PDF(Pubmed)
Abstract：
Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The \"timing in acute care surgery\" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts.
This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.
Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.
The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a \"safe\" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.
Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.
The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a \"safe\" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
摘要：
背景：及时进入手术室进行紧急普外科（EGS）适应症仍然是全球面临的挑战，很大程度上是由手术室的可用性和人员配备限制驱动的。先前发布了“急性护理手术时机”（TACS）分类，以引入一种新工具来分类EGS患者及时，适当地进入手术室。然而,TACS分类的临床和操作有效性尚未在后续验证研究中进行研究.本研究旨在改进TACS分类，并通过与国际专家的标准化Delphi方法就适当使用新的TACS分类提供进一步的共识。
方法：这是由选定的国际专家小组使用Delphi方法对新型TACS进行的验证研究。TACS问卷设计为基于网络的调查。共识协议水平确定为≥75%。集体共识协议被定义为所有参与者中最高李克特等级等级（4-5）的百分比之和。为每个提议的类别定义了外科急诊疾病和相关的临床情景。随后进行了几轮谈判，直到达成最终的共识。计算频率和百分比以确定每种手术疾病的一致程度。
结果：进行了四轮投票。新的TACS分类提供了与手术的精确时机相关的6种颜色代码类别，定义的场景和手术条件。引入了WHITE颜色代码类，以迅速（在一周内）重新安排取消或推迟的外科手术。血流动力学稳定性是在存在脓毒症/脓毒性休克的情况下对患者进行立即手术与否分层的主要工具。51种外科疾病被包括在不同的颜色代码类别中。
结论：新的TACS分类是一个全面的，简单,清晰且可重复的分诊系统，可用于评估患者和外科疾病的严重程度，为了减少进入手术室的时间，并在“安全”的时间范围内管理急诊手术患者。通过将明确定义的外科疾病纳入不同的颜色代码优先类别，通过德尔菲共识验证，新的TACS改善了外科医生之间的沟通，在外科医生和麻醉师之间，减少了紧急手术患者进入手术室的冲突和浪费以及等待时间。
方法：这是由选定的国际专家小组使用Delphi方法对新型TACS进行的验证研究。TACS问卷设计为基于网络的调查。共识协议水平确定为≥75%。集体共识协议被定义为所有参与者中最高李克特等级等级（4-5）的百分比之和。为每个提议的类别定义了外科急诊疾病和相关的临床情景。随后进行了几轮谈判，直到达成最终的共识。计算频率和百分比以确定每种手术疾病的一致程度。
结果：进行了四轮投票。新的TACS分类提供了与手术的精确时机相关的6种颜色代码类别，定义的场景和手术条件。引入了WHITE颜色代码类，以迅速（在一周内）重新安排取消或推迟的外科手术。血流动力学稳定性是在存在脓毒症/脓毒性休克的情况下对患者进行立即手术与否分层的主要工具。51种外科疾病被包括在不同的颜色代码类别中。
结论：新的TACS分类是一个全面的，简单,清晰且可重复的分诊系统，可用于评估患者和外科疾病的严重程度，为了减少进入手术室的时间，并在“安全”的时间范围内管理急诊手术患者。通过将明确定义的外科疾病纳入不同的颜色代码优先类别，通过德尔菲共识验证，新的TACS改善了外科医生之间的沟通，在外科医生和麻醉师之间，减少了紧急手术患者进入手术室的冲突和浪费以及等待时间。
