对外科手术安全核对表的态度及其使用相关因素：一项针对一线医疗专业人员的全球调查。
Attitudes towards the surgical safety checklist and factors associated with its use: A global survey of frontline medical professionals.
作者信息
Vohra Ravinder S, Cowley Jonathan B, Bhasin Neeraj, Barakat Hashem M, Gough Michael J
机构信息
Academic Department of Surgery, School of Cancer Sciences, University of Birmingham, Birmingham B15 2TH, UK.
Academic Surgical Unit, Castle Hill Hospital, Cottingham HU16 5JQ, UK.
出版信息
Ann Med Surg (Lond). 2015 Apr 20;4(2):119-23. doi: 10.1016/j.amsu.2015.04.001. eCollection 2015 Jun.
BACKGROUND
The Surgical Safety Checklist (SSC) has been shown to reduce perioperative errors and complications and its implementation is recommended by the World Health Organisation (WHO). However, it is unknown how widely this intervention is used. We investigated attitudes and factors associated with use of WHO SSC in frontline medical professionals across the globe using a survey distributed through social networks.
METHODS
A survey of usage and opinions regarding the SSC was posted on the Facebook and Twitter pages of a not-for-profit surgical news website for one month (March 2013). Respondents were grouped into four groups based on their country's Gross National Income: high, upper middle, lower middle and low income. Univariate and multivariate analyses were performed to investigate how different factors were associated with the use of the SSC.
RESULTS
6269 medical professionals from 69 countries responded to the survey: most respondents were from lower middle (47.4%) countries, followed by: high (35.0%), upper middle (14.6%), and low (3.0%) income countries. In total, 57.5% reported that they used the WHO SSC perioperatively. Fewer respondents used the WHO SSC in upper middle, lower middle and low income countries (LMICs) compared to high income countries (43.5% vs. 83.5%, p < 0.001). Female (61.3% vs. 56.4% males, p = 0.001), consultant surgeons (59.6% vs. 53.2% interns, p < 0.001) and working in university hospitals (61.4% vs. 53.7% non-university hospitals, p < 0.001) were more likely to use the SSC. Believing the SSC was useful, did not work or caused delays was independently associated with the respondents reported use of the SSC (OR 1.22 95% CI 1.07-1.39; OR 0.47 95% CI 0.36-0.60; OR 0.64 95% CI 0.53-0.77, respectively).
CONCLUSION
This study suggests the use of the WHO SSC is variable across countries, especially in LMICs where it has the most potential to improve patient safety. Critical appraisal of the documented benefits of the WHO SSC may improve its adoption by those not currently using it.
背景
手术安全核对表（SSC）已被证明可减少围手术期错误和并发症，世界卫生组织（WHO）建议实施该核对表。然而，尚不清楚这种干预措施的使用范围有多广。我们通过社交网络分发的一项调查，研究了全球一线医疗专业人员对WHO手术安全核对表的使用态度及相关因素。
方法
关于手术安全核对表的使用情况和意见的调查在一个非营利性手术新闻网站的Facebook和Twitter页面上发布了一个月（2013年3月）。根据受访者所在国家的国民总收入将其分为四组：高收入、中高收入、中低收入和低收入。进行单因素和多因素分析以研究不同因素与手术安全核对表使用之间的关联。
结果
来自69个国家的6269名医疗专业人员回复了调查：大多数受访者来自中低收入国家（47.4%），其次是：高收入国家（35.0%）、中高收入国家（14.6%）和低收入国家（3.0%）。总体而言，57.5%的受访者表示他们在围手术期使用WHO手术安全核对表。与高收入国家相比，中高收入、中低收入和低收入国家（LMICs）使用WHO手术安全核对表的受访者较少（43.5%对83.5%，p<0.001）。女性（61.3%对男性的56.4%，p = 0.001）、顾问外科医生（59.6%对实习生的53.2%，p<0.001）以及在大学医院工作（61.4%对非大学医院的53.7%，p<0.001）的人员更有可能使用手术安全核对表。认为手术安全核对表有用、无用或会导致延误，分别与受访者报告使用手术安全核对表独立相关（OR 1.22，95%CI 1.07 - 1.39；OR 0.47，95%CI 0.36 - 0.60；OR 0.64，95%CI 0.53 - 0.77）。
结论
本研究表明，WHO手术安全核对表的使用在不同国家存在差异，尤其是在中低收入国家，该核对表在这些国家改善患者安全方面最具潜力。对WHO手术安全核对表已记录的益处进行批判性评估，可能会提高目前未使用者对其的采用率。
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