A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes
A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes
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DOI：
10.1136/bmjqs.2010.048983
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发表时间：
2011-07-01
影响因子：
5.4
通讯作者：
Barach, Paul
中科院分区：
文献类型：
--
作者：
Schraagen, Jan Maarten;Schouten, Ton;Barach, Paul
目的：儿科心脏手术的容错性较低，对认知和技术水平要求较高。越来越多的证据表明，患者预后的进一步改善取决于系统因素，特别是有效的团队技能。对术中小的非常规事件(NRES)可以升级为更严重的情况以及有效的团队合作可以防止严重情况的发展的假设进行了研究，以开发一种评估这些技能的方法，并为培训和绩效的改进提供证据。方法：这种混合方法设计采用定量和定性两种方法，依赖于训练有素的人为因素观察员，他们观察和编码从患者进入手术室到患者移交到重症监护病房的NRES和团队合作元素。实时的团队合作观察与微系统准备措施、手术持续时间、评估手术难度和患者结果测量相结合。根据行为是否阻碍或加强团队合作来对行为进行评级。结果：观察了40例儿科心脏手术病例。外科医生在复杂的过程中表现出更好的团队合作，特别是在外科搭桥/修复时期。手术方式越多，术后病程越复杂(M-无并发症=9.08；M-小并发症=11.11；M-大并发症=14.60，F(2，26)=3.46，P<0.05)。
Objective: Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraoperative non-routine events (NREs) can escalate to more serious situations and that effective teamwork can prevent the development of serious situations were examined to develop a method to assess these skills and to provide evidence for improvements in training and performance.Methods: This mixed-method design, using both quantitative and qualitative measures, relied on trained human factor observers who observed and coded NREs and teamwork elements from the time of patient arrival into the operating room to patient handover to the intensive care unit. Real-time teamwork observations were coupled with microsystem preparedness measures, operative duration, assessed difficulty of the operation and patient outcome measures. Behaviour was rated based on whether it hindered or enhanced teamwork.Results: 40 paediatric cardiac surgery cases were observed. Surgeons displayed better teamwork during complicated procedures, particularly during the surgical bypass/repair epoch. More procedural NREs were associated with a more complicated postoperative course (M-uncomplicated=9.08; M-minor complications=11.11; M-major morbidity=14.60, F(2,26)=3.46, p