Background. A rising number of claims against hospitals and the lack of a standardized consent form based on individual calculations of death and complications is a growing problem in Poland.
Aim: Evaluation of the usefulness of the Medical Electronic File System (ESDM) in clinical practice on the Vascular Surgery Ward. Accuracy evaluation of the P-POSSUM scale as a tool supplying detailed risk calculation for the patient consent form.
Material and methods. A comparison of the time consumption of the two parallel patient’s medical file systems (electronic and classic/paper) done on 50 elective cases. Evaluation of the predictive accuracy of the P-POSSUM scale in a group of 1270 patients treated in the Vascular Surgery Department of Pomerania University during one year. A prospective comparison of the time taken in dealing with the two systems of medical data files (electronic versus paper). Statistical (Statistica PL) assessment of the accuracy of the P-POSSUM risk calculator and searching for new predictors of early death in Vascular Surgery.
Results. The Medical Electronic File System (ESDM) was certified with ISO (hospital quality standard). It allowed a saving of almost half the time for dealing with medical files (14 hours and 6 minutes versus 7 hours and 53 minutes). The time consumed in doctors’ paperwork has been decreased by about 30 per cent (3 hours and 43 minutes versus 2 hours and 42 minutes) and the quality of the paperwork has been improved. We confirmed the clinical effectiveness of P-POSSUM as well as ASA scale in vascular surgery. Additional multifactor analysis of early death predictors shows the independent influence of the new factors never used in calculators, e.g. glomellular filtration rate (GFR) beloved 30 ml/min/1.73 msq (p = 0.0014), systemic inflamatory response syndrome (SIRS) (p = 0.00078), critical limb ischaemia (p = 0.000039), acute limb ischaemia (p = 0.000001).
Conclusions. 1. Introduction of the Medical Electronic File System (ESDM) in the Vascular Surgery Department of Pomerania Medical University in Szczecin has improved the quality of medical files and greatly reduces the paperwork time. 2. The P-POSSUM calculator is suitable for risk assessment in Vascular Surgery but, due to the progress in medicine, might need to be refreshed. 3. The creation of the National Vascular Surgery Register (KRON) might support work on the suitable risk calculator for “vascular patent” and allow comparison of the results between the sites and the surgeons in Poland.
Acta Angiol 2011; 17, 2: 158–172