提高内镜诊疗室的患者安全性：利用远程视频审核提高手术暂停合规性。
Improving patient safety in the endoscopy unit: utilization of remote video auditing to improve time-out compliance.
机构信息
Zucker School of Medicine at Hofstra-Northwell, Division of Gastroenterology, Department of Medicine, Northwell Health System, Manhasset, New York, USA.
North American Partners Anesthesiology, Northwell Health System, Manhasset, New York, USA.
出版信息
Gastrointest Endosc. 2019 Sep;90(3):424-429. doi: 10.1016/j.gie.2019.04.237. Epub 2019 May 2.
BACKGROUND AND AIMS
Patient and procedure verification, or the time-out process (TOP), is considered one of the most vital components of patient safety. It has long been a focus of intervention in the surgical community and recently was incorporated into the American Society for Gastrointestinal Endoscopy guidelines for safety in the GI endoscopy unit. The TOP has had limited attention in the endoscopy literature but remains an area for improvement in clinical endoscopy practice. The aim of this study was to identify barriers and improve TOP compliance rates in our endoscopy unit using remote video auditing (RVA).
METHODS
This was a single-center, prospective, pilot initiative in an endoscopy unit at a tertiary care academic medical center. Video cameras with offsite monitoring were installed in each procedure room in our endoscopy suite in November 2016. Baseline TOP compliance rates were audited with RVA over a 2-month period. A multidisciplinary quality improvement team reviewed the data, identified barriers to the TOP, and implemented actionable items in January 2017. TOP compliance rates were again monitored via RVA, and data were collected through October 2018. Pre- and postintervention TOP compliance rates were compared.
RESULTS
Over the baseline period, 692 procedures were audited and TOP compliance documented. Baseline TOP compliance rate was 69.6%. Identifiable barriers to TOP compliance included a lack of designated team member to lead TOP, inconsistent documentation of TOP, irrelevant safety checklist items not applicable to endoscopic procedures, and lack of patient safety culture. Actionable items implemented in response to these barriers included designation of a TOP leader, visual indication of initiation of TOP, creation of a concise endoscopy-specific safety checklist, and formal notification/education of the entire endoscopy team. Postintervention TOP compliance rates were then audited from January 2017 to October 2018 and included 12,008 procedures. The mean TOP compliance rate significantly improved from baseline (95.3% vs 69.6%; 95% confidence interval, 22.4-29.3; P < .0001). Additionally, the improvement was maintained throughout the entire postintervention observation period.
CONCLUSIONS
TOP compliance rates significantly improved in our endoscopy unit through the use of RVA and implementation of 4 actionable items. Future studies should evaluate the reproducibility of this method in other endoscopy units.
背景与目的
患者和程序验证，或称为“暂停时间”（timeout）过程，被认为是患者安全的最重要组成部分之一。它长期以来一直是外科界关注的焦点，最近也被纳入美国胃肠内镜协会（American Society for Gastrointestinal Endoscopy）关于胃肠内镜检查单位安全的指南。尽管在内镜文献中对此关注有限，但它仍然是临床内镜实践中有待改进的一个领域。本研究旨在通过远程视频审核（remote video auditing，RVA）来确定我们内镜单位的“暂停时间”流程中存在的障碍，并提高其执行率。
方法
这是一项单中心、前瞻性、试点计划，在一家三级护理学术医疗中心的内镜单位进行。2016 年 11 月，我们在内镜套房的每个检查室都安装了带有远程监控的摄像头。在两个月的时间里，通过 RVA 对“暂停时间”流程的执行率进行了基线审核。一个多学科质量改进团队审查了数据，确定了“暂停时间”流程的障碍，并在 2017 年 1 月实施了可行的措施。再次通过 RVA 监测“暂停时间”流程的执行率，并在 2018 年 10 月前收集数据。比较干预前后的“暂停时间”流程执行率。
结果
在基线期间，共审核了 692 例手术，并记录了“暂停时间”流程的执行情况。基线时“暂停时间”流程的执行率为 69.6%。“暂停时间”流程执行率低的原因包括缺乏指定的团队成员来领导“暂停时间”流程、“暂停时间”流程记录不一致、安全检查表中存在不适用内镜操作的无关项目，以及缺乏患者安全文化。针对这些障碍，我们实施了一些可行的措施，包括指定一名“暂停时间”流程的领导者、可视化地表示“暂停时间”流程的开始、创建一份简洁的内镜操作专用安全检查表，并向整个内镜团队发出正式通知/进行教育。随后，从 2017 年 1 月至 2018 年 10 月，我们对“暂停时间”流程的执行率进行了审核，共包括 12008 例手术。与基线相比，“暂停时间”流程的执行率明显提高（95.3%比 69.6%；95%置信区间，22.4-29.3；P<.0001）。此外，在整个干预后观察期间，这种提高得以维持。
结论
通过使用 RVA 和实施 4 项可行措施，我们的内镜单位的“暂停时间”流程执行率显著提高。未来的研究应该评估这种方法在其他内镜单位的可重复性。
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