Gitelis Matthew E, Kaczynski Adelaide, Shear Torin, Deshur Mark, Beig Mohammad, Sefa Meredith, Silverstein Jonathan, Ujiki Michael
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Section of Minimally Invasive Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.
Am J Surg. 2017 Jul;214(1):7-13. doi: 10.1016/j.amjsurg.2016.07.024. Epub 2016 Aug 16.
In 2009, NorthShore University HealthSystem adapted the World Health Organization Surgical Safety Checklist (SSC) at each of its 4 hospitals. Despite evidence that SSC reduces intraoperative mistakes and increase patient safety, compliance was found to be low with the paper form. In November 2013, NorthShore integrated the SSC into the electronic health record (EHR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety.
An anonymous OR observer selected cases at random and evaluated the compliance rate before the rollout of the electronic SSC. In June 2014, an electronic audit was performed to assess the compliance rate. Random OR observations were also performed throughout the summer in 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perception survey was also administered to NorthShore OR personnel.
Compliance increased from 48% (n = 167) to 92% (n = 1,037; P < .001) after the SSC was integrated into the electronic health record. Surgeons (91% vs 97%; P < .001), anesthesiologists (89% vs 100%; P < .001), and nurses (55% vs 93%; P < .001) demonstrated an increase in compliance. A comparison between risk events in the pre- and post-rollout period showed a 32% decrease (P < .01). Hospital-wide indicators including length of stay and 30-day readmissions were lower. In a survey to assess the OR personnel's perceptions of the new checklist, 76% of surgeons, 86% of anesthesiologists, and 88% of nurses believed the electronic SSC will have a positive impact on patient safety.
The World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety.
2009年，北岸大学医疗系统（NorthShore University HealthSystem）在其4家医院的每一家都采用了世界卫生组织手术安全核对表（SSC）。尽管有证据表明手术安全核对表可减少术中失误并提高患者安全性，但发现纸质表格的依从性较低。2013年11月，北岸大学将手术安全核对表整合到电子健康记录（EHR）中。目的是加强手术室（OR）人员之间的沟通，并鼓励外科医生、麻醉师和护士在自然工作流程中采用最佳做法。本研究的目的是检验电子手术安全核对表对依从性和患者安全的影响。
一名匿名的手术室观察员随机选择病例，并在电子手术安全核对表推出之前评估依从率。2014年6月，进行了一次电子审核以评估依从率。2014年夏季还进行了随机的手术室观察。比较了电子手术安全核对表推出前后围手术期风险事件，如同意问题、计数错误、手术部位错误和手术程序错误。还对北岸大学手术室人员进行了一次认知调查。
将手术安全核对表整合到电子健康记录后，依从率从48%（n = 167）提高到92%（n = 1,037；P < .001）。外科医生（91%对97%；P < .001）、麻醉师（89%对100%；P < .001）和护士（55%对93%；P < .001）的依从性均有所提高。推出前后风险事件的比较显示减少了32%（P < .01）。包括住院时间和30天再入院率在内的全院指标较低。在一项评估手术室人员对新核对表看法的调查中，76%的外科医生、86%的麻醉师和88%的护士认为电子手术安全核对表将对患者安全产生积极影响。
世界卫生组织手术安全核对表是一种经过验证的工具，可提高患者安全性并减少术中并发症。电子手术安全核对表已显示出依从率提高、风险事件数量减少，并且大多数手术室人员认为它将对患者安全产生积极影响。
