The Surgical Safety Checklist: Lessons Learned During Implementation
The Surgical Safety Checklist: Lessons Learned During Implementation
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手术安全检查表：实施过程中吸取的经验教训
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Reid Adams
中科院分区：
文献类型：
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作者：
J. F. Calland;F. Turrentine;S. Guerlain;V. Bovbjerg;G. R. Poole;Kelsey Lebeau;J. Peugh;Reid Adams
程序性核对表可能有助于提高安全关键流程的可靠性，因为它们具有改善团队合作、情景感知和错误捕捉的潜在能力。为了测试检查表对手术团队的假设实用性和适应性，我们进行了一项程序检查表的随机对照试验，以确定它们在47例腹腔镜胆囊切除术中增加安全关键行为频率的能力。一家学术三级护理中心的10名主治外科医生被随机分为两组-其中一半接受了基本的团队培训并使用了术前检查清单，而另一半则进行了标准的腹腔镜胆囊切除术。所有过程都被录像，并由训练有素的评审员对是否存在安全关键行为进行评分。在患者结局、病例时间或技术熟练程度方面，两组之间没有发现差异。由干预组(核对表)的外科医生进行的病例更有可能涉及积极的安全相关团队行为，如病例陈述、明确的角色和责任讨论、应急计划、设备检查和病例后汇报。总体而言，干预组和控制组之间的情景意识没有显著差异。干预组(检查表)的参与者一致认为，与对照组的外科医生相比，他们的病例涉及的主观舒适度、团队效率和沟通水平较低。手术程序安全清单能够增加在腹腔镜手术期间手术室中积极的团队行为的频率。适应程序性清单的使用最初可能会让参与者感到不舒服。
Procedural checklists may be useful for increasing the reliability of safety-critical processes because of their potential capacity to improve teamwork, situation awareness, and error catching. To test the hypothesized utility and adaptability of checklists to surgical teams, we performed a randomized controlled trial of procedural checklists to determine their capacity to increase the frequency of safety-critical behaviors during 47 laparoscopic cholecystectomies. Ten attending surgeons at an academic tertiary care center were randomized into two equal groups - half of these surgeons received basic team training and used a preprocedural checklist whereas the other half performed standard laparoscopic cholecystectomies. All procedures were videotaped and scored by trained reviewers for the presence of safety-critical behaviors. There were no differences detected in patient outcomes, case times, or technical proficiency between groups. Cases performed by surgeons in the intervention (checklist) group were significantly more likely to involve positive safety-related team behaviors such as case presentations, explicit discussions of roles and responsibilities, contingency planning, equipment checks, and postcase debriefings. Overall, situational awareness did not significantly differ between the intervention and control groups. Participants in the intervention (checklist) group consistently rated their cases as involving less satisfactory subjective levels of comfort, team efficiency, and communication compared with those performed by surgeons in the control group. Surgical procedural safety checklists have the capacity to increase the frequency of positive team behaviors in the operating room during laparoscopic surgery. Adapting to the use of a procedural checklist may be initially uncomfortable for participants.