Goldhaber-Fiebert Sara N, Lei Vivian, Nandagopal Kiruthiga, Bereknyei Sylvia
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.
Jt Comm J Qual Patient Saf. 2015 May;41(5):212-20. doi: 10.1016/s1553-7250(15)41028-1.
Emergency manuals (EMs)-context-relevant sets of cognitive aids such as crisis checklists-are useful tools to enhance perioperative patient care. Studies in high-hazard industries demonstrate that humans, regardless of expertise, do not optimally retrieve or deploy key knowledge under stress. EM use has been shown in both health care simulation studies and other industries to help expert teams effectively manage critical events. However, clinical adoption and use are still nascent in health care. Recognizing that training with, access to, and cultural acceptance of EMs can be vital elements for successful implementation, this study assessed the impact of a brief in situ operating room (OR) staff training program on familiarity with EMs and intention to use them during critical events.
Nine 50-minute training sessions were held with OR staff as part of a broader perioperative EM implementation. Participants primarily included OR nurses and surgical technologists. The simulation-based in situ trainings included why and how to use EMs, familiarization with format, simulated scenarios of critical events, and debriefings. A retrospective pre-post survey was conducted to determine participants' levels of EM familiarity and intentions to use EMs clinically.
The 126 trained OR staff self-reported increases in awareness of the EM (p < .01), familiarity with EM (p < .01), willingness to use for educational review (p < .01), and intention to use during critical events (p < .01). Participants rated the sessions highly and expressed interest in more opportunities to practice using EMs.
Implementing institutions should not only provide EMs in accessible places in ORs but also incorporate training mechanisms to increase clinicians' familiarity, cultural acceptance, and planned clinical use.
应急手册（EMs）——诸如危机清单等与情境相关的认知辅助工具集——是提高围手术期患者护理水平的有用工具。对高风险行业的研究表明，无论专业知识如何，人类在压力下都无法最佳地检索或运用关键知识。在医疗模拟研究和其他行业中，EMs的使用已被证明有助于专家团队有效管理关键事件。然而，在医疗保健领域，其临床应用和使用仍处于起步阶段。认识到EMs的培训、获取和文化接受度对于成功实施至关重要，本研究评估了简短的手术室（OR）工作人员现场培训计划对其熟悉EMs程度以及在关键事件中使用EMs意愿的影响。
作为更广泛的围手术期EMs实施的一部分，与手术室工作人员进行了九次50分钟的培训课程。参与者主要包括手术室护士和手术技师。基于模拟的现场培训内容包括使用EMs的原因和方法、熟悉其格式、关键事件模拟场景以及汇报总结。进行了一项回顾性前后调查，以确定参与者对EMs的熟悉程度以及临床使用EMs的意愿。
126名接受培训的手术室工作人员自我报告称，对EMs的认知（p < .01）、对EMs的熟悉程度（p < .01）、用于教育复习的意愿（p < .01）以及在关键事件中使用的意愿（p < .01）均有所提高。参与者对这些课程评价很高，并表示有兴趣获得更多练习使用EMs的机会。
实施机构不仅应在手术室的便利位置提供EMs，还应纳入培训机制，以提高临床医生的熟悉程度、文化接受度以及计划中的临床使用。
