Abstract：
BACKGROUND: Patients with intestinal malrotation with volvulus (MWV) may suffer bowel ischemia, which can be correlated with the timing of surgical intervention. The purpose of this study was to identify and assess time-blocks in the care of patients from initial physician assessment (IPA) to surgical intervention to highlight potential opportunities for improvement.
METHODS: Retrospective chart review of patients with MWV presenting to McMaster Children\'s Hospital between January 1st, 2000 and December 31st, 2020 (n = 31). Demographic data and time-blocks of care were identified and analyzed (p < 0.05 considered significant). All times were reported as medians.
RESULTS: 22 males (71%) and 9 females (29%) were identified; median age was 9.8 d. IPA to incision was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients <1 y was not significantly different than those >1 y (10.5hrs vs 10.7hrs, p = 0.737). The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs, p = 0.128). For patients requiring resection or having pan-necrosis there was no significant difference in time from IPA (10.9hrs vs 10.5hrs, p = 0.238) or surgical consult to incision (4.0hrs vs 3.3hrs, p = 0.808).
CONCLUSIONS: Time from IPA to surgical consult and time from surgical consult to surgical intervention represented the largest proportions of time. Age, use of ultrasound, and need for resection or having pan-necrosis did not significantly affect the time to incision. This data may be used to inform opportunities for expediting the management of patients with MWV once they have presented to a physician.
METHODS: III.
METHODS: Retrospective chart review of patients with MWV presenting to McMaster Children\'s Hospital between January 1st, 2000 and December 31st, 2020 (n = 31). Demographic data and time-blocks of care were identified and analyzed (p < 0.05 considered significant). All times were reported as medians.
RESULTS: 22 males (71%) and 9 females (29%) were identified; median age was 9.8 d. IPA to incision was 10.7hrs and surgical consult to incision was 3.4hrs. Time to incision for patients <1 y was not significantly different than those >1 y (10.5hrs vs 10.7hrs, p = 0.737). The use of ultrasound did not significantly affect time to incision (7.9hrs vs 12.0hrs, p = 0.128). For patients requiring resection or having pan-necrosis there was no significant difference in time from IPA (10.9hrs vs 10.5hrs, p = 0.238) or surgical consult to incision (4.0hrs vs 3.3hrs, p = 0.808).
CONCLUSIONS: Time from IPA to surgical consult and time from surgical consult to surgical intervention represented the largest proportions of time. Age, use of ultrasound, and need for resection or having pan-necrosis did not significantly affect the time to incision. This data may be used to inform opportunities for expediting the management of patients with MWV once they have presented to a physician.
METHODS: III.
摘要：
背景：肠扭转（MWV）肠旋转不良患者可能遭受肠缺血，这可能与手术干预的时机相关。这项研究的目的是确定和评估从初始医师评估（IPA）到手术干预的患者护理时间障碍，以突出潜在的改善机会。
方法：1月1日期间到McMaster儿童医院就诊的MWV患者的回顾性图表回顾，2000年12月31日,2020年（n=31）。识别并分析人口统计学数据和护理时间块(p<0.05认为是显著的)。所有时间都被报告为中位数。
结果：确定了22名男性（71％）和9名女性（29％）；中位年龄为9.8d。切口的IPA为10.7小时，切口的手术咨询为3.4小时。<1y的患者的切口时间与>1y的患者没有显着差异（10.5hrsvs10.7hrs，p=0.737）。超声的使用并没有显著影响到切口的时间(7.9hrsvs12.0hrs,p=0.128）。对于需要切除或泛坏死的患者，与IPA的时间没有显着差异（10.9小时vs10.5小时，p=0.238）或手术咨询切口（4.0小时vs3.3小时，p=0.808）。
结论：从IPA到手术会诊的时间和从手术会诊到手术干预的时间代表了最大的时间比例。年龄,使用超声波，并且需要切除或泛坏死并没有显着影响切口时间。一旦MWV患者被呈现给医生,该数据可用于通知加速对MWV患者的管理的机会。
方法：III.
方法：1月1日期间到McMaster儿童医院就诊的MWV患者的回顾性图表回顾，
结果：确定了22名男性（71％）和9名女性（29％）；中位年龄为9.8d。切口的IPA为10.7小时，切口的手术咨询为3.4小时。
结论：从IPA到手术会诊的时间和从手术会诊到手术干预的时间代表了最大的时间比例。
方法：III.
