Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Organization, Work and Technology Group, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland Quality Management and Patient Safety, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Br J Anaesth. 2016 May;116(5):662-9. doi: 10.1093/bja/aew030.
Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol.
We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines.
The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001).
This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.
提高临床医生的教育水平有望提高患者安全。教育的一个重要组成部分是遵守标准协议，这些协议主要以书面形式提供。我们相信视频的潜在力量，因此假设引入基于机构标准协议的教育视频将促进对协议的遵守。
我们对 7 个大学医院的 30 个手术室中的 1091 名团队成员（516 名预视频和 575 名后视频）进行了一项前瞻性干预研究，涉及 425 个麻醉程序和团队（202 个预视频和 223 个后视频）。在引入演示基于循证和最佳实践指南的教育视频之前和之后，通过系统的现场观察评估在快速顺序诱导麻醉期间安全关键任务的遵守情况。
干预前后，安全关键任务不遵守的可能性降低，优势比为 0.34（95%置信区间 0.27-0.42，P<0.001）。14 项安全关键任务中有八项（均 P<0.001）的不遵守风险显著降低。
这项研究为在复杂医疗程序中使用教育视频来提高对标准协议的遵守提供了经验证据。引入视频可以降低对安全关键任务的不遵守率，并有助于患者安全。我们建议引入视频以提高协议的遵守率。
