南卡罗来纳州手术室工作人员对手术实践安全性的认知与全因 30 天术后死亡率相关的调查数据显示。

Perception of Safety of Surgical Practice Among Operating Room Personnel From Survey Data Is Associated With All-cause 30-day Postoperative Death Rate in South Carolina.

机构信息

*Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, Boston, MA †Department of Surgery, Massachusetts General Hospital, Boston, MA ‡South Carolina Hospital Association, Columbia, SC §Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA ¶Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.

出版信息

Ann Surg. 2017 Oct;266(4):658-666. doi: 10.1097/SLA.0000000000002378.

DOI:10.1097/SLA.0000000000002378

PMID:28657942

Abstract

OBJECTIVE

To evaluate whether the perception of safety of surgical practice among operating room (OR) personnel is associated with hospital-level 30-day postoperative death.

BACKGROUND

The relationship between improvements in the safety of surgical practice and benefits to postoperative outcomes has not been demonstrated empirically.

METHODS

As part of the Safe Surgery 2015: South Carolina initiative, a baseline survey measuring the perception of safety of surgical practice among OR personnel was completed. We evaluated the relationship between hospital-level mean item survey scores and rates of all-cause 30-day postoperative death using binomial regression. Models were controlled for multiple patient, hospital, and procedure covariates using supervised principal components regression.

RESULTS

The overall survey response rate was 38.1% (1793/4707) among 31 hospitals. For every 1 point increase in the hospital-level mean score for respect [adjusted relative risk (aRR) 0.78, 95% CI 0.65-0.93, P = 0.0059], clinical leadership (aRR 0.86, 95% CI 0.74-0.9932, P = 0.0401), and assertiveness (aRR 0.71, 95% CI 0.54-0.93, P = 0.01) among all survey respondents, there were associated decreases in the hospital-level 30-day postoperative death rate after inpatient surgery ranging from 14% to 29%. Higher hospital-level mean scores for the statement, "I would feel safe being treated here as a patient," were associated with significantly lower hospital-level 30-day postoperative death rates (aRR 0.83, 95% CI 0.70-0.97, P = 0.02). Although most findings seen among all OR personnel were seen among nurses, they were often absent among surgeons.

CONCLUSIONS

Perception of OR safety of surgical practice was associated with hospital-level 30-day postoperative death rates.

摘要

目的

评估手术室（OR）工作人员对手术实践安全性的认知是否与医院层面 30 天术后死亡率相关。

背景

手术实践安全性的提高与术后结果的改善之间的关系尚未得到经验验证。

方法

作为“2015 年安全手术：南卡罗来纳倡议”的一部分，对 OR 工作人员进行了一项衡量手术实践安全性认知的基线调查。我们使用二项式回归评估了医院层面平均项目调查评分与所有原因 30 天术后死亡率之间的关系。使用监督主成分回归对多个患者、医院和手术程序协变量进行模型控制。

结果

31 家医院中，共有 4707 名工作人员中的 38.1%（1793 名）参与了整体调查。对于每个 1 分的增加，医院层面对尊重的平均得分[校正相对风险（aRR）0.78，95%置信区间（CI）0.65-0.93，P=0.0059]、临床领导力（aRR 0.86，95%CI 0.74-0.9932，P=0.0401）和自信（aRR 0.71，95%CI 0.54-0.93，P=0.01），在住院手术中，医院层面 30 天术后死亡率下降 14%至 29%。医院层面平均得分越高，表明“我在这里作为患者接受治疗会感到安全”，则医院层面 30 天术后死亡率显著降低（aRR 0.83，95%CI 0.70-0.97，P=0.02）。尽管所有 OR 工作人员中观察到的大多数发现都在护士中观察到，但在外科医生中却经常没有发现。