Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial.
Feasibility of Surgeon-Delivered Audit and Feedback Incorporating Peer Surgical Coaching to Reduce Fistula Incidence following Cleft Palate Repair: A Pilot Trial.
复制标题
外科医生提供的审核和反馈结合同行手术指导以减少腭裂修复后瘘管发生率的可行性：试点试验。
DOI：
10.1097/prs.0000000000006907
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发表时间：
2020
影响因子：
3.6
通讯作者：
Britto,MariaT
中科院分区：
文献类型：
--
作者：
Sitzman,ThomasJ;Tse,RaymondW;Allori,AlexanderC;Fisher,DavidM;Samson,ThomasD;Beals,StephenP;Matic,DamirB;Marcus,JeffreyR;Grossoehme,DanielH;Britto,MariaT
背景：提高外科医生的技术水平可能会降低他们术后并发症的发生率。在未来的有效性试验之前，作者进行了一项试点试验，以评估外科医生提供的审计和反馈干预的可行性，其中包括同行手术指导对进行腭裂修复的外科医生的技术表现。方法：一项非随机、双臂、非盲目的试点试验，招募了进行腭裂修复的外科医生。参与者完成了对瘘管发生率的基线审计。瘘管发生率高于中位数的参与者被分配到密集的反馈干预措施中，包括选择同行外科教练，观察教练进行腭部修复，与教练一起查看他们自己的手术技术的手术视频，以及提出和实施他们的技术改变。所有其他人都被分配给简单的反馈(接收审计结果)。评估的结果是完成基线审计的外科医生的比例，向同行披露他们的瘘管发生率，以及完成反馈干预。结果：7名外科医生参加了试验。所有七个人都完成了基线审计，并向其他参与者披露了他们的瘘管发生率。中位基线瘘管发生率为0.4%(范围为0至10.5%)。两名外科医生无法接受反馈干预。在剩下的五名外科医生中，两名被分配到密集反馈组，三名被分配到简单反馈组。所有外科医生都完成了指定的反馈干预。在接受密集反馈的外科医生中，瘘管的发生率基线时为5.9%，反馈后为0.0%(调整后的OR为0.98；95%的CI为0.44至2.17)。结论：外科医生提供的审计和反馈结合同行对技术性能的指导对外科医生是可行的。
Background:Improving surgeons’ technical performance may reduce their frequency of postoperative complications. The authors conducted a pilot trial to evaluate the feasibility of a surgeon-delivered audit and feedback intervention incorporating peer surgical coaching on technical performance among surgeons performing cleft palate repair, in advance of a future effectiveness trial.Methods:A nonrandomized, two-arm, unblinded pilot trial enrolled surgeons performing cleft palate repair. Participants completed a baseline audit of fistula incidence. Participants with a fistula incidence above the median were allocated to an intensive feedback intervention that included selecting a peer surgical coach, observing the coach perform palate repair, reviewing operative video of their own surgical technique with the coach, and proposing and implementing changes in their technique. All others were allocated to simple feedback (receiving audit results). Outcomes assessed were proportion of surgeons completing the baseline audit, disclosing their fistula incidence to peers, and completing the feedback intervention.Results:Seven surgeons enrolled in the trial. All seven completed the baseline audit and disclosed their fistula incidence to other participants. The median baseline fistula incidence was 0.4 percent (range, 0 to 10.5 percent). Two surgeons were unable to receive the feedback intervention. Of the five remaining surgeons, two were allocated to intensive feedback and three to simple feedback. All surgeons completed their assigned feedback intervention. Among surgeons receiving intensive feedback, fistula incidence was 5.9 percent at baseline and 0.0 percent following feedback (adjusted OR, 0.98; 95 percent CI, 0.44 to 2.17).Conclusion:Surgeon-delivered audit and feedback incorporating peer coaching on technical performance was feasible for surgeons.