Hannam J A, Glass L, Kwon J, Windsor J, Stapelberg F, Callaghan K, Merry A F, Mitchell S J
Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, , Auckland, New Zealand.
BMJ Qual Saf. 2013 Nov;22(11):940-7. doi: 10.1136/bmjqs-2012-001749. Epub 2013 Jul 9.
The reported benefits of using the WHO Surgical Safety Checklist (SSC) are likely to depend on compliance with its correct use. Compliance with SSC administration in centres that have introduced the checklist under a research protocol may differ from centres where the SSC is introduced independently.
To compare compliance with SSC administration at an original WHO pilot study centre (Hospital 1) with that at a similar neighbouring hospital (Hospital 2) that independently integrated the SSC with pre-existing practice.
This was a prospective, observational study. One hundred operations were observed at each hospital. We recorded: compliance with administration of SSC domains (Sign In, Time Out and Sign Out) and individual domain items; timing of domain administration; and operating room team engagement during administration.
Domain compliance at Hospital 1 and Hospital 2, respectively, was: 96% and 31% (p<0.0005) for Sign In; 99% and 48% (p<0.0005) for Time Out and 22% and 9% (p=0.008) for Sign Out. Engagement of two or more teams during Sign In and Time Out occurred more frequently at Hospital 2 than at Hospital 1.
Compliance with administration of SSC domains was lower at Hospital 2 which introduced the SSC outside the context of a strict study protocol. This finding mandates caution in extrapolation of benefits identified in SSC studies to non-study hospitals. Staff engagement was better at Hospital 2 where checklist administration leadership is strategically shared among anaesthetic, surgical and nursing team members as compared with exclusive nursing leadership at Hospital 1.
Australian and New Zealand Clinical Trials Registry: Ref: ACTRN12612000135819, http://www.anzctr.org.au/trial_view.aspx?ID=362007.
据报道，使用世界卫生组织手术安全核对表（SSC）的益处可能取决于对其正确使用的依从性。在按照研究方案引入核对表的中心，与独立引入SSC的中心相比，SSC管理的依从性可能有所不同。
比较世界卫生组织最初的试点研究中心（医院1）与独立将SSC与现有实践相结合的相邻类似医院（医院2）在SSC管理方面的依从性。
这是一项前瞻性观察研究。在每家医院观察了100例手术。我们记录了：SSC各领域（签到、暂停和签出）及各领域项目的管理依从性；各领域管理的时间安排；以及管理过程中手术室团队的参与情况。
医院1和医院2在各领域的依从性分别为：签到方面，96%和31%（p<0.0005）；暂停方面，99%和48%（p<0.0005）；签出方面，22%和9%（p=0.008）。在签到和暂停过程中，两个或更多团队的参与在医院2比在医院1更频繁。
在严格研究方案之外引入SSC的医院2，SSC各领域管理的依从性较低。这一发现要求在将SSC研究中确定的益处外推至非研究医院时要谨慎。与医院1由护士独家领导相比，医院2的员工参与度更高，在医院2，核对表管理领导权在麻醉、外科和护理团队成员之间进行了战略性分享。
澳大利亚和新西兰临床试验注册中心：编号：ACTRN12612000135819，网址：http://www.anzctr.org.au/trial_view.aspx?ID=362007 。
