Preoperative Briefing in the Operating Room Shared Cognition, Teamwork, and Patient Safety
Preoperative Briefing in the Operating Room Shared Cognition, Teamwork, and Patient Safety
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DOI：
10.1378/chest.08-1732
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发表时间：
2010-02-01
期刊：
影响因子：
9.6
通讯作者：
Donchin, Yoel
中科院分区：
文献类型：
--
作者：
Einav, Yael;Gopher, Daniel;Donchin, Yoel
为提高患者安全而进行的当代术前小组简报主要侧重于提供有关患者和手术过程的识别细节。借鉴认知理论的原则，在本研究中制定了一个简报协议，提出了一个更广泛的视角模型的病人和计划的过程。除了习惯的识别细节和药物敏感性，新的简报还包括对重要背景信息、所需设备、计划手术阶段等的审查。简报内容是根据在妇科和骨科手术室进行的130次连续、非结构化观察而制定的。简报表被设计成一张大海报，挂在手术室墙上可见的位置。该海报指导团队成员（即护士、外科医生和麻醉师）的行为。简报会以口头方式进行，不需要书面记录。将130例不进行简报的手术中观察到的非常规事件（即，如果不加以纠正，可能导致患者伤害的情况）的数量与102例进行简报的手术中观察到的事件数量进行比较。当进行简报时，非常规事件的数量减少了25%，而没有观察到非常规事件的手术数量显著增加。团队成员认为简报对他们自己的工作、团队合作和患者安全最有价值。在研究之后，新的简报格式被接受并作为日常使用。旨在提供更广泛视角的手术模型的团队简报可能是一种易于应用的工具，可以减少手术过程中非常规事件的数量，提高患者的安全性。胸部2010;137 (2): 443 - 449
Contemporary preoperative team briefings conducted to improve patient safety focus mainly on supplying identification details regarding the patient and the surgical procedure. Drawing on cognitive theory principles, in this study a briefing protocol was developed that presents a broader perspective model of the patient and the planned procedure. In addition to customary identification details and drug sensitivities, the new briefing also includes review of significant background information, needed equipment, planned surgery stages, and so forth. The briefing content was developed following 130 continuous, nonstructured observations conducted in gynecologic and orthopedic operating rooms. The briefing form was designed as a large poster hung in a visible position on the operating room wall. The poster guides the team members (ie, nurses, surgeons, and anesthesiologists) in their conduct. Briefing is conducted orally, and no written records are required. The number of nonroutine events (ie, situations that, if not corrected, might lead to patient harm) observed in the 130 surgeries conducted without briefing was compared with the number of events in 102 surgeries in which briefing was conducted. There was a 25% reduction in the number of nonroutine events when briefing was conducted and a significant increase in the number of surgeries in which no nonroutine event was observed. Team members evaluated the briefing as most valuable for their own work, the teamwork, and patient safety. Following the study, the new briefing format was accepted and adopted for routine use. Team briefings designed to supply a broader-perspective surgery model may be an easy-to-apply tool to reduce the number of nonroutine events during surgery and increase patient safety. CHEST 2010; 137(2):443-449