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Three years' experience of collaborative care pathways on a maxillofacial ward

BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第2期38卷 132-137页

作者： Rogers, SN Naylor, R Potter, L Magennis, P Univ Hosp Aintree Reg Maxillofacial Unit Liverpool L9 1AL Merseyside England

Collaborative care pathways (CCPs) provide a framework for multidisciplinary patient care. They provide guidelines and a mechanism for audit, and were first introduced at the Regional Unit, Walton Hospital, Liverpool, in November 1994. They have been designed for many surgical groups. Between August 1996 and 31 July 1997, 955 patients were admitted on to the nine established pathways: fractured mandible (n=213), fractured zygoma (n=117), minor oral surgery (n=244), abscess (n=18), examination under anaesthesia (n=73), nasal surgery (n=73), osteotomy (n=80), salivary (n=63), and temporomandibular joint (n=74). The purpose of this article is to report the introduction of CCP in a maxillofacial ward and give results from a one-year audit. CCP have proved to be an extremely useful tool and have several advantages over traditional documentation. They are more accurate, easily computerized, and facilitate audit. They promote the development of guidelines and standardized perioperative care, and this in turn facilitates training and raises standards of care.

关键词：脓肿/外科学麻醉全身/统计学和数值数据临床路径/统计学和数值数据文献工作/统计学和数值数据英格兰/流行病学下颌骨折/外科学医学审核病案系统计算机化口腔疾病/外科学鼻/外科学口腔外科手术/统计学和数值数据截骨术/统计学和数值数据围手术期医护/标准涎腺/外科学外科口腔/教育外科手术小/统计学和数值数据颞下颌关节/外科学颧骨骨折/外科学人类

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Isolated orbital blowout fractures: survey and review

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第5期38卷 496-503页

作者： Courtney, DJ Thomas, S Whitfield, PH Frenchay Hosp Dept Oral & Maxillofacial Surg Bristol BS16 1LE Avon England Royal United Hosp Dept Oral & Maxillofacial Surg Bath BA1 3NG Avon England Southmead Hosp Dept Oral & Maxillofacial Surg Bristol Avon England

The management of orbital blowout fractures is controversial. The continuing debate includes the use of antibiotics and steroids, imaging, the surgical approach, and the choice of implant material for repair of the bony defect. A cross-sectional study was undertaken to assess current practice in treating orbital blowout fractures in the UK, in the form of a tick-box questionnaire. The questionnaire contained 9 closed and 2 open questions, and was forwarded to 256 practising fellows of the British Association of Oral and Maxillofacial Surgery. The response rate to the questionnaire was 73% (187/256). There was no consensus about the use of prophylactic antibiotics. However, 91% prescribed post-operative antibiotics and over half the respondents prescribed steroids. The most common imaging techniques used were computed tomography (CT, 88%) and plain radiograph (83%), 60% routinely sought an ophthalmic opinion and 65% assessed visual acuity, The most common surgical approaches were the subciliary (41%) and the infraorbital (37%), over half the respondents preferred to operate 6-10 days after the injury, and silicone elastomer was the preferred implant material of 66%. (C) 2000 The British Association of Oral and Maxillofacial Surgeons.

关键词：抗生素预防包被物质生物相容性横断面研究二甲基聚硅氧烷类大不列颠口腔外科手术/方法口腔外科手术/统计学和数值数据眶骨折/诊断眶骨折/外科学问卷调查聚硅酮类时间因素人类

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Use of theatre time for dentoalveolar operations under general anaesthesia

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第4期38卷 331-334页

作者： Ogden, GR Kershaw, AE Hussein, I Dundee Dent Hosp & Sch Sect Oral & Maxillofacial Surg Dundee DD1 4HR Scotland

Efficient use of hospital resources is essential if waiting lists are to be reduced. We undertook this study because there seems to be little information on the use of theatre time for dentoalveolar surgery under general anaesthesia. The time taken for each sequence of events (from start of case, induction, operation to recovery, and so on) for each patient was recorded. Of the 30 lists examined, 22 lists (73%) finished on time or early, and 8 lists (27%) ran late, The time spent operating occupied less than 50% of theatre time available, The 'total time' for each case was increased (by about 10 minutes a patient) when a junior anaesthetist was anaesthetizing rather than a consultant. The overall time used per list was 79% with the remaining 21% of the list being 'unused', Where these lists did over-run, then this was usually because the operation took longer, although grade of anaesthetist was a factor. We identified several areas in which efficiency could be improved.

关键词：方差分析麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据临床工作能力牙医诊疗模式/统计学和数值数据效率治疗过程片断手术室/利用口腔外科手术/统计学和数值数据前瞻性研究统计学非参数作业完成和分析时间因素人类

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Direct access day case oral surgery

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BRITISH DENTAL JOURNAL 2000年第8期188卷 452-456页

作者： Joshi, A Doyle, L Worthington, HV Rood, JP Manchester Royal Infirm Dept Oral & Maxillofacial Surg Manchester M13 9WL Lancs England Univ Manchester Dent Hosp Dept Dent Med & Surg Manchester M15 6FH Lancs England GKT Sch Dent London SE5 9RW England

Objective To compare the effectiveness of direct access referrals with standard letter referrals, and also assess the impact of the direct access system on the primary care provider, secondary sector and from the patients perspective. Design Surgical and anaesthetic guidelines were agreed and 12 general dental practitioners were recruited to participate in the study. Each practitioner was given 100 envelopes which contained randomly allocated 50 direct and 50 standard referrals. For direct referrals, GDPs completed a pre-operative assessment and obtained an operation date by telephone from the day case unit while the patient was in the surgery. The clinical history sheet was fared to the day unit and the radiographs posted. The only contact the patient had with the hospital was on the day of surgery. Standard referral patients were referred in the traditional way with a referral letter being sent to an out-patient clinic. Evaluation of the effectiveness of the direct referral system versus standard letter method were made via completion of questionnaires by the patients, dental practitioners, hospital clinicians, day case anaesthetist and co-ordinator. Setting The study was carried out over 2 years commencing in 1997 at the Oral Surgery Day Case Unit at Manchester Royal Infirmary. Results A greater number of direct access referrals (409;90%) were treated in comparison with (312;75%) standard referrals IP < 0.001). Eighty nine per cent of direct access records were adequate pre-operatively. More than 70% of dentists and hospital clinicians preferred the direct access referral method. Sixty-three per cent of standard letter patients were satisfied with their mode of referral compared with 87% of direct access patients. Conclusions Given appropriate guidelines dental practitioners are able to refer directly to oral surgery day case operation lists. This has proved to be the favoured method of referral for dental practitioners, the secondary sector and patients.

关键词：门诊外科手术/统计学和数值数据医务工作者的态度牙科医院/统计学和数值数据开业医生牙科/组织和管理开业医生牙科/统计学和数值数据口腔外科手术/统计学和数值数据病人满意度随机分配转诊和会诊/组织和管理转诊和会诊/统计学和数值数据外科口腔/组织和管理青少年成年人人类中年人

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