Trentzsch H, Urban B, Sandmeyer B, Hammer T, Strohm P C, Lazarovici M
Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Campus Innenstadt, Schillerstraße 53, 80336, München, Deutschland,
Unfallchirurg. 2013 Oct;116(10):900-8. doi: 10.1007/s00113-013-2444-8.
Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.
在认识到可预防的不良事件在住院期间对发病率和死亡率有显著影响后,患者安全在医学以及急诊医学中变得至关重要。潜在的错误通常不能仅用医疗技术不足来解释,而更多是由于在临床实际情况下将理论知识转化为任务存在困难。团队资源管理和人为因素决定了复杂情况下人员的安全性和效率,适用于控制此类错误来源。模拟显著提高了高可靠性组织(如航空航天工业)的安全性。因此,基于模拟器的团队培训也被提议应用于医疗领域。由于这种培训在成本、时间和人力资源方面消耗巨大,成本效益比的问题显然随之而来。本综述概述了基于模拟器的团队培训对患者安全的影响。这种课程形式不仅能够提高对安全文化的认识并加以改进,还能提高团队技术表现,并将团队表现作为一种临床能力加以强调。一些研究甚至表明以患者为中心的结果有所改善,如不良事件发生率降低,但在这方面还需要进一步研究。总之,基于模拟器的团队培训应被视为提高患者安全的合适策略。