儿科创伤复苏期间非例行事件的分类及团队应对措施。
Classification and team response to nonroutine events occurring during pediatric trauma resuscitation.
作者信息
Webman Rachel B, Fritzeen Jennifer L, Yang JaeWon, Ye Grace F, Mullan Paul C, Qureshi Faisal G, Parker Sarah H, Sarcevic Aleksandra, Marsic Ivan, Burd Randall S
机构信息
From the Division of Trauma and Burn Surgery, Children's National Medical Center, Washington, District of Columbia (R.B.W., J.L.F., J.Y., R.S.B.); George Washington University School of Medicine, Washington, District of Columbia (G.F.Y.); Division of Emergency Medicine and Trauma Services, Children's Hospital of the King's Daughters, Norfolk, Virginia (P.C.M.); Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (F.G.Q.); Virginia Tech Carilion Research Institute, Roanoke, Virginia (S.H.P.); College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania (A.S.); and Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New Jersey (I.M.).
出版信息
J Trauma Acute Care Surg. 2016 Oct;81(4):666-73. doi: 10.1097/TA.0000000000001196.
BACKGROUND
Errors directly causing serious harm are rare during pediatric trauma resuscitation, limiting the use of adverse outcome analysis for performance improvement in this setting. Errors not causing harm because of mitigation or chance may have similar causation and are more frequent than those causing adverse outcomes. Analyzing these error types is an alternative to adverse outcome analysis. The purpose of this study was to identify errors of any type during pediatric trauma resuscitation and evaluate team responses to their occurrence.
METHODS
Errors identified using video analysis were classified as errors of omission or commission and selection errors using input from trauma experts. The responses to error types and error frequency based on patient and event features were compared.
RESULTS
Thirty-nine resuscitations were reviewed, identifying 337 errors (range, 2-26 per resuscitation). The most common errors were related to cervical spine stabilization (n = 93, 27.6%). Errors of omission (n = 135) and commission (n = 106) were more common than errors of selection (n = 96). Although 35.9% of all errors were acknowledged and compensation occurred after 43.6%, no response (acknowledgement or compensation) was observed after 51.3% of errors. Errors of omission and commission were more often acknowledged (40.7% and 39.6% vs. 25.0%, p = 0.03 and p = 0.04, respectively) and compensated for (50.4% and 47.2% vs. 29.2%, p = 0.004 and p = 0.01, respectively) than selection errors. Response differences between errors of omission and commission were not observed. The number of errors and the number of high-risk errors that occurred did not differ based on patient or event features.
CONCLUSIONS
Errors are common during pediatric trauma resuscitation. Teams did not respond to most errors, although differences in team response were observed between error types. Determining causation of errors may be an approach for identifying latent safety threats contributing to adverse outcomes during pediatric trauma resuscitation.
LEVEL OF EVIDENCE
Therapeutic study, level III.
背景
在儿科创伤复苏过程中，直接导致严重伤害的错误很少见，这限制了通过不良后果分析来改善该场景下的医疗表现。由于缓解措施或偶然因素而未造成伤害的错误可能具有相似的病因，且比导致不良后果的错误更为常见。分析这些错误类型是不良后果分析的一种替代方法。本研究的目的是识别儿科创伤复苏过程中任何类型的错误，并评估团队对错误发生的反应。
方法
使用视频分析识别的错误，根据创伤专家的意见，分为遗漏错误、执行错误和选择错误。比较基于患者和事件特征对错误类型和错误频率的反应。
结果
回顾了39次复苏过程，识别出337个错误（每次复苏2 - 26个错误）。最常见的错误与颈椎固定有关（n = 93，27.6%）。遗漏错误（n = 135）和执行错误（n = 106）比选择错误（n = 96）更常见。虽然35.9%的所有错误得到了承认，43.6%的错误在之后得到了弥补，但51.3%的错误之后未观察到任何反应（承认或弥补）。遗漏错误和执行错误比选择错误更常得到承认（分别为40.7%和39.6%对25.0%，p = 0.03和p = 0.04）和弥补（分别为50.4%和47.2%对29.2%，p = 0.004和p = 0.01）。未观察到遗漏错误和执行错误之间的反应差异。错误数量和发生的高风险错误数量在患者或事件特征方面没有差异。
结论
在儿科创伤复苏过程中错误很常见。团队对大多数错误没有做出反应，尽管在不同错误类型之间观察到了团队反应的差异。确定错误的病因可能是一种识别导致儿科创伤复苏不良后果的潜在安全威胁的方法。
证据水平
治疗性研究，III级。
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