息。结果：共有116名创伤提供者做出了回应（估计外科专业的回应率为11%）。大多数受访者(72/116；65%)是顾问医生或研究员。37%的受访者（43/116）报告说，他们的机构为创伤患者制定了静脉血栓栓塞指南。大多数受访者(115/116；99%)报告使用某种形式的机械预防。最常见的给药方案是依诺肝素40mg 24小时(44/116；38%)。44%的应答者（51/116）表示肥胖患者需要调整剂量。观察到创伤性脑损伤、实体器官损伤和脊柱损伤后的初始预防时间存在高度差异。结论：在爱尔兰的创伤提供者中有不同的静脉血栓栓塞预防实践。需要一种标准化的、全国性的方法来预防创伤护理中的静脉血栓栓塞。

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引用次数: 0

Pitfalls of crude pooling in assessing diagnostic accuracy: A cautionary note 在评估诊断准确性的粗池的陷阱：一个警告。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-06-16 DOI: 10.1016/j.surge.2025.05.005

Javier Arredondo Montero MD, PhD

引用次数: 0

Ultrasound-guided versus laparoscopic-guided transversus abdominus plane block for laparoscopic cholecystectomy – A systematic review and meta-analysis of randomised clinical trials 超声引导与腹腔镜引导下经腹平面阻滞用于腹腔镜胆囊切除术-随机临床试验的系统回顾和荟萃分析。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-06-03 DOI: 10.1016/j.surge.2025.05.003

Matthew G. Davey , Gordon R. Daly , Noel E. Donlon , Nuala A. Healy , Arnold D.K. Hill

Background

The use of transversus abdominus plane (TAP) blocks have come into vogue in recent times, with the ambition to reduce post-operative pain following laparoscopic cholecystectomy. TAP block is commonly performed using an ultrasound-guided approach (US-TAP), with emerging data indicating that laparoscopic-guided (L-TAP) approach may also be useful.

Aim

To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) comparing outcomes following US-TAP and L-TAP block in patients undergoing laparoscopic cholecystectomy.

Methods

A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4.

Results

6 RCTs including 428 patients were included. Overall, 212 patients were randomised to US-TAP (49.5 %) and 216 to L-TAP (50.5 %) respectively. A non-significant difference was observed between groups for mean age, gender, mean body mass indices, and American Society of Anesthesiologists grades (all P > 0.050). At meta-analyses, a non-significant difference was observed for US-TAP and L-TAP with respect to 2-, 6-, 12-, 24-, and 48-h post-operative visual analogue scores. A non-significant difference was also observed in relation to intraoperative duration, breakthrough opioid consumption, and post-operative vomiting, at meta-analysis. Patients who underwent US-TAP had longer anesthetic administration times (mean difference: 6.38, 95 % confidence interval: 2.77–10.00, P < 0.001) compared to those randomised to undergo L-TAP.

Conclusion

L-TAP and US-TAP provided similar post-operative pain scores, intraoperative duration, breakthrough opioid consumption, and post-operative vomiting following laparoscopic cholecystectomy. However, the time taken to perform L-TAP was significantly shorter. Should expertise allow, L-TAP should be considered in patients undergoing laparoscopic cholecystectomy.

背景：近年来，为了减少腹腔镜胆囊切除术后的疼痛，使用腹横平面（TAP）阻滞已成为一种时尚。TAP阻滞通常使用超声引导入路（US-TAP）进行，新出现的数据表明腹腔镜引导（L-TAP）入路也可能有用。目的：对随机临床试验（rct）进行系统回顾和荟萃分析，比较腹腔镜胆囊切除术患者采用US-TAP和L-TAP阻断治疗的结果。方法：按照PRISMA指南进行系统评价。meta分析使用Review Manager版本5.4进行。结果：共纳入6项rct，共纳入428例患者。总体而言，212名患者随机分配到US-TAP组（49.5%）和216名患者随机分配到L-TAP组（50.5%）。各组间的平均年龄、性别、平均体重指数和美国麻醉医师学会评分差异无统计学意义（P均为0.050）。在荟萃分析中，US-TAP和L-TAP在术后2、6、12、24和48小时的视觉模拟评分方面无显著差异。在荟萃分析中，也观察到术中持续时间、突破性阿片类药物消耗和术后呕吐方面的无显著差异。采用US-TAP的患者麻醉时间更长（平均差异：6.38,95%可信区间：2.77-10.00，P）。结论：L-TAP和US-TAP在腹腔镜胆囊切除术后的术后疼痛评分、术中持续时间、突破性阿片类药物消耗和术后呕吐方面具有相似的差异。然而，执行L-TAP所需的时间明显缩短。在专业知识允许的情况下，腹腔镜胆囊切除术患者应考虑L-TAP。

{"title":"Ultrasound-guided versus laparoscopic-guided transversus abdominus plane block for laparoscopic cholecystectomy – A systematic review and meta-analysis of randomised clinical trials","authors":"Matthew G. Davey , Gordon R. Daly , Noel E. Donlon , Nuala A. Healy , Arnold D.K. Hill","doi":"10.1016/j.surge.2025.05.003","DOIUrl":"10.1016/j.surge.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>The use of transversus abdominus plane (TAP) blocks have come into vogue in recent times, with the ambition to reduce post-operative pain following laparoscopic cholecystectomy. TAP block is commonly performed using an ultrasound-guided approach (US-TAP), with emerging data indicating that laparoscopic-guided (L-TAP) approach may also be useful.</div></div><div><h3>Aim</h3><div>To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) comparing outcomes following US-TAP and L-TAP block in patients undergoing laparoscopic cholecystectomy.</div></div><div><h3>Methods</h3><div>A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4.</div></div><div><h3>Results</h3><div>6 RCTs including 428 patients were included. Overall, 212 patients were randomised to US-TAP (49.5 %) and 216 to L-TAP (50.5 %) respectively. A non-significant difference was observed between groups for mean age, gender, mean body mass indices, and American Society of Anesthesiologists grades (all <em>P</em> > 0.050). At meta-analyses, a non-significant difference was observed for US-TAP and L-TAP with respect to 2-, 6-, 12-, 24-, and 48-h post-operative visual analogue scores. A non-significant difference was also observed in relation to intraoperative duration, breakthrough opioid consumption, and post-operative vomiting, at meta-analysis. Patients who underwent US-TAP had longer anesthetic administration times (mean difference: 6.38, 95 % confidence interval: 2.77–10.00, <em>P</em> < 0.001) compared to those randomised to undergo L-TAP.</div></div><div><h3>Conclusion</h3><div>L-TAP and US-TAP provided similar post-operative pain scores, intraoperative duration, breakthrough opioid consumption, and post-operative vomiting following laparoscopic cholecystectomy. However, the time taken to perform L-TAP was significantly shorter. Should expertise allow, L-TAP should be considered in patients undergoing laparoscopic cholecystectomy.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 399-405"},"PeriodicalIF":2.3,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Knowledge gaps and radiation exposure concerns: Time for a revamp of radiation training structures for trainee surgeons 知识差距和辐射暴露问题：是时候对实习外科医生的辐射培训结构进行改革了。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-05-29 DOI: 10.1016/j.surge.2025.05.002

Lylas Aljohmani , Aoife Gaffney , Linda Kelly , Lucy-Anne O'Sullivan , Eunice Leyva , Michael O'Connor , Jackie McCavana , Eric Heffernan , Christine Quinlan , Roisin Dolan

Objective

This study aims to assess surgical trainee knowledge of occupational radiation exposure, personal protection equipment (PPE) compliance, and prior radiation protection training.

Design

A cross-sectional quantitative study using a questionnaire-based survey.

Setting

Tertiary care hospitals in Ireland.

Participants

79 surgical trainees across six surgical disciplines, with a 70 % response rate.

Results

Seventy-nine of 112 surgical trainees (70 %) completed the survey. Most were specialist registrars (47 %), with orthopaedics, plastic surgery, and urology comprising 70 % of respondents. Although 78 % had attended a radiation safety course, 40 % lacked fluoroscopy-specific training. Knowledge gaps were evident—60 % of questions were commonly answered incorrectly, with only 11 % correctly identifying CT radiation dose. Despite frequent fluoroscopy use, dosimeter use was poor: only 7.6 % always wore one. Prior training correlated with increased PPE use and awareness of long-term radiation risks, including fertility concerns. While 67 % expressed concern about exposure, only 21.5 % said it influenced speciality choice. The most used PPE was lead skirt/top (72 %), followed by thyroid shield (52 %), while lead glasses and gloves were rarely worn.

Conclusion

Significant knowledge gaps and low PPE compliance were observed amongst surgical trainees. Given the strong desire for further training, we recommend a modernised, interactive national radiation safety training program tailored to surgical specialities.

目的：本研究旨在评估外科培训生的职业辐射暴露知识、个人防护装备（PPE）符合性以及先前的辐射防护培训。设计：采用基于问卷的横断面定量研究。环境：爱尔兰三级保健医院。参与者：来自6个外科学科的79名外科实习生，反应率为70%。结果：112名外科培训生中有79人（70%）完成了调查。大多数是专科登记员（47%），其中骨科、整形外科和泌尿外科占70%。虽然78%的人参加过辐射安全课程，但40%的人缺乏专门的透视培训。知识差距很明显——60%的问题通常回答错误，只有11%的问题正确识别了CT辐射剂量。尽管经常使用透视检查，但剂量计的使用很差：只有7.6%的人总是佩戴剂量计。先前的培训与PPE使用的增加和对长期辐射风险的认识相关，包括生育问题。虽然67%的人表示担心暴露，但只有21.5%的人表示这会影响专业选择。使用最多的PPE是铅裙/上衣（72%），其次是甲状腺屏蔽（52%），而很少戴铅眼镜和手套。结论：外科培训生存在明显的知识缺口和较低的PPE依从性。鉴于对进一步培训的强烈愿望，我们建议为外科专业量身定制一个现代化的、互动的国家辐射安全培训计划。

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引用次数: 0

POSE-UK: Paediatric orthopaedic surgery exposure in the UK POSE-UK：英国儿童骨科手术暴露。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-05-28 DOI: 10.1016/j.surge.2025.04.003

Chloe Jane Lowe , Jun Wei Lim , Stephanie Buchan , Anouska Ayub , Felicity Pease , Emily Baird

Aim

This study aims to investigate the early exposure of orthopaedic trainees to paediatric orthopaedics and explore their training experiences, focusing on the factors influencing their decision to either select or deselect paediatric orthopaedics as a subspecialty.

Method

A national survey was distributed electronically to members of the British Orthopaedic Trainees' Association following a pilot survey sent to British Society of Children's Orthopaedic Surgery members. The survey concentrated on trainees' experiences and interest in paediatric orthopaedics. It included open, closed, and free-text questions, with the responses thematically analysed using NVivo software.

Results

133 responses were received from trainees across the UK and Ireland. The findings showed significant variation in the timing of the first exposure to paediatric orthopaedics, with 25 % not encountering it until Specialty Trainee level 6 or later. Most participants had mixed placements involving both adult and paediatric orthopaedics. Limited theatre exposure and insufficient emphasis on paediatric orthopaedic surgery during training may contribute to a lack of interest. A worrying lack of confidence was noted amongst trainees in performing standard emergency paediatric orthopaedic procedures, which are expected competencies for newly appointed consultants, regardless of their intended subspecialty. Furthermore, many trainees indicated that they might not meet the required work-based assessments and indicative numbers necessary to complete training.

Conclusion

Earlier and more extensive exposure to paediatric orthopaedics during training could help foster greater interest in the subspecialty. Enhanced training in standard emergency paediatric orthopaedic presentations is essential to ensure trainees are confident in performing these procedures as newly appointed general orthopaedic consultants.

目的：本研究旨在调查骨科实习生对儿科骨科的早期接触情况，探讨其培训经历，重点研究影响其选择或不选择儿科骨科作为亚专科的因素。方法：在向英国儿童骨科外科学会成员发送试点调查后，向英国骨科实习协会成员分发了一份全国性的电子调查。调查集中于受训者对儿科骨科的经验和兴趣。它包括开放、封闭和自由文本问题，并使用NVivo软件对回答进行主题分析。结果：从英国和爱尔兰的学员那里收到了133份回复。研究结果显示，首次接触儿科骨科的时间存在显著差异，25%的儿童直到专业培训生6级或更高水平才接触到儿科骨科。大多数参与者的位置混合，包括成人和儿科骨科。在培训期间，有限的手术室暴露和对儿科骨科手术的重视不够可能导致缺乏兴趣。令人担忧的是，受训者在执行标准儿科急诊矫形手术方面缺乏信心，而这是新任命的顾问所期望具备的能力，无论其拟从事何种专科。此外，许多受训人员表示，他们可能达不到完成培训所需的基于工作的评估和指示性数字。结论：在培训期间更早和更广泛地接触儿科骨科可以帮助培养对该亚专科的更大兴趣。加强标准儿科急诊骨科演示的培训是必不可少的，以确保受训者作为新任命的普通骨科顾问有信心执行这些程序。

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引用次数: 0

Intern involvement in emergency general surgical handover and implications for patient care 急诊普通外科手术交接及其对病人护理的影响。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-05-26 DOI: 10.1016/j.surge.2025.05.004

Niall Murnaghan , Jessica M. Ryan , William P. Duggan , Deborah A. McNamara

Background

Surgical handover is a key risk area in patient care, yet the impact of junior team member involvement in the process is not well understood. This study aims to assess the level of intern involvement in emergency general surgery (EGS) handover and its impact on daily tasks.

Methods

Overt, structured, non-participant observations of morning EGS handover meetings were carried out to assess intern involvement. The same interns were then observed over the course of the day-shift immediately following the handover. During these observation periods, details of all patient care queries addressed to the interns were recorded.

Results

Five general surgery interns (42%) were observed across six EGS handover meetings. A total of 100 clinical queries were recorded during 25 h of observation. Only 2/6 handover meetings had full intern involvement. While all appeared to be actively listening during handover, questions were asked, and readbacks were provided by interns during 4/6 and 3/6 handovers, respectively. Clinical queries directed at interns who were fully involved in the morning handover were more likely to be answered immediately (96.6 %,n = 29 vs. 78.6 %,n = 55; p = 0.024) and using memory of the verbal handover (50 %,n = 15 vs 24.3 %,n = 17; p = 0.012). One incidence of negligible harm occurred, due to omission of a patient's allergy information from the handover.

Conclusion

Interns who are fully involved in handover show evidence of learning and are more likely to respond to queries faster and from memory. Reduced involvement in the post-call handover process has the potential to delay, and therefore negatively impact, patient care.

背景：手术交接是患者护理的一个关键风险领域，然而初级团队成员参与这一过程的影响尚未得到很好的理解。本研究旨在评估实习生在急诊普外科（EGS）工作交接中的参与程度及其对日常工作的影响。方法：采用公开的、结构化的、非参与性的观察方法，对上午的EGS交接会议进行评估。然后，这些实习生在交接后的白班进行观察。在这些观察期间，记录了所有向实习生提出的病人护理问题的细节。结果：在6次EGS交接会议中观察到5名普外科实习生（42%）。在25小时的观察中，共记录了100例临床询问。只有2/6的交接会议有实习生全程参与。虽然所有人在交接过程中都表现得很积极，但在4月6日和3月6日的交接期间，实习生分别提出了问题，并提供了反馈。直接向充分参与早间交接的实习生提出的临床问题更有可能立即得到回答(96.6%,n = 29 vs. 78.6%,n = 55；P = 0.024)和使用言语切换记忆(50%,n = 15 vs 24.3%,n = 17；p = 0.012)。由于在交接过程中遗漏了患者的过敏信息，发生了一个可忽略不计的伤害事件。结论：充分参与交接的实习生表现出学习能力，更有可能更快地根据记忆对问题做出反应。减少对呼叫后交接过程的参与有可能延迟，从而对患者护理产生负面影响。

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引用次数: 0

The impact of direct consultant-to-consultant referrals on the spinal care pathway: A clinical audit 直接咨询师到咨询师转诊对脊柱护理途径的影响：临床审计。

IF 2.3 4区医学 Q2 SURGERY

Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

Pub Date : 2025-05-26 DOI: 10.1016/j.surge.2025.05.001

Arnav Barve , Paul McCarroll , Kevin Clesham , Harry Marland , Jake M. McDonnell , Stacey Darwish , Marcus Timlin , Sam Lynch , Seamus Morris , Joseph S. Butler , Keith Synnott

Background

The institution in focus is a tertiary referral centre for all spinal pathology in the country. Traditionally, referrals to this centre have been reviewed by an on-call resident at the referring hospital. However, on May 10, 2023, this changed to a direct consultant-to-consultant referral protocol. This study aims to evaluate the impact of this change in protocol on the spinal care pathway.

Methods

A retrospective review was conducted based on patients with spinal pathology referred to the tertiary centre from February 2023 to August 2023. Referrals made using the traditional referral system (‘Before’ from 08/02/2023–09/05/2023) were compared to referrals made through the consultant-led referral system (‘After’ from 10/05/2023–08/08/2023). Parameters such as the number of referrals, number of surgically managed patients, and patients with complete imaging at the time of referral (TOR) were statistically compared between the groups.

Results

There were 31.2 % fewer referrals in the ‘After’ group (223) than in the ‘Before’ group (324). The proportion of patients with complete imaging at TOR increased significantly (67.3 % vs. 81.6 %, p < 0.05). Also, the number of patients who were treated surgically increased significantly (33.3 % vs. 40.4 %, p < 0.05). Furthermore, the number of patients referred for follow-up to the outpatient department (OPD) decreased significantly (5.2 % vs. 0.9 %; p < 0.05).

Conclusion

The consultant-to-consultant referral protocol decreased the overall referral numbers, increased the number of patients with complete imaging, increased the surgical yield, and decreased the rates of OPD follow-up. This can be attributed to more efficient consultant-led local decision-making, which fortifies the benefits of this referral protocol.

背景：重点机构是三级转诊中心所有脊柱病理在该国。传统上，转诊到本中心的病人由转诊医院的一名随叫随到的住院医生进行复查。然而，在2023年5月10日，这改为直接咨询师对咨询师的推荐协议。本研究旨在评估这一方案改变对脊柱护理途径的影响。方法：对2023年2月至2023年8月在第三中心就诊的脊柱病理患者进行回顾性分析。使用传统转介系统（208/02/23 -09/05/2023）的转介个案与使用顾问转介系统（208/05/2023 -08/08/2023）的转介个案进行比较。转诊人数、手术处理患者人数、转诊时影像完整的患者（TOR）等参数在两组间进行统计学比较。结果：“治疗后”组（223例）比“治疗前”组（324例）少31.2%。结论：医师对医师的转诊方案减少了总体转诊人数，增加了完整影像的患者数量，提高了手术成功率，降低了OPD随访率。这可归因于更有效的顾问领导的地方决策，这加强了这种转诊协议的好处。

{"title":"The impact of direct consultant-to-consultant referrals on the spinal care pathway: A clinical audit","authors":"Arnav Barve , Paul McCarroll , Kevin Clesham , Harry Marland , Jake M. McDonnell , Stacey Darwish , Marcus Timlin , Sam Lynch , Seamus Morris , Joseph S. Butler , Keith Synnott","doi":"10.1016/j.surge.2025.05.001","DOIUrl":"10.1016/j.surge.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The institution in focus is a tertiary referral centre for all spinal pathology in the country. Traditionally, referrals to this centre have been reviewed by an on-call resident at the referring hospital. However, on May 10, 2023, this changed to a direct consultant-to-consultant referral protocol. This study aims to evaluate the impact of this change in protocol on the spinal care pathway.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted based on patients with spinal pathology referred to the tertiary centre from February 2023 to August 2023. Referrals made using the traditional referral system (‘Before’ from 08/02/2023–09/05/2023) were compared to referrals made through the consultant-led referral system (‘After’ from 10/05/2023–08/08/2023). Parameters such as the number of referrals, number of surgically managed patients, and patients with complete imaging at the time of referral (TOR) were statistically compared between the groups.</div></div><div><h3>Results</h3><div>There were 31.2 % fewer referrals in the ‘After’ group (223) than in the ‘Before’ group (324). The proportion of patients with complete imaging at TOR increased significantly (67.3 % vs. 81.6 %, p < 0.05). Also, the number of patients who were treated surgically increased significantly (33.3 % vs. 40.4 %, p < 0.05). Furthermore, the number of patients referred for follow-up to the outpatient department (OPD) decreased significantly (5.2 % vs. 0.9 %; p < 0.05).</div></div><div><h3>Conclusion</h3><div>The consultant-to-consultant referral protocol decreased the overall referral numbers, increased the number of patients with complete imaging, increased the surgical yield, and decreased the rates of OPD follow-up. This can be attributed to more efficient consultant-led local decision-making, which fortifies the benefits of this referral protocol.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 359-364"},"PeriodicalIF":2.3,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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