Sheena Y, Fishman J M, Nortcliff C, Mawby T, Jefferis A F, Bleach N R
Department of Otolaryngology, Wexham Park Hospital, Slough, UK.
J Laryngol Otol. 2012 Oct;126(10):1049-55. doi: 10.1017/S002221511200165X. Epub 2012 Aug 15.
The World Health Organization 'Surgical Safety Checklist' has been adopted by UK surgical units following National Patient Safety Agency guidance. Our aim was to assess compliance with our local version of this Checklist.
Otolaryngology trainee doctors prospectively assessed compliance with the local Checklist over a six-week period. A staff educational intervention was implemented and the audit was repeated 12 months later.
A total of 72 cases were assessed. The initial audit found that: 44 per cent of procedures were undocumented at 'Sign in'; 'Time out' was inappropriately interrupted in 39 per cent of cases; the procedure started before Checklist completion in 33 per cent of cases; and the 'Sign out' was not read out in 94 per cent of cases and was not fully documented in 42 per cent of cases. Following education, re-audit indicated that overall compliance had improved from 63.7 per cent (± 8.9 per cent standard error of the mean) to 90.4 per cent (± 2.7 per cent standard error of the mean).
Our completed audit cycle demonstrated a significant improvement in Checklist compliance following educational intervention. We discuss barriers to compliance, as well as strategies for quality improvement, and we call for other surgeons to similarly publish their Checklist experience and assess its impact on surgical outcomes.
英国各外科科室已根据国家患者安全机构的指导意见采用了世界卫生组织的《手术安全检查表》。我们的目的是评估对本地版该检查表的依从性。
耳鼻喉科实习医生在六周时间内前瞻性地评估对本地检查表的依从性。实施了一次员工教育干预，并在12个月后重复进行审核。
共评估了72例病例。初次审核发现：44%的手术在“签到”时无记录；39%的病例中“暂停”被不当打断；33%的病例中在检查表完成前手术就已开始；94%的病例中“签出”未宣读，42%的病例中“签出”记录不完整。经过教育后，再次审核表明总体依从性从63.7%（平均标准误差±8.9%）提高到了90.4%（平均标准误差±2.7%）。
我们完整的审核周期表明，经过教育干预后，检查表的依从性有了显著提高。我们讨论了依从性的障碍以及质量改进策略，并呼吁其他外科医生同样公布他们使用检查表的经验并评估其对手术结果的影响。
