Alidina Shehnaz, Hur Hye-Chun, Berry William R, Molina George, Guenthner Guy, Modest Anna M, Singer Sara J
Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, USA.
Int J Qual Health Care. 2017 Aug 1;29(4):461-469. doi: 10.1093/intqhc/mzx050.
To examine narrative feedback to understand surgical team perceptions about surgical safety checklists (SSCs) and their impact on the safety of surgical practice.
We reviewed free-text comments from surveys administered before and after SSC implementation between 2011 and 2013. We categorized feedback thematically and as positive, negative or neutral.
South Carolina hospitals participating in a statewide collaborative on checklist implementation.
Surgical teams from 11 hospitals offering free-text comments in both pre-and post-implementation surveys.
Implementation of the World Health Organization SSC.
Differences in comments made before and after implementation and by provider role; types of complications averted through checklist use.
Before SSC implementation, the proportion of positive comments among provider roles differed significantly (P = 0.04), with more clinicians offering negative comments (87.9%, (29/33)) compared to other surgical team members (58.3% (7/12) to 60.9% (14/23)), after SSC implementation, these proportions did not significantly differ (clinicians 77.8% (14/18)), other surgical team members (50% (2/4) to 76.9% (20/26)) (P = 0.52). Distribution of negative comments differed significantly before and after implementation (P = 0.01); for example, there were more negative comments made about checklist buy-in after implementation (51.3 % (20/39)) compared to before implementation (24.5% (13/53)). Surgical team members most frequently reported that checklist use averted complications involving antibiotic administration, equipment and side/site of surgery.
Narrative feedback suggested that SSC implementation can facilitate patient safety by averting complications; however, buy-in is a persistent challenge. Presenting information on the impact of the SSC on lives saved, teamwork and complications averted, adapting the SSC to fit the local context, demonstrating leadership support and engaging champions to promote checklist use and address concerns could improve checklist adoption and efficacy.
通过分析叙述性反馈，了解手术团队对手术安全核对表（SSC）的看法及其对手术操作安全性的影响。
我们回顾了2011年至2013年期间SSC实施前后进行的调查中的自由文本评论。我们按主题将反馈分类为积极、消极或中性。
南卡罗来纳州参与全州核对表实施协作项目的医院。
来自11家医院的手术团队，在实施前和实施后的调查中都提供了自由文本评论。
实施世界卫生组织的SSC。
实施前后评论的差异以及按提供者角色分类的差异；通过使用核对表避免的并发症类型。
在SSC实施前，不同提供者角色之间的积极评论比例存在显著差异（P = 0.04），与其他手术团队成员相比，更多临床医生给出负面评论（87.9%，（29/33）），而其他手术团队成员的负面评论比例为58.3%（7/12）至60.9%（14/23）。在SSC实施后，这些比例没有显著差异（临床医生为77.8%（14/18）），其他手术团队成员为50%（2/4）至76.9%（20/26）（P = 0.52）。实施前后负面评论的分布存在显著差异（P = 0.01）；例如，与实施前（24.5%，（13/53））相比，实施后对核对表接受度的负面评论更多（51.3%（20/39））。手术团队成员最常报告使用核对表避免了涉及抗生素使用、设备以及手术部位的并发症。
叙述性反馈表明，实施SSC可通过避免并发症促进患者安全；然而，获得接受度仍是一个持续的挑战。展示SSC对挽救生命、团队协作及避免并发症的影响信息，使SSC适应当地情况，展示领导支持并让倡导者参与以促进核对表的使用并解决相关问题，可能会提高核对表的采用率和效果。
