Shah Rahul K, Arjmand Ellis, Roberson David W, Deutsch Ellen, Derkay Craig
Children's National Medical Center, George Washington University Medical School, Washington, DC, USA.
Arch Otolaryngol Head Neck Surg. 2011 Jan;137(1):69-73. doi: 10.1001/archoto.2010.232.
To determine variation in surgical time-out and site-marking within pediatric otolaryngology.
Survey e-mailed via the American Society of Pediatric Otolaryngology (ASPO).
A total of 167 Children's Hospital Corp of America (CHCA) operating room (OR) directors and ASPO members were asked about perioperative preparation of their patients.
Most respondents who operate at children's hospitals report policies that do not require site marking for bilateral placement of ventilation tubes, adenotonsillar surgery, airway endoscopy, or nasal surgery. Policies allowing assistants to perform site marking were identified by 45.0% of respondents from children's hospitals. Community hospitals were 3.68 times (range, 1.31-10.31 times) more likely than other facilities to permit only the attending to perform site marking. Most respondents operating at children's hospitals (84.4%) were satisfied with their hospital's site-marking policy and with their hospital's surgical checklist policy for pediatric otolaryngology procedures (87.1%). There seems to be a relationship between ear tube insertion marking policy and surgeon's age (χ² = 12.9; P = .045), area of country (χ² = 29.1; P = .004), and ambulatory centers for children (χ² = 8.1; P = .02). Twenty-one percent of survey respondents reported involvement in a wrong-site surgery at some point in their career.
This survey of ASPO members and CHCA OR directors reveals substantial variation in the time-out and site-marking procedures. There is a dynamic tension between universal, national mandates, and allowing local variation to encourage hospitals to tailor policies to unique needs. Further study is needed to determine if the observed variations are beneficial or harmful.
确定小儿耳鼻喉科手术暂停及手术部位标记的差异。
通过美国小儿耳鼻喉科学会（ASPO）以电子邮件方式进行调查。
共向167名美国儿童医院集团（CHCA）手术室主任及ASPO成员询问了其患者的围手术期准备情况。
大多数在儿童医院开展手术的受访者报告称，其所在医院的政策规定，在进行双侧通气管置入、腺样体扁桃体手术、气道内镜检查或鼻腔手术时无需进行手术部位标记。45.0%的儿童医院受访者表示其所在医院允许助手进行手术部位标记。社区医院比其他机构更有可能（3.68倍，范围为1.31 - 10.31倍）只允许主刀医生进行手术部位标记。大多数在儿童医院开展手术的受访者（84.4%）对其所在医院的手术部位标记政策以及小儿耳鼻喉科手术的手术核对清单政策（87.1%）感到满意。耳管插入标记政策与外科医生的年龄（χ² = 12.9；P = .045）、所在地区（χ² = 29.1；P = .004）以及儿童门诊中心（χ² = 8.1；P = .02）之间似乎存在关联。21%的受访者报告在其职业生涯中的某个时候曾参与过一次手术部位错误的手术。
这项对ASPO成员及CHCA手术室主任的调查揭示了手术暂停及手术部位标记程序存在显著差异。在通用的国家规定与允许地方差异以鼓励医院根据独特需求制定政策之间存在动态矛盾。需要进一步研究以确定所观察到的差异是有益还是有害。
