Centre for Education Research and Innovation, Health Sciences Addition, University of Western Ontario, London, Canada.
BMJ Qual Saf. 2011 Jun;20(6):475-82. doi: 10.1136/bmjqs.2009.032326. Epub 2011 Feb 8.
BACKGROUND Suboptimal communication within healthcare teams can lead to adverse patient outcomes. Team briefings were previously associated with improved communication patterns, and we assessed the impact of briefings on clinical practice. To quantify the impact of the preoperative team briefing on direct patient care, we studied the timing of preoperative antibiotic administration as compared to accepted treatment guidelines. STUDY DESIGN A retrospective pre-intervention/post-intervention study design assessed the impact of a checklist-guided preoperative team briefing on prophylactic antibiotic administration timing in surgical cases (N=340 pre-intervention and N=340 post-intervention) across three institutions. χ(2) Analyses were performed to determine whether there was a significant difference in timely antibiotic administration between the study phases. RESULTS The process of collecting and analysing these data proved to be more complicated than expected due to great variability in documentation practices, both between study sites and between individual practitioners. In cases where the timing of antibiotics administration was documented unambiguously in the chart (n=259 pre-intervention and n=283 post-intervention), antibiotic prophylaxis was on time for 77.6% of cases in the pre-intervention phase of the study, and for 87.6% of cases in the post-intervention phase (p<0.01). CONCLUSIONS Use of a preoperative team checklist briefing was associated with improved physician compliance with antibiotic administration guidelines. Based on the results, recommendations to enhance timely antibiotic therapy are provided.
医疗团队内部沟通不畅可能导致患者预后不良。团队简报先前与改善沟通模式有关,我们评估了简报对临床实践的影响。为了量化术前团队简报对直接患者护理的影响,我们研究了术前给予抗生素的时间与公认的治疗指南相比。
回顾性干预前/干预后研究设计评估了术前团队检查表指导对三个机构中手术病例预防性抗生素给药时机的影响(干预前 340 例,干预后 340 例)。采用 χ(2)分析来确定研究阶段之间及时给予抗生素的差异是否具有统计学意义。
由于研究地点之间和个别医生之间的记录实践存在很大差异,收集和分析这些数据的过程比预期的要复杂得多。在抗生素给药时间在图表中明确记录的情况下(干预前 259 例,干预后 283 例),干预前阶段有 77.6%的病例按时给予抗生素预防,干预后阶段有 87.6%的病例按时给予抗生素预防(p<0.01)。
使用术前团队清单简报与医生遵守抗生素给药指南的情况改善有关。基于结果,提供了加强及时抗生素治疗的建议。