Tapson Victor F, Karcher Rachel Bongiorno, Weeks Randy
Duke University Medical Center, Durham, NC, USA..
Am J Med Qual. 2011 Nov-Dec;26(6):423-32. doi: 10.1177/1062860611404694. Epub 2011 May 23.
Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)--a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and guideline-recommended prophylaxis regimens. Reviews of patient charts preinitiative and postinitiative demonstrated performance improvement in meeting guideline recommendations for the timing, inpatient duration, and use of VTE prophylaxis beyond discharge. This new model joins continuing medical education with CRM to improve the appropriate use of VTE prophylaxis in surgery.
尽管有安全有效的预防措施，但手术患者中静脉血栓栓塞（VTE）预防措施的合理使用仍未达到最佳水平。在个体机构层面，需要开展多方面的质量改进（QI）活动以实现持续改进。这项工作描述了一项针对手术中VTE预防的QI倡议，该倡议将临床教育与机组资源管理（CRM）相结合，CRM是航空业中用于沟通、团队合作和避免错误的一套原则和技术。对参与该倡议的临床医生进行的调查显示，他们在识别导致错误的过程相关因素、将CRM应用于患者护理以及识别VTE预防候选者和指南推荐的预防方案方面，信心立即增强且得以保持，知识也有所增加。对倡议实施前和实施后的患者病历进行审查表明，在达到VTE预防的时间、住院时长以及出院后使用方面的指南建议方面，表现有所改善。这种新模式将继续医学教育与CRM相结合，以改善手术中VTE预防措施的合理使用。
