Scottish Clinical Simulation Centre, Forth Valley Royal Hospital, Larbert, UK.
BJU Int. 2014 Jan;113(1):167-75. doi: 10.1111/bju.12268.
To identify current attitudes to patient safety among urology trainees. To examine whether these have changed with the recent increase in emphasis on patient safety and the introduction of new working procedures in operating theatres.
Subjects included 28 urology trainees, based in the West of Scotland, UK. Trainee attitudes were examined using the Operating Room Management Attitudes Questionnaire, a validated tool for examining attitudes towards patient safety.
Attitudes to teamwork were highly positive, with 89-100% of trainees acknowledging the need to share information and conduct pre- and postoperative briefs, and 82-96% being accepting of multidisciplinary feedback on performance. Attitudes to preoperative briefing and multidisciplinary feedback were improved compared with a similar historical cohort. Trainees were reluctant to acknowledge the effect of stress and fatigue on personal performance; 50% felt they worked effectively in critical phases of operations even when tired, only 50% would tell team members their workload was becoming excessive and only 36% of trainees recognized that personal problems could affect their performance. There was no significant change in these attitudes from 2006 data. Regarding leadership and confidence assertion, 68% of trainees felt that leadership in the operating theatre should rest with the medical staff, 18% stated senior decisions or actions should not be questioned unless they threaten safety and 7% that they should not be questioned at all. This was similar to previous data.
Attitudes to briefing and multidisciplinary feedback appear to have improved since the introduction of the World Health Organization surgical checklist and wider use of feedback tools; other safety attitudes remain largely unchanged. Urology trainees may benefit from further training to better understand the mechanisms of error development, to raise awareness of human performance limitation, particularly the effects of stress and fatigue, and to develop techniques to challenge decisions/respond to challenges.
确定泌尿科住院医师对患者安全的当前态度。检查这些态度是否因最近对患者安全的重视增加以及手术室新工作程序的引入而发生变化。
研究对象包括英国苏格兰西部的 28 名泌尿科住院医师。使用手术室管理态度问卷评估住院医师的态度，该问卷是用于检查对患者安全态度的有效工具。
团队合作的态度非常积极，89-100%的住院医师承认需要分享信息并进行术前和术后简报，82-96%的人接受多学科对绩效的反馈。与类似的历史队列相比，对术前简报和多学科反馈的态度有所改善。住院医师不愿承认压力和疲劳对个人表现的影响；50%的人认为即使疲倦，他们在手术的关键阶段也能有效地工作，只有 50%的人会告诉团队成员他们的工作量过大，只有 36%的住院医师认识到个人问题会影响他们的表现。这些态度与 2006 年的数据相比没有明显变化。关于领导力和自信表达，68%的住院医师认为手术室的领导权应属于医务人员，18%的人表示除非危及安全，否则不应质疑高级决策或行动，而 7%的人则表示不应质疑高级决策或行动。这与之前的数据相似。
自从引入世界卫生组织手术清单和更广泛地使用反馈工具以来，对简报和多学科反馈的态度似乎有所改善；其他安全态度基本保持不变。泌尿科住院医师可能受益于进一步的培训，以更好地理解错误发展的机制，提高对人类绩效限制的认识，特别是压力和疲劳的影响，并开发挑战决策/应对挑战的技术。
