老年手术患者的麻醉、手术和初级保健提供者之间的术前沟通

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES Joint Commission journal on quality and patient safety Pub Date : 2024-01-18 DOI:10.1016/j.jcjq.2024.01.006
Donna Ron MD (is Clinical Research Fellow, Department of Community and Family Medicine, and Department of Anesthesiology and Perioperative Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth.), Christine M. Gunn PhD (is Assistant Professor, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.), Jeana E. Havidich MD, MS (is Pediatric Anesthesiologist and Associate Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth.), Madison M. Ballacchino (is Medical Student, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo.), Timothy E. Burdick MD, MBA, MSc (is Associate Professor, Department of Community and Family Medicine, Dartmouth Health and Geisel School of Medicine at Dartmouth, and Associate Professor, Dartmouth Institute for Health Policy and Clinical Practice.), Stacie G. Deiner MD, MS (is Anesthesiologist and Professor, Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center and Geisel School of Medicine at Dartmouth. Please address correspondence to Donna Ron)
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引用次数: 0

摘要

背景临床医生之间沟通不畅仍是导致可预防的不良医疗相关事件、成本增加以及患者和医生不满的一个常见原因。调查对象包括:(1) 新英格兰北部的初级医疗服务提供者;(2) 在三级农村学术医疗中心围手术期诊所工作的麻醉服务提供者;(3) 同一中心的外科医生;(4) 在同一中心接受术前评估的老年手术患者。结果 共有 107/249 名(43.0%)服务提供者和 103/265 名(39.9%)患者完成了调查。人们认为术前沟通在后勤方面具有挑战性(59.8%),尤其是在不同医疗系统之间。超过 77% 的麻醉和手术提供者表示他们经常或有时进行沟通,但 92.5% 的初级医疗提供者表示他们很少或从未与麻醉提供者进行沟通。术前沟通最常见的原因是讨论复杂病人、围手术期用药管理和优化合并症。虽然 96.1% 的老年手术患者表示医疗服务提供者之间的术前沟通很重要,但只有 40.4% 的患者认为他们的医疗服务提供者之间的沟通非常好或非常好。许多患者强调了医疗服务提供者之间术前沟通的重要性,以确保关键临床信息的传递。结论在一个农村三级医疗中心,外科医生和麻醉师很少与初级医疗服务提供者进行沟通,这与患者的期望和价值观形成了鲜明对比。这些研究结果将有助于确定优先事项和潜在的可解决障碍,以弥合住院围手术期团队和门诊初级医疗团队之间的差距。未来的研究应重点关注改善医院和社区医疗服务提供者之间沟通的策略,以预防并发症和再入院。
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Preoperative Communication Between Anesthesia, Surgery, and Primary Care Providers for Older Surgical Patients

Background

Suboptimal communication between clinicians remains a frequent driver of preventable adverse health care–related events, increased costs, and patient and physician dissatisfaction.

Methods

Cross-sectional surveys on preoperative interspecialty communication, tailored by stakeholder type, were administered to (1) primary care providers in northern New England, (2) anesthesia providers working in the perioperative clinic of a tertiary rural academic medical center, (3) surgeons from the same center, and (4) older surgical patients who underwent preoperative assessment at the same center.

Results

In total, 107/249 (43.0%) providers and 103/265 (39.9%) patients completed the survey. Preoperative communication was perceived as logistically challenging (59.8%), particularly across health systems. More than 77% of anesthesia and surgery providers indicated that they communicate frequently or sometimes, but 92.5% of primary care providers indicated that they rarely or never communicate with anesthesia providers. Some of the most common reasons for preoperative communication were discussion of complex patients, perioperative medication management, and optimization of comorbidities. Although 96.1% of older surgical patients reported that preoperative communication between providers is important, only 40.4% felt that their providers communicate very or extremely well. Many patients emphasized the importance of preoperative communication between providers to ensure transfer of critical clinical information.

Conclusion

Surgeons and anesthesiologists infrequently communicate with primary care providers in one rural tertiary center, in contrast to patient expectations and values. These study results will help identify priorities and potentially resolvable barriers to bridging the gap between the inpatient perioperative and outpatient primary care teams. Future studies should focus on strategies to improve communication between hospital and community providers to prevent complications and readmission.

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CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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Table of Contents Editorial Board The Joint Commission Journal on Quality and Patient Safety 50th Anniversary Article Collections: 50 Most Cited Table of Contents Editorial Board
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