The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study.
Classification
Delay in surgery
Delphi method
Emergency surgery
Healthcare system
Operating room management
Priority
Time to surgery
Timing in acute care surgery (TACS)
Triage
Journal
World journal of emergency surgery : WJES
ISSN: 1749-7922
Titre abrégé: World J Emerg Surg
Pays: England
ID NLM: 101266603
Informations de publication
Date de publication:
28 04 2023
28 04 2023
Historique:
received:
24
02
2023
accepted:
13
04
2023
medline:
1
5
2023
pubmed:
29
4
2023
entrez:
29
4
2023
Statut:
epublish
Résumé
Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The "timing in acute care surgery" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts. This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease. Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority. The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a "safe" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
Sections du résumé
BACKGROUND
Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The "timing in acute care surgery" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts.
METHODS
This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.
RESULTS
Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.
CONCLUSION
The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a "safe" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
Identifiants
pubmed: 37118816
doi: 10.1186/s13017-023-00499-3
pii: 10.1186/s13017-023-00499-3
pmc: PMC10147354
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32Investigateurs
Vishal Shelat
(V)
Dimitrios Damaskos
(D)
Paolo Carcoforo
(P)
Walter L Biffl
(WL)
Luigi Bonavina
(L)
Andreas Hecker
(A)
Isidoro Di Carlo
(I)
Fikri M Abu-Zidan
(FM)
Joseph M Galante
(JM)
Andrew Kirkpatrick
(A)
Massimo Sartelli
(M)
Edoardo Picetti
(E)
Raul Coimbra
(R)
Salomone Di Salomone
(S)
Zsolt Balogh
(Z)
Solomon Gurmu Beka
(SG)
Richard Ten Broek
(RT)
Georges Velmahos
(G)
Boris Sakakushev
(B)
Edward Tan
(E)
Marco Ceresoli
(M)
Osvaldo Chiara
(O)
Philip Stahel
(P)
Vanni Agnoletti
(V)
Emmanouil Pikoulis
(E)
Ari Leppaniemi
(A)
Ingo Marzi
(I)
Giovanni D Tebala
(GD)
Ibrahima Sall
(I)
Kenji Inaba
(K)
Vladimir Khokha
(V)
Imtaz Wani
(I)
Viktor Reva
(V)
Ernest E Moore
(EE)
Luca Ansaloni
(L)
Mansoor Khan
(M)
Adriana Toro
(A)
Andrey Litvin
(A)
Nicola De' Angelis
(N)
Mark Malangoni
(M)
Yoram Kluger
(Y)
Emanuele Scozzafava
(E)
Mircea Chirica
(M)
Ian Civil
(I)
Ron Maier
(R)
Dieter Weber
(D)
Massimo Chiarugi
(M)
Rao Ivatury
(R)
Kjetil Soreide
(K)
Gabriele Sganga
(G)
Yunfeng Cui
(Y)
Informations de copyright
© 2023. The Author(s).
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