Rampersad Sally E, Martin Lizabeth D, Geiduschek Jeremy M, Weiss Gillian K, Bates Shelly W, Martin Lynn D
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA 98105, USA.
Paediatr Anaesth. 2013 Jul;23(7):627-33. doi: 10.1111/pan.12198. Epub 2013 May 23.
Patients with central venous catheters who are transferred out of the Intensive Care Unit to the care of an anesthesiology team for an operation or interventional radiology procedure had excessive rates of catheter associated blood stream infection (CABSI).
We convened a multi-disciplinary team to audit anesthesia practice and to develop countermeasures for those aspects of practice that were thought to be contributing to CABSI's. It was noted that provider behavior changed in the presence of an auditor (Hawthorne effect) and so videorecordings were used, in the hope that this Hawthorne effect would be reduced. Clips were chosen from the hours of video (without audio) recordings that showed medication administration, airway management and touching the anesthesia cart of equipment/supplies.
These clips were viewed by three observers and measurements were made to assess intra-rater and inter-rater reliability. The clips were then viewed to quantify differences in practice before and after our bundle of "best practices" was introduced.
Although video recording has been used to evaluate adherence to resuscitation protocols in both trauma and in neonatal resuscitation, (Pediatric Emergency Care, 26, 2010, 803; Pediatrics, 117, 2006, 658; Pediatrics, 106, 2000, 654) we believe this is the first time that video has been used to record before and after behaviors for an anesthesia quality improvement initiative.
对于接受中心静脉导管置入的患者，在从重症监护病房转出至麻醉团队进行手术或介入放射学操作的过程中，导管相关血流感染（CABSI）发生率过高。
我们召集了一个多学科团队来审核麻醉操作，并针对那些被认为会导致CABSI的操作环节制定对策。注意到在有审核人员在场时，医护人员的行为会发生改变（霍桑效应），因此使用了视频记录，希望能减少这种霍桑效应。从数小时的视频（无音频）记录中选取片段，这些片段展示了用药、气道管理以及触碰麻醉推车的设备/用品。
由三名观察者观看这些片段，并进行测量以评估评分者内和评分者间的可靠性。然后观看这些片段以量化在引入我们的“最佳实践”组合前后操作上的差异。
尽管视频记录已被用于评估创伤和新生儿复苏中对复苏方案的依从性（《儿科急诊护理》，26卷，2010年，803页；《儿科学》，117卷，2006年，658页；《儿科学》，106卷，2000年，654页），但我们认为这是首次将视频用于记录麻醉质量改进举措前后的行为。
