Magill Stephen T, Wang Doris D, Rutledge W Caleb, Lau Darryl, Berger Mitchel S, Sankaran Sujatha, Lau Catherine Y, Imershein Sarah G
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurg. 2017 Nov;107:597-603. doi: 10.1016/j.wneu.2017.08.090. Epub 2017 Aug 24.
Patient safety is foundational to neurosurgical care. Postprocedural "debrief" checklists have been proposed to improve patient safety, but data about their use in neurosurgery are limited. Here, we implemented an initiative to routinely perform postoperative debriefs and evaluated the impact of debriefing on operating room (OR) safety culture.
A 10-question safety attitude questionnaire (SAQ) was sent to neurosurgical OR staff at a major academic medical center before and 18 months after the implementation of a postoperative debriefing initiative. Rates of debrief compliance and changes in attitudes before and after the survey were evaluated. The survey used a Likert scale and analyzed with standard statistical methods.
After the debrief initiative, the rate of debriefing increased from 51% to 86% of cases for the neurosurgery service. Baseline SAQ responses found that neurosurgeons had a more favorable perception of OR safety than did anesthesiologists and nurses. After implementation of the postoperative debriefing process, perceptions of OR safety significantly improved for neurosurgeons, anesthesiologists, and nurses. Furthermore, the disparity between nurses and surgeons was no longer significant. After debrief implementation, neurosurgical OR staff had improved perceptions of patient safety compared with surgical services that did not commonly perform debriefing. Debriefing identified OR efficiency concerns in 26.9% of cases, and prevention of potential adverse events/near misses was reported in 8% of cases.
Postoperative debriefing can be effectively introduced into the OR and improves the safety culture after implementation. Debriefing is an effective tool to identify OR inefficiencies and potential adverse events.
患者安全是神经外科护理的基础。有人提出术后“汇报”清单以提高患者安全，但关于其在神经外科应用的数据有限。在此，我们实施了一项常规进行术后汇报的倡议，并评估了汇报对手术室（OR）安全文化的影响。
在一家大型学术医疗中心实施术后汇报倡议之前和之后18个月，向神经外科手术室工作人员发送了一份包含10个问题的安全态度调查问卷（SAQ）。评估了汇报的依从率以及调查前后态度的变化。该调查采用李克特量表，并使用标准统计方法进行分析。
在汇报倡议实施后，神经外科服务的汇报率从51%提高到了86%。SAQ的基线回复发现，神经外科医生对手术室安全的认知比麻醉医生和护士更为积极。在实施术后汇报流程后，神经外科医生、麻醉医生和护士对手术室安全的认知显著改善。此外，护士和外科医生之间的差距不再显著。在汇报实施后，与通常不进行汇报的外科服务相比，神经外科手术室工作人员对患者安全的认知有所提高。汇报在26.9%的病例中发现了手术室效率问题，在8%的病例中报告了预防潜在不良事件/险些发生的事件。
术后汇报可以有效地引入手术室，并在实施后改善安全文化。汇报是识别手术室效率低下和潜在不良事件的有效工具。
