Thirty-Day Outcomes Support Implementation of a Surgical Safety Checklist
Thirty-Day Outcomes Support Implementation of a Surgical Safety Checklist
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DOI：
10.1016/j.jamcollsurg.2012.07.015
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发表时间：
2012-12-01
影响因子：
5.2
通讯作者：
Ellner, Scott J.
中科院分区：
文献类型：
--
作者：
Bliss, Lindsay A.;Ross-Richardson, Cynthia B.;Ellner, Scott J.
背景：意外伤害导致的术后30天并发症会对患者及其家人造成不利影响，并增加医院的医疗费用。手术清单是一种廉价的工具，可以促进有效的沟通和团队合作。外科手术团队培训为利益相关者提供了机会，通过调整权威梯度来专业地相互参与，以防止患者受到伤害。美国外科医师学会国家外科质量改进计划数据库是一个结果报告工具，能够验证手术检查表的使用。STUDY设计：进行了三次60分钟的团队培训，参与者被引导使用全面的手术检查表。手术小组使用了从美国外科医生学会国家外科质量改进计划分析的程序中挑选出来的高风险程序清单。结果：来自美国外科医师学会国家外科质量改进计划的数据与2,079例历史对照病例、246例未使用清单病例和73例使用清单病例进行了比较。清单部分总体完成率为97.26%。30天发病率的比较显示，总体不良事件发生率从历史对照病例的23.60%和只接受团队训练的病例的15.90%降低到使用核对表的病例的8.20%，具有统计学意义(p=0.000)。结论：使用全面的手术安全清单和实施结构化的团队训练课程可以在统计学上显著降低30天的发病率。通过团队训练干预，采用全面的核对表是可行的，并可以在患者结果中产生可衡量的改善。J am Coll Surg 2012；215：766-776。(C)2012年由美国外科医师学会颁发)
BACKGROUND: Thirty-day postoperative complications from unintended harm adversely affect patients and their families and increase institutional health care costs. A surgical checklist is an inexpensive tool that will facilitate effective communication and teamwork. Surgical team training has demonstrated the opportunity for stakeholders to professionally engage one another through leveling of the authority gradient to prevent patient harm. The American College of Surgeons National Surgical Quality Improvement Program database is an outcomes reporting tool capable of validating the use of surgical checklists.STUDY DESIGN: Three 60-minute team training sessions were conducted and participants were oriented to the use of a comprehensive surgical checklist. The surgical team used the checklist for high-risk procedures selected from those analyzed for the American College of Surgeons National Surgical Quality Improvement Program. Trained observers assessed the checklist completion and collected data about perioperative communication and safety-compromising events.RESULTS: Data from the American College of Surgeons National Surgical Quality Improvement Program were compared for 2,079 historical control cases, 246 cases without checklist use, and 73 cases with checklist use. Overall completion of the checklist sections was 97.26%. Comparison of 30-day morbidity demonstrated a statistically significant (p = 0.000) reduction in overall adverse event rates from 23.60% for historical control cases and 15.90% in cases with only team training, to 8.20% in cases with checklist use.CONCLUSIONS: Use of a comprehensive surgical safety checklist and implementation of a structured team training curriculum produced a statistically significant decrease in 30-day morbidity. Adoption of a comprehensive checklist is feasible with team training intervention and can produce measurable improvements in patient outcomes. (J Am Coll Surg 2012;215:766-776. (c) 2012 by the American College of Surgeons)