Columbus Alexandra B, Castillo-Angeles Manuel, Berry William R, Haider Adil H, Salim Ali, Havens Joaquim M
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Brigham and Women's Hospital, Division of Trauma, Burns and Surgical Critical Care, Boston, Massachusetts.
J Surg Res. 2018 Aug;228:281-289. doi: 10.1016/j.jss.2018.03.007. Epub 2018 Apr 13.
Emergency general surgery (EGS) is characterized by high rates of morbidity and mortality. Though checklists and associated communication-based huddle strategies have improved outcomes, these tools have never been specifically examined in EGS. We hypothesized that use of an evidence-based communication tool aimed to trigger intraoperative discussion could improve communication in the EGS operating room (OR).
We designed a set of discussion prompts based on modifiable factors identified from previously published studies aimed to encourage all team members to speak up and to centralize awareness of patient disposition and intraoperative transfusion practices. This tool was pilot-tested using OR human patient simulators and was then rolled out to EGS ORs at an academic medical center. The perceived effect of our tool's implementation was evaluated through mixed-methodologic presurvey and postsurvey analysis.
Preimplementation and postimplementation survey-based data revealed that providers reported the EGS-focused discussion prompts as improving team communication in EGS. A trend toward shared awareness of intraoperative events was observed; however, nurses described cultural impedance of discussion initiation. Providers described a need for further reinforcement of the tool and its indications during implementation.
Use of a discussion-based communication tool is perceived as supporting team communication in the EGS OR and led to a trend toward improving a shared understanding of intraoperative events. Analyses suggest the need for enhanced reinforcement of use during implementation and improvement of team-based education regarding EGS. Furthermore work is needed to understand the full impact of this evidence-based tool on OR team dynamics and EGS patient outcomes.
急诊普通外科手术（EGS）具有较高的发病率和死亡率。尽管检查表及相关的基于沟通的碰头策略已改善了手术结果，但这些工具从未在EGS中进行过专门研究。我们假设，使用旨在引发术中讨论的循证沟通工具可以改善EGS手术室（OR）中的沟通。
我们根据先前发表的研究中确定的可改变因素设计了一套讨论提示，旨在鼓励所有团队成员畅所欲言，并集中关注患者处置和术中输血操作的意识。该工具在手术室人体患者模拟器上进行了预测试，然后在一家学术医疗中心推广至EGS手术室。通过混合方法的术前和术后调查分析评估了我们工具实施的感知效果。
基于术前和术后调查的数据显示，医疗人员报告称，以EGS为重点的讨论提示改善了EGS中的团队沟通。观察到术中事件的共享意识有上升趋势；然而，护士们描述了讨论发起时的文化障碍。医疗人员表示在实施过程中需要进一步强化该工具及其适用情况。
使用基于讨论的沟通工具被认为有助于EGS手术室中的团队沟通，并导致对术中事件的共同理解有改善趋势。分析表明，在实施过程中需要加强工具的使用，并改进关于EGS的团队教育。此外，还需要开展工作以了解这种循证工具对手术室团队动态和EGS患者结局的全面影响。
