Porter Allison J, Narimasu Jon Y, Mulroy Michael F, Koehler Richard P
Jt Comm J Qual Patient Saf. 2014 Jan;40(1):3-9. doi: 10.1016/s1553-7250(14)40001-1.
Adoption ofa preprocedural pause (PPP) associated with a checklist and a team briefing has been shown to improve teamwork function in operating rooms (ORs) and has resulted in improved outcomes. The format of the World Health Organization Safe Surgery Saves Lives checklist has been used as a template for a PPP. Performing a PPP, described as a "time-out," is one of the three principal components, along with a preprocedure verification process and marking the procedure site, of the Joint Commission's Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. However, if the surgeon alone leads the pause, its effectiveness may be decreased by lack of input from other operating team members.
In this study, the PPP was assessed to measure participation and input from operating team members. On the basis of low participation levels, the pause was modified to include an attestation from each member of the team.
Preliminary analysis of our surgeon-led pause revealed only 54% completion of all items, which increased to 97% after the intervention. With the new format, operating team members stopped for the pause in 96% of cases, compared with 78% before the change. Operating team members introduced themselves in 94% of cases, compared with 44% before the change. Follow-up analysis showed sustained performance at 18 months after implementation.
A preprocedural checklist format in which each member of the operating team provides a personal attestation can improve pause compliance and may contribute to improvements in the culture of teamwork within an OR. Successful online implementation of a PPP, which includes participation by all operating team members, requires little or no additional expense and only minimal formal coaching outside working situations.
采用与检查表及团队简报相关的术前暂停（PPP）已被证明可改善手术室（OR）中的团队协作功能，并带来更好的手术结果。世界卫生组织“安全手术拯救生命”检查表的格式已被用作PPP的模板。进行被称为“暂停”的PPP是联合委员会预防手术部位错误、手术程序错误、手术人员错误的通用协议的三个主要组成部分之一，另外两个部分是术前核查流程和标记手术部位。然而，如果仅由外科医生主导暂停，由于缺乏其他手术团队成员的参与，其效果可能会降低。
在本研究中，对PPP进行评估以衡量手术团队成员的参与度和投入情况。基于低参与度，对暂停进行了修改，使其包括团队每个成员的确认。
对我们由外科医生主导的暂停的初步分析显示，所有项目的完成率仅为54%，干预后提高到了97%。采用新格式后，手术团队成员在96%的情况下会停下来进行暂停，而改变前这一比例为78%。手术团队成员在94%的情况下会进行自我介绍，而改变前为44%。后续分析显示，实施18个月后仍保持良好表现。
一种手术团队每个成员都进行个人确认的术前检查表格式可以提高暂停的依从性，并可能有助于改善手术室的团队协作文化。成功在线实施包括所有手术团队成员参与的PPP几乎不需要额外费用，在工作之外仅需极少的正式培训。
