使用全球触发工具对手术和神经外科患者进行研究：一项可行性研究。
Using the Global Trigger Tool in surgical and neurosurgical patients: A feasibility study.
机构信息
Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.
Central Division Medical Synergies, University Hospital of Cologne, Cologne, Germany.
出版信息
PLoS One. 2022 Aug 16;17(8):e0272853. doi: 10.1371/journal.pone.0272853. eCollection 2022.
BACKGROUND
The Global Trigger Tool (GTT) has become a worldwide used method for estimating adverse events through a retrospective patient record review. However, little is known about the facilitators and the challenges in the GTT-implementation process. Thus, this study followed two aims: First, to apply a comprehensive set of feasibility criteria to qualitatively and systematically assess the GTT-implementation process in three departments of German university hospitals. Second, to identify the facilitators and the obstacles met in the GTT-implementation process and to derive recommendations for supporting other hospitals in implementing the GTT in clinical practice.
METHODS
The study used a qualitative documentary method based on process documentation, with written and verbal feedback from the reviewer, as well as evaluating the study sites during the implementation process. The study was conducted in three departments, each in a different German university hospital. The authors applied a comprehensive set of 22 feasibility criteria assessing the level of challenge in GTT implementation. The results were synthesized and they focused on the facilitators and the challenges.
RESULTS
Of these 22 feasibility criteria, nine were assessed as a low-level challenge, eleven regarded as a moderate-level challenge, and two with a problematic level of challenge. In particular, the lack of time and staff resources, the quality of the information in the patient records, organizational procedures, and local issues, posed major challenges in the implementation process. By contrast, the use of local coordinators and an external expert made important contributions to the GTT implementation.
CONCLUSIONS
Considering the facilitators and the obstacles beforehand may help with the implementation of the GTT in routine practice. In particular, early and effective planning can reduce or prevent critical challenges in terms of time, staff resources, and organizational aspects.
背景
全球触发工具（GTT）已成为一种通过回顾性病历审查来估计不良事件的全球通用方法。然而，对于 GTT 实施过程中的促进因素和挑战知之甚少。因此，本研究有两个目的：首先，应用一套全面的可行性标准，定性和系统地评估德国大学医院三个科室的 GTT 实施过程。其次，确定 GTT 实施过程中遇到的促进因素和障碍，并为支持其他医院将 GTT 应用于临床实践提供建议。
方法
该研究采用了基于过程文件的定性文件方法，包括审查员的书面和口头反馈，并在实施过程中评估研究地点。该研究在三个科室进行，每个科室都在德国的一所大学医院。作者应用了一套全面的 22 项可行性标准来评估 GTT 实施的挑战水平。对结果进行了综合分析，重点关注促进因素和挑战。
结果
在这 22 项可行性标准中，有 9 项被评估为低水平挑战，11 项为中等水平挑战，2 项为有问题的水平挑战。特别是，缺乏时间和人员资源、病历信息质量、组织程序和当地问题，给实施过程带来了重大挑战。相比之下，使用当地协调员和外部专家对 GTT 的实施做出了重要贡献。
结论
事先考虑促进因素和障碍可能有助于在常规实践中实施 GTT。特别是，早期和有效的规划可以减少或预防时间、人员资源和组织方面的关键挑战。
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