PDF(Pubmed)
Abstract：
Globally exacerbated surgical waitlists have provided the opportunity to reflect on prioritization and resource allocation decisions. The unique circumstances of paediatric surgery and consequences of surgical delay prompted the study reported in this paper. As part of a larger project to attend to prioritization in our surgical waitlists, we conducted a Quality Improvement study, the purpose of which is to understand surgeon\'s perspectives regarding the ethical and practical realities of surgical prioritization at our institution. The study comprises semi-structured interviews with nine full-time paediatric surgeons from a variety of subspecialties conducted at our institution, which is a tertiary paediatric hospital with ten surgical subspecialties in a publicly funded healthcare system. Participants articulated how they prioritize their waitlists, and how they understand ethical prioritization. These findings resonate with the growing public concern for ethical practice in healthcare delivery and transparency in prioritization and resource allocation practices. Specifically, more transparency, consistency, and support is required in prioritization practices. This work highlights the importance of institutional dialogue regarding surgical case prioritization. Because quality improvement work is necessarily site-specific, concrete generalizations cannot be offered. However, the insights gleaned from these interviews and the process by which they were gleaned are a valuable knowledge-sharing resource for any institution that is interested in ongoing quality improvement work. The objectives here were to clarify the goals of prioritization within the institution, improve prioritization practices, and make them more ethical and transparent.
摘要：
全球加剧的外科候补名单提供了反思优先次序和资源分配决定的机会。儿科手术的独特情况和手术延迟的后果促使本文报道了这项研究。作为一个更大的项目的一部分，在我们的手术候补名单中进行优先排序，我们进行了一项质量改进研究，其目的是了解外科医生对我们机构手术优先次序的伦理和实践现实的看法。该研究包括对来自我们机构的各种亚专科的九名全职儿科医生的半结构化访谈，这是一家三级儿科医院，在公共资助的医疗保健系统中拥有十个外科亚专科。参与者阐明了他们如何优先考虑他们的候补名单，以及他们如何理解道德优先次序。这些发现引起了公众对医疗保健提供中的道德实践以及优先次序和资源分配实践的透明度的日益关注。具体来说,更多的透明度，一致性,和支持是需要优先的做法。这项工作强调了有关外科病例优先次序的机构对话的重要性。因为质量改进工作必然是针对特定地点的，不能提供具体的概括。然而,从这些访谈中收集到的见解和收集到的过程对于任何对持续质量改进工作感兴趣的机构来说都是宝贵的知识共享资源。这里的目标是澄清机构内优先次序的目标，改进优先次序做法，让他们更加道德和透明。
