Carenzo Luca, Baker Chloe, Jones Steve, Hurst Tom
Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; London's Air Ambulance, London, United Kingdom.
London's Air Ambulance, London, United Kingdom; Royal London Hospital, Barts Health National Health Services Trust, London, United Kingdom.
Air Med J. 2022 Nov-Dec;41(6):521-525. doi: 10.1016/j.amj.2022.09.005. Epub 2022 Oct 15.
Clinical governance is the framework around which health care organizations can maintain a higher standard of safety and care. One of the central aspects of clinical governance is continuous professional education, including case-based review and case-based learning. In this article, we present the case-based education process in use at London's Air Ambulance, a mature advanced prehospital system in London, UK. The case review process begins with an on-scene hot debrief, an informal process often involving other emergency services. This is usually followed by internal team feedback and debrief and patient follow-up. All cases are then reviewed over the next 24 to 48 hours by the duty prehospital consultant (attending) in the rapid review process. After this, certain cases are volunteered or selected for discussion in the twice weekly death and disability (D&D) meeting or the monthly dispatch meeting. A small subset of cases is highlighted through this process for full formal audit and presentation at the monthly clinical governance meetings based on their educational value. Another subset of cases involving a fatality is also discussed at the monthly clinical pathology correlation meeting with the input of local forensic pathologists. Organization of the process, structure of the meetings, and educational value are described in detail.
临床治理是医疗保健组织用以维持更高安全和护理标准的框架。临床治理的核心方面之一是持续专业教育，包括基于案例的回顾和基于案例的学习。在本文中，我们介绍了英国伦敦成熟的院前急救系统——伦敦空中救护所采用的基于案例的教育过程。案例回顾过程始于现场即时汇报，这是一个通常会涉及其他应急服务的非正式过程。接下来通常是内部团队反馈、汇报以及患者随访。然后，所有案例会在接下来的24至48小时内由值班院前顾问（主治医生）在快速回顾过程中进行审查。在此之后，某些案例会被主动提出或挑选出来，在每周两次的死亡与残疾（D&D）会议或月度调度会议上进行讨论。通过这个过程，一小部分案例因其教育价值被挑选出来进行全面正式审核，并在月度临床治理会议上进行展示。另一部分涉及死亡病例的子集也会在月度临床病理关联会议上，在当地法医病理学家的参与下进行讨论。本文详细描述了该过程的组织、会议结构以及教育价值。
