Bartz-Kurycki Marisa A, Anderson Kathryn T, Abraham Jocelyn E, Masada Kendall M, Wang Jiasen, Kawaguchi Akemi L, Lally Kevin P, Tsao KuoJen
Department of Pediatric Surgery, McGovern Medical School, The University Of Texas Health Sciences Center At Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center For Surgical Trials and Evidence-based Practices (C-STEP), The University of Texas Health Sciences Center At Houston, Houston, Texas.
Department of Pediatric Surgery, McGovern Medical School, The University Of Texas Health Sciences Center At Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas; Center For Surgical Trials and Evidence-based Practices (C-STEP), The University of Texas Health Sciences Center At Houston, Houston, Texas.
J Surg Res. 2017 Jun 1;213:222-227. doi: 10.1016/j.jss.2017.02.072. Epub 2017 Mar 6.
The debriefing phase of the surgical safety checklist (SSC) provides the operative team an opportunity to share pertinent intraoperative information and communicate postoperative plans. Prior quality improvement initiatives at our institution focused on the preincision phase of the SSC; however, the debriefing phase has not been evaluated. We aimed to assess adherence to the debrief checklist at our institution and identify areas for improvement.
An observational study was conducted from 2014 to 2016 with a convenience sample of pediatric surgery cases at an academic children's hospital over 8-wk periods annually to evaluate the debriefing checklist across 14 subspecialties. Intraoperative team members' adherence to eight prespecified checkpoints was assessed. Descriptive statistics, Pearson's chi square, Kruskal-Wallis rank test, and Cohen's kappa for interrater reliability were used (P < 0.05 was significant).
A total of 603 cases were observed (2014 n = 191; 2015 n = 195; 2016 n = 217). The debriefing checklist was conducted in 90.6%, 90.3%, and 94.9% of observed cases each year respectively with the median number of checklist items completed relatively unchanged (8, 7, and 7, range 0-8). However, the checklist was only fully completed in 55%, 48%, and 50% of cases over the study period (P = 0.001) with no debriefing at all in approximately 9% of cases in 2014 and 2015 versus 5% in 2016 (P < 0.001). Interrater reliability annually was >0.65.
Despite slight increases annually in overall compliance to the debriefing checklist, only half of all checklists were completed in full. Future efforts to augment adherence are needed and will include interventions targeting the debriefing phase and increasing operating room efficiency.
手术安全核查表（SSC）的术后总结阶段为手术团队提供了一个分享术中相关信息并沟通术后计划的机会。我们机构之前的质量改进举措主要集中在SSC的切口前阶段；然而，术后总结阶段尚未得到评估。我们旨在评估我们机构对术后总结核查表的遵守情况，并确定改进的领域。
2014年至2016年进行了一项观察性研究，每年在一家学术儿童医院选取为期8周的小儿外科病例作为便利样本，以评估14个亚专业的术后总结核查表。评估了术中团队成员对八个预先设定的检查点的遵守情况。使用描述性统计、Pearson卡方检验、Kruskal-Wallis秩和检验以及用于评估评分者间信度的Cohen's kappa系数（P < 0.05具有统计学意义）。
共观察了603例病例（2014年n = 191；2015年n = 195；2016年n = 217）。术后总结核查表每年分别在90.6%、90.3%和94.9%的观察病例中进行，完成的核查表项目中位数相对不变（8项、7项和7项，范围为0 - 8项）。然而，在研究期间，核查表仅在55%、48%和50%的病例中完整完成（P = 0.001），2014年和2015年约9%的病例根本没有进行术后总结，而2016年为5%（P < 0.001）。每年评分者间信度>0.65。
尽管每年对术后总结核查表的总体依从性略有提高，但所有核查表中只有一半得到了完整填写。未来需要加大努力提高依从性，这将包括针对术后总结阶段的干预措施以及提高手术室效率。
