Factors Associated with Effective Implementation of a Surgical Safety Checklist

描述(申请人提供)：2009年，从坦桑尼亚到美国的8家不同医院发现，严格遵守世卫组织外科安全检查表，这是一种廉价且易于使用的工具，可将30天死亡率从1.5%降至0.8%，总并发症从11%降至7%。从那时起，93个国家的3200家医院采用了这份清单。然而，清单的好处取决于个别医院有效执行清单的能力。实施是采用组织、引入创新并鼓励其使用的过程。实施可能会也可能不会有效地产生对目标创新的一致、高质量的利用。这项拟议的研究将检查一大批美国和国际医院的实施过程，并将确定支持有效实施的因素。这项研究还将审查有效执行与团队合作的关系，以解释核对表如何改善结果。为了实现这些目标，将从75个外科单位收集数据。将从执行负责人和外科医生那里获得关于清单执行过程的数据，方法是利用先前的工具和初步研究制定一项调查。关于实施效果、团队合作和核对表结果的数据将由直接护士经理、患者安全官员和外科手术程序的循环护士观察获得。横向和纵向比较将把执行进程与有效执行联系起来，将有效执行与团队合作和清单结果联系起来。本研究将对实施科学领域做出重大的理论、方法论、实践和贡献。我们将通过证明有效的核对表实施可以导致良性循环，以持续提高实施效率和创新的好处的方式影响团队动力，从而为创新实施和团队合作的理论做出贡献。我们将采用可广泛应用的新的评价工具和培训方法，以增加有效实施核对表的可能性，并在今后对实施类似创新的研究中增加这种可能性。出于实际目的，我们将确定导致有效实施清单的具体背景因素和活动，其他实施清单和类似创新的组织可以效仿这些因素和活动。 与公共健康相关：一份简单的手术安全清单已被证明可以将手术并发症和死亡减少30%以上。然而，只有在持续和正确地使用的情况下，它的影响才会蔓延到每年进行的2亿多次手术。这项研究将调查医院如何实施清单，以及实施过程中的差异如何导致团队合作的差异，并最终导致手术护理的安全性。

DESCRIPTION (provided by applicant): In 2009, strict adherence to the WHO Surgical Safety Checklist, an inexpensive and easy-to-use tool, was found to reduce 30-day mortality from 1.5% to 0.8% and overall complications from 11% to 7% in eight diverse hospitals from Tanzania to the United States. Since then, the Checklist has been adopted by 3,200 hospitals in 93 countries. The benefits of the Checklist, however, depend upon the individual hospitals' ability to implement it effectively. Implementation is the process by which adopting organizations introduce innovations and encourages their use. Implementation may or may not be effective at producing consistent, high-quality utilization of a target innovation. The proposed study will examine implementation processes in a large group of US and international hospitals and will identify factors supportive of effective implementation. The study will also examine the relationship of effective implementation to teamwork, as an explanation for how the Checklist improves outcomes. In order to achieve these aims, data will be collected from 75 surgical units. Data on Checklist implementation processes will be obtained from implementation leaders and surgeons using a survey developed by drawing on prior instruments and preliminary research. Data on implementation effectiveness, teamwork, and Checklist outcomes will be obtained by direct nurse manager, patient safety officer and circulating nurse observations of surgical procedures. Cross-sectional and longitudinal comparisons will relate implementation processes to effective implementation and effective implementation to teamwork and Checklist outcomes. This study will make significant theoretical, methodological, practical and contributions to the field of implementation science. We will contribute to theory about innovation implementation and teamwork by demonstrating that effective Checklist implementation can lead to a virtuous cycle, affecting team dynamics in ways that can continuously improve implementation effectiveness and thus the benefits of the innovation. We will employ novel evaluation tools and training methods that can be applied broadly to increase the likelihood of effective implementation of the Checklist and in future studies of the implementation of similar innovations. For practical purposes, we will identify specific contextual factors and activities that lead to effective Checklist implementation, which can be emulated by other organizations implementing the Checklist and similar innovations. PUBLIC HEALTH RELEVANCE: A simple Surgical Safety Checklist has been shown to reduce complications and death from surgery by more than 30 percent. However, its impact will spread to the more than 200 million operations performed each year only if used consistently and correctly. This study will investigate how hospitals implement the Checklist and how differences in their implementation processes lead to differences in teamwork and, ultimately, the safety of surgical care.