Norton Elizabeth K, Singer Sara J, Sparks William, Ozonoff Al, Baxter Jessica, Rangel Shawn
From the Departments of *Nursing and #General Surgery, Boston Children's Hospital; †Department of Health Policy and Management, Harvard School of Public Health; ‡Department of Medicine, Harvard Medical School/Mongan \Institute for Health Policy, Massachusetts General Hospital; §Anesthesiology and Perioperative Pain Management, and ∥Design and Analysis Core, Clinical Research Center, Boston Children's Hospital; and ¶Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
J Patient Saf. 2016 Mar;12(1):44-50. doi: 10.1097/PTS.0000000000000120.
Despite mounting evidence that use of surgical checklists improves patient morbidity and mortality, compliance among surgical teams in executing required elements of checklists has been low. Recognizing that clinicians' receptivity is a major determinant of checklist use, we conducted a survey to investigate how mandated use of a surgical checklist impacts its operating room clinicians' attitudes about and perceptions of operating room safety, efficiency, teamwork, and prevention of medical errors.
Operating room clinicians at 1 pediatric hospital were surveyed on their attitudes and perception of the novel Pediatric Surgical Safety Checklist and the impact the checklist had on efficiency, teamwork, and prevention of medical errors 1 year after its implementation. The survey responses were compared and classified by multidisciplinary perioperative clinical staff.
Most responses reflected positive attitudes toward checklist use. The respondents felt that the checklist reduced complications and errors and improved patient safety, communication among team members, teamwork in complex procedures, and efficiency in the operating room. Many operating room staff also reported that checklist use had prevented or averted an error or a complication. Perceptions varied according to perioperative clinical discipline, reflecting differences in perspectives. For example, the nurses perceived a higher rate of consent-related errors and site marking errors than did the physicians; the surgeons reported more antibiotic timing and equipment errors than did others.
The surgical staff at 1 pediatric hospital who responded viewed the novel Pediatric Surgical Safety Checklist as potentially beneficial to operative patient safety by improving teamwork and communication, reducing errors, and improving efficiency. Responses varied by discipline, indicating that team members view the checklist from different perspectives.
尽管越来越多的证据表明使用手术清单可降低患者的发病率和死亡率，但手术团队在执行清单所需项目方面的依从性一直很低。鉴于临床医生的接受程度是清单使用的主要决定因素，我们开展了一项调查，以研究强制使用手术清单如何影响手术室临床医生对手术室安全、效率、团队合作及医疗差错预防的态度和认知。
对一家儿科医院的手术室临床医生就其对新型儿科手术安全清单的态度和认知，以及该清单在实施1年后对效率、团队合作和医疗差错预防的影响进行了调查。多学科围手术期临床工作人员对调查回复进行了比较和分类。
大多数回复反映出对使用清单持积极态度。受访者认为清单减少了并发症和差错，提高了患者安全性、团队成员间的沟通、复杂手术中的团队合作以及手术室效率。许多手术室工作人员还报告称，使用清单预防或避免了差错或并发症。认知因围手术期临床学科而异，反映出观点的差异。例如，护士察觉到的与同意相关的差错和手术部位标记差错发生率高于医生；外科医生报告的抗生素使用时机和设备差错比其他人更多。
一家儿科医院做出回复的手术工作人员认为，新型儿科手术安全清单通过改善团队合作和沟通、减少差错及提高效率，可能对手术患者安全有益。回复因学科而异，表明团队成员从不同角度看待清单。
