San Francisco Orthopaedic Residency Program, St Mary's Medical Center, San Francisco, CA, USA.
Clin Orthop Relat Res. 2013 Jun;471(6):1792-800. doi: 10.1007/s11999-012-2719-3.
The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited.
QUESTIONS/PURPOSES: We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems.
We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles.
Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care.
Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.
尽管已经提高了对安全计划的认识并加以实施，但是预防医疗和手术伤害仍然是一个重要的公共卫生问题。成功引入和维持手术安全计划既需要外科医生的领导，也需要外科医生与医院的协作。在骨科实践中，成功实施手术安全计划的记录有限。
问题/目的：我们描述了骨科手术患者安全问题的范围，定义了骨科手术安全的关键要素，并概述了骨科医生在建立和维持当代医疗保健系统安全文化方面所需的领导角色。
我们根据提交给联合委员会的不良和警戒手术事件，确定了可预防手术伤害的最常见原因。通过对 MEDLINE（®）数据库（1982 年 1 月至 2012 年 4 月）进行全面文献回顾，以确定相关的骨科手术安全文章，发现了 14 篇文章。在确定骨科文献存在空白的地方，通过对 22 篇非骨科手术参考资料的回顾进行了补充。我们的最终审查包括 36 篇文章。
确定了消除可预防手术伤害所需的六个重要手术安全计划要素：（1）有效的手术团队沟通，（2）适当的知情同意，（3）实施和定期使用手术检查表，（4）正确的手术部位/手术识别，（5）减少手术团队分心，（6）常规手术数据收集和分析，以提高手术患者护理的安全性和质量。
成功的手术安全计划需要一种安全文化，这种文化需要由所有六个关键手术安全计划要素、积极的外科医生拥护者以及旨在增强手术安全性和改善手术患者结局的协作医院和/或行政支持来支持。需要进一步研究衡量此类手术安全系统在骨科护理中的改进情况。
