Artikel
Evidence-based medicine and the factor "surgeon" in ophthalmic surgery
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Autoren
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K. Gerstmeyer
- Eye Clinic Minden; Friedrich Alexander University Erlangen-Nuremberg, Clinic for Psychiatry and Psychotherapy
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S. Lehrl
- Eye Clinic Minden; Friedrich Alexander University Erlangen-Nuremberg, Clinic for Psychiatry and Psychotherapy
| Veröffentlicht: | 22. September 2004 |
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Gliederung
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Objective
The evidence-based medicine whose highest basic goal is the optimized patient care, covers not only individual measures, but also the entire operational sequence of the medical supply. The operating surgeon with his skill, experience, expertise and intuition is frequently considered as a guarantor for a high quality attendance of patients, because the success or the failure of the operation depends on him. His activity requires a high mental and sensomotor load. Does it remain during the operation on the same high level?
Methods
Follow-up examination of 8212 cataract operation reports. Recording of complications (active errors) and specific features (latent errors).
Results
Active and latent errors are not distributed evenly between 07.45 h and 13.30 h (Chi2-test: p < 0,001). At the beginning intraoperative features accumulate which refers to a mental and/or motor warming up phase. The maximum performance is to be seen between 08.30 h and 09.30 h and is replaced by a drop in efficiency between 10.45 h and 11.14 h. Afterwards the performance curve of the operating surgeon reaches again its maximum. Both periods of low performance show an increase of latent errors (Chi2-test: p < 0,001), while the frequency of active errors during all time periods does not differ statistically significant. Latent errors neither directly nor alone cause complications, they favour however the occurrence of unwanted events. Ergonomical investigations, accident statistics and efficiency curves correspond with our results until 11.30 h. Afterwards they find a further drop in performance, while we documented an achievement maximum of the operating surgeon.
Conclusions
Guidelines and quality management should change medical everyday routines effectively and make an effective and economic supply possible. Therefore operating surgeons should keep in mind that latent errors are (biorhythmically) given weak points. An analysis of every single case forms the condition to lower their influences and the probability of repetition in order to optimize the patient supply.
