Hsu Ya-Chi, Jerng Jih-Shuin, Chang Ching-Wen, Chen Li-Chin, Hsieh Ming-Yuan, Huang Szu-Fen, Liu Yueh-Ping, Hung Kuan-Yu
Center for Quality Management, National Taiwan University, Taipei, Taiwan.
BMC Surg. 2014 Aug 11;14:51. doi: 10.1186/1471-2482-14-51.
The process involved in organ procurement and transplantation is very complex that requires multidisciplinary coordination and teamwork. To prevent error during the processes, teamwork education and training might play an important role. We wished to evaluate the efficacy of implementing a Team Resource Management (TRM) program on patient safety and the behaviors of the team members involving in the process.
We implemented a TRM training program for the organ procurement and transplantation team members of the National Taiwan University Hospital (NTUH), a teaching medical center in Taiwan. This 15-month intervention included TRM education and training courses for the healthcare workers, focused group skill training for the procurement and transplantation team members, video demonstration and training, and case reviews with feedbacks. Teamwork culture was evaluated and all procurement and transplantation cases were reviewed to evaluate the application of TRM skills during the actual processes.
During the intervention period, a total of 34 staff members participated the program, and 67 cases of transplantations were performed. Teamwork framework concept was the most prominent dimension that showed improvement from the participants for training. The team members showed a variety of teamwork behaviors during the process of procurement and transplantation during the intervention period. Of note, there were two potential donors with a positive HIV result, for which the procurement processed was timely and successfully terminated by the team. None of the recipients was transplanted with an infected organ. No error in communication or patient identification was noted during review of the case records.
Implementation of a Team Resource Management program improves the teamwork culture as well as patient safety in organ procurement and transplantation.
器官获取与移植过程非常复杂，需要多学科协作与团队合作。为防止过程中出现差错，团队合作教育与培训可能发挥重要作用。我们希望评估实施团队资源管理（TRM）项目对患者安全以及参与该过程的团队成员行为的效果。
我们为台湾一家教学医学中心国立台湾大学医院（NTUH）的器官获取与移植团队成员实施了TRM培训项目。这项为期15个月的干预措施包括为医护人员开展TRM教育与培训课程、为获取与移植团队成员进行焦点小组技能培训、视频演示与培训以及带有反馈的病例回顾。评估团队合作文化，并对所有获取与移植病例进行回顾，以评估TRM技能在实际过程中的应用情况。
在干预期间，共有34名工作人员参与了该项目，进行了67例移植手术。团队合作框架概念是参与者培训后改善最为显著的维度。在干预期间的器官获取与移植过程中，团队成员展现出多种团队合作行为。值得注意的是，有两名潜在捐赠者HIV检测呈阳性，团队及时且成功地终止了获取过程。没有受者接受感染器官移植。在病例记录回顾中未发现沟通或患者识别方面的差错。
实施团队资源管理项目可改善器官获取与移植中的团队合作文化以及患者安全。
