Medical team training and coaching in the veterans health administration; assessment and impact on the first 32 facilities in the programme
Medical team training and coaching in the veterans health administration; assessment and impact on the first 32 facilities in the programme
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DOI：
10.1136/qshc.2008.031005
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发表时间：
2010-08-01
影响因子：
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通讯作者：
Bagian, James P.
中科院分区：
文献类型：
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作者：
Neily, Julia;Mills, Peter D.;Bagian, James P.
背景沟通在医疗保健中存在问题。退伍军人健康管理局正在实施医疗队培训。作者描述了130个地点中的前32个进行该方案的结果。这份报告是独一无二的;它提供了一个机组人员资源管理方案的汇总结果为众多facility.Methods设施教医疗队培训和实施简报，述职和其他项目。作者通过一年多的咨询电话采访来指导团队。执行小组自我报告了执行情况并评定了方案影响：1 =“无影响”，5 =“重大影响”。“我们使用逻辑回归来检查执行情况的简报/debriefing.Results百分之九十七的设施执行简报和debriefing. Results，所有实施了一个额外的项目。截至最后一次访谈，73%的OR和67%的ICU实施团队自我报告并将员工影响评为4-5。86%的OR和82%的ICU实施团队自我报告并将患者影响评为4-5。84%的OR和75%的ICU实施团队报告了团队合作的改善。94%的OR实施团队报告了效率改进。几乎所有的设施（97%）都报告了成功的故事或避免了不良事件。低容量的网站更有可能进行简报/汇报在所有情况下，所有的外科服务（p = 0.03）。结论网站正在实施的方案，对患者和工作人员产生积极的影响，并提高团队合作，效率和安全。该方案的一个独特之处是，通过后续支助促进了执行工作。这可能有助于该方案的早期成功。
Background Communication is problematic in healthcare. The Veterans Health Administration is implementing Medical Team Training. The authors describe results of the first 32 of 130 sites to undergo the programme. This report is unique; it provides aggregate results of a crew resource-management programme for numerous facilities.Methods Facilities were taught medical team training and implemented briefings, debriefings and other projects. The authors coached teams through consultative phone interviews over a year. Implementation teams self-reported implementation and rated programme impact: 1 = 'no impact' and 5 = 'significant impact.' We used logistic regression to examine implementation of briefing/debriefing.Results Ninety-seven per cent of facilities implemented briefings and debriefings, and all implemented an additional project. As of the final interview, 73% of OR and 67% of ICU implementation teams self-reported and rated staff impact 4-5. Eighty-six per cent of OR and 82% of ICU implementation teams self-reported and rated patient impact 4-5. Improved teamwork was reported by 84% of OR and 75% of ICU implementation teams. Efficiency improvements were reported by 94% of OR implementation teams. Almost all facilities (97%) reported a success story or avoiding an undesirable event. Sites with lower volume were more likely to conduct briefings/debriefings in all cases for all surgical services (p = 0.03).Conclusions Sites are implementing the programme with a positive impact on patients and staff, and improving teamwork, efficiency and safety. A unique feature of the programme is that implementation was facilitated through follow-up support. This may have contributed to the early success of the programme.