Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA.
N Engl J Med. 2013 Jan 17;368(3):246-53. doi: 10.1056/NEJMsa1204720.
Operating-room crises (e.g., cardiac arrest and massive hemorrhage) are common events in large hospitals but can be rare for individual clinicians. Successful management is difficult and complex. We sought to evaluate a tool to improve adherence to evidence-based best practices during such events.
Operating-room teams from three institutions (one academic medical center and two community hospitals) participated in a series of surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. The primary outcome measure was failure to adhere to critical processes of care. Participants were also surveyed regarding their perceptions of the usefulness and clinical relevance of the checklists.
A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed when checklists were available vs. 23% when they were unavailable, P<0.001). The results were similar in a multivariate model that accounted for clustering within teams, with adjustment for institution, scenario, and learning and fatigue effects (adjusted relative risk, 0.28; 95% confidence interval, 0.18 to 0.42; P<0.001). Every team performed better when the crisis checklists were available than when they were not. A total of 97% of the participants reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used.
In a high-fidelity simulation study, checklist use was associated with significant improvement in the management of operating-room crises. These findings suggest that checklists for use during operating-room crises have the potential to improve surgical care. (Funded by the Agency for Healthcare Research and Quality.).
手术室危机（如心脏骤停和大出血）在大型医院中很常见，但对于个别临床医生来说可能很少见。成功的管理是困难和复杂的。我们试图评估一种工具，以提高在这种情况下遵循循证最佳实践的能力。
来自三个机构（一个学术医疗中心和两个社区医院）的手术室团队在模拟手术室中参与了一系列手术危机情景。每个团队都被随机分配到一半的场景，使用一套危机检查表，另一半场景则仅靠记忆管理。主要观察指标是未能遵守关键护理流程。参与者还被调查了他们对检查表的有用性和临床相关性的看法。
共有 17 个手术室团队参与了 106 个模拟手术危机情景。在有检查表可用的情况下，不遵守救生护理流程的情况较少（检查表可用时有 6%的步骤遗漏，而不可用时则有 23%，P<0.001）。在考虑到团队内的聚类、机构、情景以及学习和疲劳效应的多变量模型中，结果相似（调整相对风险，0.28；95%置信区间，0.18 至 0.42；P<0.001）。每个团队在有危机检查表可用时表现都更好。97%的参与者表示，如果在手术过程中发生其中一种危机，他们希望使用检查表。
在高保真度模拟研究中，检查表的使用与手术室危机管理的显著改善相关。这些发现表明，在手术室危机期间使用检查表有可能改善手术护理。（由医疗保健研究和质量局资助）。
