Russ Stephanie, Rout Shantanu, Caris Jochem, Mansell Jenny, Davies Rachel, Mayer Erik, Moorthy Krishna, Darzi Ara, Vincent Charles, Sevdalis Nick
Department of Surgery and Cancer, Imperial College London, UK.
Department of Surgery and Cancer, Imperial College London, UK.
J Am Coll Surg. 2015 Jan;220(1):1-11.e4. doi: 10.1016/j.jamcollsurg.2014.09.021. Epub 2014 Oct 12.
Full implementation of safety checklists in surgery has been linked to improved outcomes and team effectiveness; however, reliable and standardized tools for assessing the quality of their use, which is likely to moderate their impact, are required.
This was a multicenter prospective study. A standardized observational instrument, the "Checklist Usability Tool" (CUT), was developed to record precise characteristics relating to the use of the WHO's surgical safety checklist (SSC) at "time-out" and "sign-out" in a representative sample of 5 English hospitals. The CUT was used in real-time by trained assessors across general surgery, urology, and orthopaedic cases, including elective and emergency procedures.
We conducted 565 and 309 observations of the time-out and sign-out, respectively. On average, two-thirds of the items were checked, team members were absent in more than 40% of cases, and they failed to pause or focus on the checks in more than 70% of cases. Information sharing could be improved across the entire operating room (OR) team. Sign-out was not completed in 39% of cases, largely due to uncertainty about when to conduct it. Large variation in checklist use existed between hospitals, but not between surgical specialties or between elective and emergency procedures. Surgical safety checklist performance was better when surgeons led and when all team members were present and paused.
We found large variation in WHO checklist use in a representative sample of English ORs. Measures sensitive to checklist practice quality, like CUT, will help identify areas for improvement in implementation and enable provision of comprehensive feedback to OR teams.
手术中全面实施安全检查表与改善手术结果及团队效率相关；然而，需要可靠且标准化的工具来评估检查表的使用质量，因为检查表的使用质量可能会调节其影响效果。
这是一项多中心前瞻性研究。开发了一种标准化的观察工具“检查表可用性工具”（CUT），用于记录在5家英国医院的代表性样本中，世界卫生组织手术安全检查表（SSC）在“暂停”和“结束”环节使用的精确特征。经过培训的评估人员在普通外科、泌尿外科和骨科手术病例（包括择期和急诊手术）中实时使用CUT。
我们分别对“暂停”和“结束”环节进行了565次和309次观察。平均而言，三分之二的项目得到了检查，超过40%的情况下团队成员缺席，超过70%的情况下他们未能暂停或专注于检查。整个手术室团队的信息共享有待改善。39%的病例未完成“结束”环节，主要原因是对何时进行该环节存在不确定性。不同医院之间检查表的使用存在很大差异，但在不同外科专科之间以及择期和急诊手术之间不存在差异。当外科医生主导且所有团队成员都在场并暂停时，手术安全检查表的执行情况更好。
我们发现，在英国手术室的代表性样本中，世界卫生组织检查表的使用存在很大差异。像CUT这样对检查表实践质量敏感的措施，将有助于识别实施过程中需要改进的领域，并能够为手术室团队提供全面反馈。
