“有些版本，大多数时候”：手术安全检查表、患者安全与日常实践变异体验。
"Some version, most of the time": The surgical safety checklist, patient safety, and the everyday experience of practice variation.
机构信息
The Wilson Centre, University Health Network, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Canada.
出版信息
Am J Surg. 2022 Jun;223(6):1105-1111. doi: 10.1016/j.amjsurg.2021.11.002. Epub 2021 Nov 17.
BACKGROUND
This study investigated checklist compliance to highlight where assumptions about the Surgical Safety Checklist might not be met in practice.
METHODS
We used ethnographic methods to investigate the practice of the Surgical Safety Checklist in one hospital. Fifty-one observation days, eight semi-structured interviews, and two surveys of operating room staff over two years were conducted. Data were collected and analyzed iteratively.
RESULTS
Despite the near 100% compliance rates reported to the Ministry of Health, practice of the Surgical Safety Checklist varied widely: 82% of Briefings, 76% of Time-Outs, and 22% of Debriefings included some sort of team huddle. Gaps between policy and practice were identified at four different levels: compliance with the stages and items; responsibility for the checklist; documentation of adherence; and interprofessional teamwork.
CONCLUSIONS
Checklist compliance data are insufficient to understand how complex interventions impact care delivery. Greater and continued attention to practice in healthcare is needed.
背景
本研究通过检查表的遵守情况来强调在实践中可能不符合手术安全检查表假设的地方。
方法
我们使用民族志方法调查了一家医院的手术安全检查表的实践情况。在两年内进行了 51 天的观察、8 次半结构化访谈和两次手术室工作人员调查。数据是反复收集和分析的。
结果
尽管向卫生部报告的遵守率接近 100%，但手术安全检查表的实践情况差异很大：82%的情况包括某种形式的团队讨论，82%的情况包括简要介绍，76%的情况包括时间核对，22%的情况包括汇报。在四个不同层面发现了政策与实践之间的差距：对各阶段和项目的遵守、检查表的责任、遵守情况的记录以及跨专业团队合作。
结论
检查表的遵守数据不足以了解复杂干预措施如何影响护理提供。需要对医疗保健中的实践给予更多和持续的关注。
Zotero 插件