Tscholl David W, Weiss Mona, Kolbe Michaela, Staender Sven, Seifert Burkhardt, Landert Daniel, Grande Bastian, Spahn Donat R, Noethiger Christoph B
From the Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland; Organization, Work and Technology Group, ETH Zurich, Zurich, Switzerland; Department of Anesthesia and Intensive Care Medicine, Regional Hospital Männedorf, Männedorf, Switzerland; Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland; and Crew Resource Management, Swiss International Air Lines Ltd., Zurich Airport, Kloten, Switzerland.
Anesth Analg. 2015 Oct;121(4):948-956. doi: 10.1213/ANE.0000000000000671.
An anesthesia preinduction checklist (APIC) to be performed before anesthesia induction was introduced and evaluated with respect to 5 team-level outcomes, each being a surrogate end point for patient safety: information exchange (the percentage of checklist items exchanged by a team, out of 12 total items); knowledge of critical information (the percentage of critical information items out of 5 total items such as allergies, reported as known by the members of a team); team members' perceptions of safety (the median scores given by the members of a team on a continuous rating scale); their perception of teamwork (the median scores given by the members of a team on a continuous rating scale); and clinical performance (the percentage of completed items out of 14 required tasks, e.g., suction device checked).
A prospective interventional study comparing anesthesia teams using the APIC with a control group not using the APIC was performed using a multimethod design. Trained observers rated information exchange and clinical performance during on-site observations of anesthesia inductions. After the observations, each team member indicated the critical information items they knew and their perceptions of safety and teamwork.
One hundred five teams using the APIC were compared with 100 teams not doing so. The medians of the team-level outcome scores in the APIC group versus the control group were as follows: information exchange: 100% vs 33% (P < 0.001), knowledge of critical information: 100% vs 90% (P < 0.001), perception of safety: 91% vs 84% (P < 0.001), perception of teamwork: 90% vs 86% (P = 0.028), and clinical performance: 93% vs 93% (P = 0.60).
This study provides empirical evidence that the use of a preinduction checklist significantly improves information exchange, knowledge of critical information, and perception of safety in anesthesia teams-all parameters contributing to patient safety. There was a trend indicating improved perception of teamwork.
引入了一份在麻醉诱导前执行的麻醉诱导前检查表（APIC），并针对5个团队层面的结果进行了评估，每个结果都是患者安全的替代终点：信息交流（团队交流的检查表项目占总项目数12项的百分比）；关键信息知晓率（团队成员知晓的5项关键信息项目，如过敏情况，占总项目数的百分比）；团队成员的安全感知（团队成员在连续评分量表上给出的中位数分数）；他们对团队合作的感知（团队成员在连续评分量表上给出的中位数分数）；以及临床表现（完成的项目占14项所需任务的百分比，例如检查吸引装置）。
采用多方法设计进行一项前瞻性干预研究，比较使用APIC的麻醉团队与未使用APIC的对照组。经过培训的观察员在现场观察麻醉诱导过程中对信息交流和临床表现进行评分。观察结束后，每个团队成员指出他们知晓的关键信息项目以及他们对安全和团队合作的感知。
将105个使用APIC的团队与100个未使用APIC的团队进行比较。APIC组与对照组在团队层面结果分数的中位数如下：信息交流：100%对33%（P<0.001），关键信息知晓率：100%对90%（P<0.001），安全感知：91%对84%（P<0.001），团队合作感知：90%对86%（P=0.028），以及临床表现：93%对93%（P=0.60）。
本研究提供了实证证据，表明使用诱导前检查表可显著改善麻醉团队的信息交流、关键信息知晓率和安全感知，所有这些参数都有助于患者安全。有趋势表明团队合作感知得到改善。
