Deering Shad, Rosen Michael A, Ludi Vivian, Munroe Michelle, Pocrnich Amber, Laky Christine, Napolitano Peter G
Andersen Simulation Center, Madigan Army Medical Center, Tacoma, Washington, USA.
Jt Comm J Qual Patient Saf. 2011 Aug;37(8):350-6. doi: 10.1016/s1553-7250(11)37045-6.
Team training has been identified as a key strategy for reducing medical errors and building a culture of safety in health care. Communication and coordination skills can serve as barriers to potential errors, as in the modern deployed U.S. Military Healthcare System (MHS), which emphasizes rapid movement of critically injured patients to facilities capable of providing definitive care. A team training intervention--TeamSTEPPS--was implemented on a large scale during one of the most intense phases of the conflict in Iraq. This evaluation of the program constituted the first undertaken in a combat theater of operations. IMPLEMENTING TEAMSTEPPS IN IRAQ: The Baghdad combat support hospital (CSH) conducted continuous operations from a fixed facility for a 13-month deployment--between November 2007 and December 2008. The TeamSTEPPS implementation in Iraq began at this facility and spread throughout the combat theater of operations. Teamwork training was implemented in two primary training sessions, followed up with reinforcement of team behaviors on the unit by hospital leadership.
A total of 153 patient safety reports were submitted during the 13 months reviewed, 94 before TeamSTEPPS implementation and 59 afterwards. After training, there were significant decreases in the rates of communication-related errors, medication and transfusion errors, and needlestick incidents. There was a significant decrease in the rate of incidents coded communication as the primary teamwork skill that could have potentially prevented the event.
Process improvement programs such as TeamSTEPPS implementation can be conducted under the extremely austere conditions of a CSH in a combat zone. Teamwork training decreased medical errors in the CSH while deployed in the combat theater in Iraq.
团队培训已被视为减少医疗差错及在医疗保健领域建立安全文化的关键策略。沟通与协调技能可成为潜在差错的阻碍，就如同现代部署的美国军事医疗系统（MHS），该系统强调将重伤患者迅速转移至能够提供确定性治疗的机构。在伊拉克冲突最激烈的阶段之一，一项团队培训干预措施——团队策略与工具提升患者安全（TeamSTEPPS）被大规模实施。对该项目的评估是在作战战区首次进行。
在伊拉克实施团队策略与工具提升患者安全（TeamSTEPPS）：巴格达战斗支援医院（CSH）于2007年11月至2008年12月期间，在一个固定设施中持续开展了13个月的行动。伊拉克的团队策略与工具提升患者安全（TeamSTEPPS）实施工作始于该设施，并扩展至整个作战战区。团队合作培训在两个主要培训课程中开展，随后由医院领导在各科室强化团队行为。
在审查的13个月期间，共提交了153份患者安全报告，其中94份在实施团队策略与工具提升患者安全（TeamSTEPPS）之前，59份在之后。培训后，与沟通相关的差错率、用药和输血差错率以及针刺伤事件显著下降。将沟通编码为可能预防该事件的主要团队合作技能的事件发生率显著降低。
诸如实施团队策略与工具提升患者安全（TeamSTEPPS）这样的流程改进项目可在战区战斗支援医院极为严峻的条件下开展。在伊拉克作战战区部署期间，团队合作培训减少了战斗支援医院的医疗差错。
