目标:在COVID-19大流行期间,四级护理机构继续为需要紧急和紧急侵入性手术的患者提供护理。尽管容量和资源有限,但仍需要围手术期方案来简化对这些患者的护理。
方法:在加州大学组建了一个多学科小组,旧金山,在10个学术部门有26位领导人,包括7名部门主席,首席医疗官,首席运营官,感染控制官员,护理领导者,和驻地工作人员冠军。流行病学家,一个伦理学家,还咨询了一名统计学家。经过修改的两轮,基于18个同意/不同意陈述的盲法德尔菲法用于建立共识。使用单侧精确二项检验对使用显著性阈值p<0.05的95%共识的预期结果测试每个陈述的显著分歧。最终的分诊方案是通过非盲化的小组级讨论制定的。
结果:总体而言,18个陈述中的15个在第一轮德尔菲法中达成共识;对存在显着分歧(p<0.01)的3个陈述进行了修改,并迭代地重新提交给专家小组以达成共识。基于共识的协议是使用非盲法多学科小组讨论制定的。最终算法1)量化爆发水平,2)根据敏锐度对患者进行分类,3)提供紧急/紧急侵入性程序清单,和4)创建了一个新的个人防护装备分配评分系统。特别是,作者修改了美国外科医生学院的三级分诊系统,以纳入更多的紧急情况,在神经外科和脊柱手术中经常遇到。
结论:在COVID-19大流行期间需要进行紧急和紧急侵入性手术。这项研究中基于共识的协议可能有助于医疗保健提供者在大流行期间优化围手术期护理。
During the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints.
A multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build
consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95%
consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion.
Overall, 15 of 18 statements achieved
consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus.
Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery.
Urgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The
consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic.