Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, the Netherlands.
IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.
BJS Open. 2020 Apr;4(2):197-205. doi: 10.1002/bjs5.50246. Epub 2019 Dec 17.
Serious preventable surgical events still occur despite considerable efforts to improve patient safety. In addition to learning from retrospective analyses, prospective risk-assessment methods may help to decrease preventable events further by targeting perioperative hazards. The aim of this systematic review was to assess the methods used to identify perioperative patient safety risks prospectively, and to describe the risk areas targeted, the quality characteristics and feasibility of methods.
MEDLINE, Embase, CINAHL and Cochrane databases were searched, adhering to PRISMA guidelines. All studies describing the development and results of prospective methods to identify perioperative patient safety risks were included and assessed on methodological quality. Exclusion criteria were interventional studies, studies targeting one specific issue, studies reporting on structural factors relating to fundamental hospital items, and non-original or case studies.
The electronic search resulted in 16 708 publications, but only 20 were included for final analysis, describing five prospective risk-assessment methods. Direct observation was used in most studies, often in combination. Direct (16 studies) and indirect (4 studies) observations identified (potential) adverse events (P)AEs, process flow disruptions, poor protocol compliance and poor practice performance. (Modified) Healthcare Failure Mode and Effect Analysis (HFMEA™) (5 studies) targeted potential process flow disruption failures, and direct (P)AE surveillance (3 studies) identified (P)AEs prospectively. Questionnaires (3 studies) identified poor protocol compliance, surgical flow disturbances and patients' willingness to ask questions about their care. Overall, quality characteristics and feasibility of the methods were poorly reported.
The direct (in-person) observation appears to be the primary prospective risk-assessment method that currently may best help to target perioperative hazards. This is a reliable method and covers a broad spectrum of perioperative risk areas.
尽管为提高患者安全已经做出了巨大努力，但仍有严重的可预防手术事件发生。除了从回顾性分析中吸取教训外，前瞻性风险评估方法通过针对围手术期危害，可能有助于进一步减少可预防事件。本系统评价的目的是评估前瞻性识别围手术期患者安全风险的方法，并描述目标风险领域、方法的质量特征和可行性。
按照 PRISMA 指南，检索 MEDLINE、Embase、CINAHL 和 Cochrane 数据库。纳入描述前瞻性识别围手术期患者安全风险方法的开发和结果的所有研究，并评估其方法学质量。排除标准为干预性研究、针对特定问题的研究、报告与基本医院项目相关的结构因素的研究、非原始或病例研究。
电子检索产生了 16708 篇出版物，但最终只有 20 篇被纳入进行分析，描述了 5 种前瞻性风险评估方法。大多数研究都使用了直接观察，通常是结合使用。直接（16 项研究）和间接（4 项研究）观察确定了（潜在）不良事件（AE）、流程中断、协议遵守不良和实践表现不佳。（改良）医疗保健失效模式与效应分析（HFMEA）（5 项研究）针对潜在的流程中断失效，直接（AE）监测（3 项研究）前瞻性地识别（AE）。问卷（3 项研究）确定了协议遵守不良、手术流程干扰和患者询问护理意愿。总体而言，方法的质量特征和可行性报告较差。
直接（现场）观察似乎是目前最有助于针对围手术期危害的主要前瞻性风险评估方法。这是一种可靠的方法，涵盖了广泛的围手术期风险领域。
