Lee Alex J-J, Raniga Sumit, Hooper Gary, Perry Ali, Bisset Robyn, Darley Diane, Hurley-Watts Carmel
Department of Orthopaedic Surgery, Christchurch Hospital, Riccarton Avenue, Private Bag 4710, Christchurch 8011, New Zealand.
N Z Med J. 2012 Sep 21;125(1362):26-35.
A preoperative surgical safety checklist was implemented into three major hospitals performing elective operations in Christchurch (New Zealand) in 2004. A prospective analysis of the results of this "Time Out Procedure" (TOP) was performed upon its implementation and 4 years later.
All members of the surgical team who participated in the TOP were recorded, as were the details of any discrepancies encountered during the TOP. The results of the initial prospective analysis from September 2004 until April 2005 (Phase 1, 10,330 procedures) were compared to a further prospective study 4 years later from October 2008 until September 2009 (Phase 2, 25,086 procedures). Surgeons' attitudes towards the TOP were analysed with a questionnaire.
There were no wrong site operations in either phases of the study. Completion of the TOP improved in Phase 2 (98% compared to 87%, p<0.001). The overall discrepancies observed increased, (7.7% in Phase 1 and 9.3% in Phase 2, p<0.001) with surgeon being absent at the TOP resulting in 73% of the discrepancies observed. Only 86% of surgeons believed that TOP was valuable in reducing wrong site operation.
This study suggests that surgical checklists such as the TOP are a useful tool in identification and prevention of wrong site surgery. Our practice with consent and limb marking has improved over the two study periods. However, there continues to be surgeon resistance to these checklists, and further research will help to identify the reasons and possible solutions to this phenomenon.
2004年，一项术前手术安全检查表在新西兰克赖斯特彻奇市的三家主要进行择期手术的医院实施。于检查表实施时及其实施4年后对这一“暂停程序”（TOP）的结果进行了前瞻性分析。
记录参与TOP的手术团队所有成员，以及TOP期间遇到的任何差异细节。将2004年9月至2005年4月首次前瞻性分析的结果（第1阶段，10330例手术）与4年后2008年10月至2009年9月的另一项前瞻性研究结果（第2阶段，25086例手术）进行比较。通过问卷调查分析外科医生对TOP的态度。
研究的两个阶段均未发生手术部位错误的手术。TOP的完成情况在第2阶段有所改善（从87%提高到98%，p<0.001）。观察到的总体差异有所增加（第1阶段为7.7%，第2阶段为9.3%，p<0.001），TOP时外科医生不在场导致了73%观察到的差异。只有86%的外科医生认为TOP在减少手术部位错误方面有价值。
本研究表明，诸如TOP之类的手术检查表是识别和预防手术部位错误手术的有用工具。在两个研究期间，我们在知情同意和肢体标记方面的做法有所改进。然而，外科医生对这些检查表仍有抵触情绪，进一步的研究将有助于找出这一现象的原因及可能的解决办法。
