Lagoo Janaka, Lopushinsky Steven R, Haynes Alex B, Bain Paul, Flageole Helene, Skarsgard Erik D, Brindle Mary E
Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA.
Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada.
BMJ Open. 2017 Oct 16;7(10):e016298. doi: 10.1136/bmjopen-2017-016298.
To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.
Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.
A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.
1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.
A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs' role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.
通过系统评价与叙述性综合分析，探讨小儿外科安全检查表（SSC）的有效性、实际应用情况及其实施策略。
自世界卫生组织推出SSC以来，检查表已被纳入全球手术系统。关于SSC如何融入小儿外科环境的信息较少。
利用PubMed、Embase、CINAHL、Cochrane Central、科学网、科学引文索引和会议论文引文索引制定广泛的检索策略。摘要和全文由两人独立筛选以确定纳入情况。提取研究特征和结果，通过亚组分析和思维导图探索产生的主题。
在标题和摘要评审后，排除了1921项研究中的1826项（kappa值为0.77），全文评审后又排除了47项（kappa值为0.86）。20项研究质量足以进行叙述性综合分析。在没有实施策略的研究中，引入SSC对临床结果没有影响。发展中国家全面的SSC实施策略显示，高危手术的结果有所改善。叙述性综合分析表明，对有意义的依从性的衡量并不一致，且很少能实现。涉及反馈的策略提高了依从性。由利益相关者制定的实施策略，包括基于团队的教育，获得了更高的接受度。三项研究表明，家长参与SSC受到家长、护士和医生的重视，可能会提高患者安全。
以小儿患者及其家庭为重点的SSC实施策略可以实现较高的可接受性和良好的依从性。SSC在改善小儿外科手术结果指标方面的作用尚未明确，但在全面的实施策略中使用时可能有效，特别是对于资源匮乏地区的高危患者。
Zotero 插件