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.
Highlights
Acute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons
Acute care surgical teams afford several advantages over the traditional model of emergency surgical care in that they allow for clear lines of responsibility to be established in the treatment of emergent surgical patients; they ensure that hospital resources are Hilsden et al World Journal of Emergency Surgery (2016) 11:11 consistently being allocated to the sickest patients in a timely fashion without drawing focus away from elective patients [6]
For continuity of care to be maintained throughout the handover process, information must be adequately passed from one party to another, agreement over the patients’ care plans must be met between the incoming and outgoing clinicians, and the care plan must be followed [7]
Summary
Acute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons. Acute care surgical teams represent an emerging model of surgical care in large hospitals and teaching institutions. The decision to shift from the traditional model of surgical care to an acute care surgical model places significant time demands on clinical staff To manage these demands, regular handover from staff surgeon to staff surgeon is required [1]. Regular handover from staff surgeon to staff surgeon is required [1] As a result, those who administrate acute care surgical services have made continuity of care a priority for these teams [3]. For continuity of care to be maintained throughout the handover process, information must be adequately passed from one party to another, agreement over the patients’ care plans must be met between the incoming and outgoing clinicians, and the care plan must be followed [7]
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