Implementing a tertiary survey in the emergency general surgery population: Imitation is the sincerest form of flattery

B Eaton; L Bonenclark; L O'Meara; N Tobin; B Bruns; J Diaz

doi:10.1016/j.amjsurg.2022.02.047

Implementing a tertiary survey in the emergency general surgery population: Imitation is the sincerest form of flattery

Am J Surg. 2022 Jul;224(1 Pt A):85-89. doi: 10.1016/j.amjsurg.2022.02.047. Epub 2022 Feb 17.

Authors

B Eaton¹, L Bonenclark², L O'Meara³, N Tobin⁴, B Bruns⁵, J Diaz⁶

Affiliations

¹ University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA. Electronic address: [email protected].
² University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA; Department of Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Center, 1301 Palm Avenue, Jacksonville, FL, 32207, USA. Electronic address: [email protected].
³ University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁴ University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA; The Queens Medical Center, 1301 Punchbowl Street, Honolulu, HI, 96813, USA. Electronic address: [email protected].
⁵ University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA. Electronic address: [email protected].
⁶ University of Maryland, R Adams Cowley Shock Trauma Center, Division of Acute Care Surgery, 22 South Greene St, Baltimore, MD, 21201, USA; Department of Surgery, University of Maryland School of Medicine, 22 South Greene St, Baltimore, MD, 21201, USA. Electronic address: [email protected].

PMID: 35227490
DOI: 10.1016/j.amjsurg.2022.02.047

Abstract

Objectives: The inherent complexity of the Emergency General Surgery (EGS) patient may preclude precise documentation at admission. To obviate lapses in documentation, an EGS tertiary survey (EGS-TS) was developed to enable early recognition of relevant omissions in documentation and clinical findings. We theorized that the creation of the EGS-TS would promote more thorough clinical documentation.

Methods: A prospective observational study was performed utilizing an EGS-TS from February 2019 through May 2019. The EGS-TS included physical exam, medication reconciliation, analysis of documentation for accuracy, and review of diagnostic imaging for incidental findings.

Results: There were 139 EGS admissions during the study period and 108 (78%) received an EGS-TS. Of those who received the EGS-TS, incorrect medication reconciliations (72%), incidental findings (12%), undocumented wounds (11%), and undocumented indwelling catheters were identified (6%).

Conclusion: Implementation of an EGS-TS triggers a detailed evaluation and reveals opportunities for education, improved adherence to documentation standards, and further research that may guide quality improvement initiatives.

Keywords: Advanced practice provider; Emergency general surgery; Structured patient assessment; Tertiary survey.

Publication types

Observational Study

MeSH terms

General Surgery*
Humans
Imitative Behavior*
Quality Improvement
Retrospective Studies
Surveys and Questionnaires