航空式计算机化手术安全检查表在大屏幕上显示并由麻醉师操作，可提高检查表的执行效果。
Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by the Anesthesia Provider Improves Checklist Performance.
机构信息
From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
Boeing Test and Evaluation, The Boeing Company, Seattle, Washington.
出版信息
Anesth Analg. 2020 Feb;130(2):382-390. doi: 10.1213/ANE.0000000000004328.
BACKGROUND
Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist.
METHODS
We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables.
RESULTS
A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed.
CONCLUSIONS
The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.
背景
许多医院已经实施了基于世界卫生组织手术安全检查表的手术安全检查表，这与改善结果有关。然而，检查表的执行经常不完整。我们认为，航空式计算机化检查表显示在大型中央位置屏幕上，并由麻醉师操作，将提高手术安全检查表的性能。
方法
我们进行了一项前瞻性的前后观察研究，以评估计算机化手术安全检查表系统对检查表性能的影响。我们创建了检查表软件，并将我们的四部分手术安全检查表从墙上海报翻译成航空式计算机化格式，显示在大型中央位置屏幕上，并由麻醉师操作。直接观察者记录了麻醉诱导前启动的手术安全检查表的第一部分的执行情况，包括完成每个检查表项目、提供者的参与和分心程度、对检查表使用的抵制以及检查表系统实施前后完成检查表所需的时间。我们比较了在干预前后期间，100%完成手术安全检查表的病例比例随时间的趋势，并在控制潜在混杂变量的情况下，使用分段逻辑回归模型评估干预开始时的跳跃。
结果
在实施计算机化手术安全检查表系统之前观察到 671 例，在实施之后观察到 547 例。在实施计算机化手术安全检查表系统后，所有检查表项目均完成的病例比例从 2.1%显著增加到 86.3%（P <.001）。在实施计算机化检查表系统之前，671 例中有 488 例（72.7%）的检查表项目完成率<75%，而在实施计算机化检查表系统之后，只有 547 例中的 3 例（0.5%）的检查表项目完成率<75%。
结论
实施计算机化手术安全检查表系统可提高检查表的性能。
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