Variability in clinicians' understanding and reported methods of identifying high-risk surgical patients: a qualitative study.
BMC Health Serv Res
; 20(1): 427, 2020 May 15.
Article
en En
| MEDLINE
| ID: mdl-32414412
ABSTRACT
BACKGROUND:
High-risk patients presenting for surgery require complex decision-making and perioperative management. However, given there is no gold standard for identifying high-risk patients, doing so may be challenging for clinicians in practice. Before a gold standard can be established, the state of current practice must be determined. This study aimed to understand how working clinicians define and identify high-risk surgical patients.METHODS:
Clinicians involved in the care of high-risk surgical patients at a public hospital in regional Australia were interviewed as part of an ongoing study evaluating a new shared decision-making process for high-risk patients. The new process, Patient-Centred Advanced Care Planning (PC-ACP) engages patients, families, and clinicians from all relevant specialties in shared decision-making in line with the patient's goals and values. The semi-structured interviews were conducted before the implementation of the new process and were coded using a modified form of the 'constant comparative method' to reveal key themes. Themes concerning patient risk, clinician's understanding of high risk, and methods for identifying high-risk surgical patients were extricated for close examination.RESULTS:
Thirteen staff involved in high-risk surgery at the hospital at which PC-ACP was to be implemented were interviewed. Analysis revealed six sub-themes within the major theme of factors related to patient risk (1) increase in high-risk patients, (2) recognising frailty, (3) risk-benefit balance, (4) suitability and readiness for surgery, (5) avoiding negative outcomes, and (6) methods in use for identifying high-risk patients. There was considerable variability in clinicians' methods of identifying high-risk patients and regarding their definition of high risk. This variability occurred even among clinicians within the same disciplines and specialties.CONCLUSIONS:
Although clinicians were confident in their own ability to identify high-risk patients, they acknowledged limitations in recognising frail, high-risk patients and predicting and articulating possible outcomes when consenting these patients. Importantly, little consistency in clinicians' reported methods for identifying high-risk patients was found. Consensus regarding the definition of high-risk surgical patients is necessary to ensure rigorous decision-making.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Personal de Hospital
/
Procedimientos Quirúrgicos Operativos
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Conocimientos, Actitudes y Práctica en Salud
Límite:
Adult
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Female
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Humans
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Male
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Middle aged
País como asunto:
Oceania
Idioma:
En
Año:
2020
Tipo del documento:
Article