A Multistep Approach to Improving Biopsy Site Identification in Dermatology Physician, Staff, and Patient Roles Based on a Delphi Consensus

作者：Alam Murad^*; Lee Andy; Ibrahimi Omar A; Kim Natalie; Bordeaux Jeremy; Chen Karen; Dinehart Scott; Goldberg David J; Hanke William; Hruza George J; Nehal Kishwer S; Olbricht Suzanne M; Orringer Jeffrey; Rohrer Thomas E; Scheinfeld Noah S; Schmults Chrysalyne D; Strasswimmer John M; Taylor James S; Yoo Simon; Nodzenski Michael; Poon Emily; Cartee Todd

来源：JAMA Dermatology, 2014, 150(5): 550-558.

DOI：10.1001/jamadermatol.2013.9804

IMPORTANCE Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. %26lt;br%26gt;OBJECTIVE To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. %26lt;br%26gt;EVIDENCE REVIEW Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. %26lt;br%26gt;FINDINGS In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders ( biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points ( day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts ( 25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. %26lt;br%26gt;CONCLUSIONS AND RELEVANCE When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.

• 出版日期2014-5
• 单位西北大学