Surgeon agreement at the time of handover, a prospective cohort study

Abstract

BackgroundAcute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons. Despite the recent emergence of this model of care, minimal research has been conducted on the quality of patient handover and no research has attempted to determine the rate of clinical agreement or disagreement among surgeons participating in these teams.MethodsA prospective cohort study was carried out with our acute care surgical service at a tertiary care teaching hospital from January 2 to March 31 2012. At the conclusion of the daily morning handover, receiving surgeons were asked to indicate, on provided handover sheets, whether they agreed with the proposed management plan for each patient that was discussed. The specific aspects of care over which they disagreed were also described, and disagreements were classified a priori as major or minor. The primary outcome was the rate of disagreement over the handed over management plan.ResultsSix staff surgeons agreed to participate and a total of 417 unique patients were handed over during the study period. For the primary outcome, a total of 41 disagreements were recorded for a disagreement rate of 9.8 %. 15 of the 41 disagreements were classified as major, for a major disagreement rate of 3.6 %. Consultant to consultant disagreements were classified as major disagreements 63 % of the time, whereas consultant to resident disagreements were classified as major 31 % of the time (P = 0.217). On average, the age of patients for which a clinical disagreement occurred were older; 63 vs. 57 (P < 0.05).ConclusionsDespite the frequency of handovers in clinical practice, little research has been conducted to determine the rate of disagreement over patient management among surgeons participating working in academic centers. This study demonstrated that the rate of clinical disagreement is low among surgeons working in an tertiary care teaching hospital.

Oblique Chest X-Ray: An Alternative Way to Detect Pneumothorax

“…Thoracic ultrasonography is an effective and sensitive diagnosing technique to evaluate patients at emergency room. 3 , 11 – 16 ) The diagnostic sensitivity and specificity of thoracic ultrasonography technique for detecting pneumothoraces range from 58.9% to 100% and 94% to 100%, respectively. 7 )…”

“…Matsumoto reported the sensitivity, specificity, and accuracy of OCXR 61.4%, 99.2%, and 90.9%, respectively, which were very close to thoracic ultrasonography. 3 )…”

“… 1 , 2 ) The standard anteroposterior supine X-ray (APSXR) is the recommended imaging modality for trauma patients according to the Advanced Trauma Life Support Course guideline. 3 , 4 )…”

“…A pneumothorax identified on CT which is not seen on supine chest X-ray is recognized as “occult pneumothorax.” 1 , 3 , 5 , 6 ) Although chest X-ray is the principal radiological imaging technique for thorax, occult pneumothorax cannot be detected for 52%–63% of all traumas. 1 , 7 )…”

“… 1 , 8 ) Tension pneumothorax can be resulted from receiving mechanical ventilation after occult pneumothorax. 3 , 9 ) CT cannot be performed in patients who have severe shock, need of immobilization and/or performing mechanical ventilation in intensive care units (ICUs). The goal of this study was to show the effectiveness of oblique chest X-ray (OCXR) both in emergency room and follow-up period in ICUs.…”