NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Griffith University, Qld, 4222, Australia.
BMJ Qual Saf. 2012 Jan;21(1):3-12. doi: 10.1136/bmjqs-2011-000169. Epub 2011 Oct 14.
In the operating room, factors such as interruptions, communication failures, team familiarity and the unpredictability of unplanned cases can prolong the length of an operation, and lead to inefficiency and increased costs. However, little is known about the extent to which such factors contribute to extending the expected length of an operation. Aim To describe factors that prolong the expected length of an operation.
Structured observations were performed on a purposive sample of 160 surgical procedures across 10 specialties of planned and unplanned surgeries. During the 6-month period, a trained observer structured observations. Bivariate correlations and a standard multiple regression model were developed to describe associations among unplanned operations, interruptions, prebriefings, team familiarity, communication failures and the outcome, and deviation from expected operation time.
Of the three explanatory variables entered into the regression model, the only significant predictor of deviation in expected length of operation was the number of communication failures (p=0.013). This model explained 4.5% of the variance in deviation in expected length of operation (p=0.018).
The results of this study validate the role of prospective observational research methods in unveiling critical factors that contribute to deviation in expected length of operation. These results have the potential to inform evidence-based interventions aimed at ameliorating the effects of miscommunications, hence improve patient safety.
在手术室中，中断、沟通失败、团队熟悉度和意外情况的不可预测性等因素可能会延长手术时间，导致效率低下和成本增加。然而，对于这些因素在多大程度上导致手术预期时间延长，我们知之甚少。目的：描述延长手术预期时间的因素。
对 10 个专科的计划性和非计划性手术的 160 例手术进行了有针对性的观察。在 6 个月的时间里，一名经过培训的观察员进行了结构观察。采用双变量相关分析和标准多元回归模型来描述非计划性手术、中断、术前简报、团队熟悉度、沟通失败与手术预期时间偏差和偏离之间的关联。
在纳入回归模型的三个解释变量中，唯一显著预测手术预期时间偏差的是沟通失败次数（p=0.013）。该模型解释了手术预期时间偏差变异的 4.5%（p=0.018）。
本研究结果验证了前瞻性观察研究方法在揭示导致手术预期时间偏差的关键因素方面的作用。这些结果有可能为基于证据的干预措施提供信息，旨在改善沟通失误的影响，从而提高患者安全。
