Importance of teamwork, communication and culture on failure-to-rescue in the elderly.
Importance of teamwork, communication and culture on failure-to-rescue in the elderly.
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团队合作，沟通和文化在老年人中失败的重要性。
DOI：
10.1002/bjs.10031
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发表时间：
2016-01
期刊：
影响因子：
--
通讯作者：
Dimick JB
中科院分区：
文献类型：
--
作者：
Ghaferi AA;Dimick JB
手术死亡率随着年龄的增长而显著增加。不同医院的死亡率差异很大，这表明有可能会有所改善。救援失败被认为是这些分歧背后的潜在机制。我们对评估手术、死亡率、抢救失败和老年人的文献进行了回顾。然后，我们对正在进行的研究和未发表的工作进行回顾，旨在更好地了解老年患者手术死亡率变化的潜在机制。多个医院宏观系统因素，如护士人员配备、可用的医院技术和教学状况与抢救失败率的差异有关。出现了一些关于与救援失败相关的重要微观系统因素的文献。这些因素可分为三大类：医院资源、态度和行为。正在进行的工作是制定干预措施，以减少救援失败率的差异，包括注重团队合作、沟通和安全文化。研究人员正在使用新的混合方法和理论，这些方法和理论适用于高可靠性组织的组织研究，以努力改善对老年手术患者的护理。尽管老年手术患者的抢救失败率比年轻患者高得多，但患者水平的影响不能充分解释这些差异。更多地关注组织动力在医院抢救这些高风险患者的能力中的作用，将建立旨在改善患者安全的高产出干预措施。
Surgical mortality increases significantly with age. Wide variations across hospitals in mortality rates suggest potential levers for improvement. Failure to rescue has been posited as a potential mechanism underlying these differences. We performed a review of the literature evaluating surgery, mortality, failure to rescue, and the elderly. We then included a review of ongoing studies and unpublished work aiming to better understand the mechanisms underlying variations in surgical mortality in elderly patients. Multiple hospital macro system factors, such as nurse staffing, available hospital technology, and teaching status are associated with differences in failure to rescue rates. There is emerging literature regarding important micro system factors associated with failure to rescue. These are grouped into three broad categories, hospital resources, attitudes, and behaviours. On-going work to produce interventions to reduce variations in failure to rescue rates include a focus on teamwork, communication, and safety culture. Researchers are using novel mixed-methods approaches and theories adapted from organizational studies in high reliability organizations in an effort to improve the care of elderly surgical patients While elderly surgical patients experience failure to rescue events at much higher rates than their younger counterparts, patient level effects do not sufficiently explain these differences. Increased attention on the role of organizational dynamics in the hospitals’ ability to rescue these high risk patients will establish high yield interventions aimed at improving patient safety.