Putnam Luke R, Anderson Kathryn T, Diffley Michael B, Hildebrandt Aubrey A, Caldwell Kelly M, Minzenmayer Andrew N, Covey Sarah E, Kawaguchi Akemi L, Lally Kevin P, Tsao KuoJen
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, TX.
Surgery. 2016 Dec;160(6):1675-1681. doi: 10.1016/j.surg.2016.04.038. Epub 2016 Jul 26.
The benefit of utilizing surgical safety checklists has been recently questioned. We evaluated our checklist performance after implementing a program that includes checklist-related good catches.
Multifaceted interventions aimed at the preincision checklist and 5 prospective audits were conducted from 2011-2015. We documented adherence to the checklist (verbalization of each checkpoint), fidelity (meaningful performance of each checkpoint), and good catches (events with the potential to cause the patient harm but that were prevented from occurring). Good catches were divided into quality improvement-based categories (processes, medication, safety, communication, and equipment).
A total of 1,346 checklist performances were observed (range, 144-373/yr). Adherence to the preincision checklist improved from 30% to 95% (P < .001), while adherence to the preinduction and debriefing checklists decreased (71% to 56%, P = .002) and remained unchanged (76%), respectively. Preincision fidelity decreased from 86% to 76% (P = .012). Good catches were identified during 16% of preincision checklist performances; process issues were most common (32%) followed by issues of medication administration (30%) and safety (22%).
Implementation of a systematic checklist program resulted in significant and sustainable improvement in performance. Meaningful use and associated good catches may be more appropriate metric than actual patient harm for measuring checklist effectiveness. Although not previously described, checklist-related good catches represent an unknown benefit of checklists.
近期有人对使用手术安全检查表的益处提出质疑。在实施一项包含与检查表相关的良好捕获事件的计划后，我们评估了我们的检查表执行情况。
从2011年至2015年，针对术前检查表进行了多方面干预以及5次前瞻性审核。我们记录了检查表的依从性（每个检查点的口头表述）、保真度（每个检查点的有效执行）以及良好捕获事件（有可能对患者造成伤害但被预防发生的事件）。良好捕获事件被分为基于质量改进的类别（流程、用药、安全、沟通和设备）。
共观察到1346次检查表执行情况（范围为每年144 - 373次）。术前检查表的依从性从30%提高到了95%（P <.001），而诱导前检查表和术后总结检查表的依从性分别下降（从71%降至56%，P =.002）和保持不变（76%）。术前保真度从86%降至76%（P =.012）。在16%的术前检查表执行过程中发现了良好捕获事件；流程问题最为常见（32%），其次是用药管理问题（30%）和安全问题（22%）。
实施系统的检查表计划导致了执行情况的显著且可持续的改善。对于衡量检查表有效性而言，有效使用及相关的良好捕获事件可能是比实际患者伤害更合适的指标。尽管此前未被描述，但与检查表相关的良好捕获事件代表了检查表一项未知的益处。
