Houben Philipp, Pascher Andreas
Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, 48149, Münster, Deutschland.
Chirurg. 2021 Mar;92(3):232-236. doi: 10.1007/s00104-020-01336-y. Epub 2021 Jan 11.
The management of errors and complications makes a significant contribution to the quality assurance of a surgical department. The structured risk management is an integral component of the surgeon's duties that is reflected by the growing relevance of simulation and other training methods employed during medical specialist advanced training. Basic prerequisites for establishing an error culture that aims at improvement of patient safety and the constructive coping with complications, are the removal of taboos and the transparent processing of complicating courses of treatment. Detecting structural and systemic sources of error is preferrable to the application of approaches that focus on individual responsibility, e.g. shame and blame. There are numerous validated tools available for the prevention, recognition and successful treatment of complications. Team time out protocols for circumventing fatal errors, standardized operating procedures and morbidity and mortality conferences are the most important measures for ensuring patient safety. The standardized, consistent and interdisciplinary handling of unavoidable complications according to the failure to rescue concept is pivotal for the prevention of a fatal course.
错误与并发症的管理对手术科室的质量保证有着重大贡献。结构化风险管理是外科医生职责的一个组成部分，这体现在模拟及医学专科高级培训中采用的其他培训方法的重要性日益增加。建立旨在提高患者安全性并建设性应对并发症的错误文化的基本前提是消除禁忌以及对复杂治疗过程进行透明处理。检测错误的结构性和系统性根源比采用侧重于个人责任的方法（如羞辱和指责）更为可取。有许多经过验证的工具可用于预防、识别和成功治疗并发症。用于规避致命错误的团队暂停协议、标准化操作程序以及发病率和死亡率会议是确保患者安全的最重要措施。根据未能挽救的概念，对不可避免的并发症进行标准化、一致且跨学科的处理对于预防致命病程至关重要。
