超越手术安全核对表：在手术室使用术中交接来促进团队态势感知。
Beyond the Surgical Safety Checklist: Using Intraoperative Handoff to Facilitate Team Situation Awareness in the OR.
机构信息
Credit Valley Hospital, Mississauga, ON, Canada.
The Wilson Centre, Toronto, ON, Canada.
出版信息
Ann Surg. 2023 Nov 1;278(5):e1142-e1147. doi: 10.1097/SLA.0000000000005838. Epub 2023 Mar 13.
BACKGROUND
The surgical safety checklist (SSC) has been credited with improving team situation awareness (SA) in the operating room. Although the SSC may support team SA at the outset of the operative case, intraoperative handoff provides an opportunity for either SA breakdown or, more preferably, SA reinforcement. High-functioning surgical teams demonstrate a high level of continued SA, whereas teams deficient in SA are more likely to be affected by surgical errors and adverse events. To date, no interprofessional intraoperative tools exist to support team SA beyond the SSC.
METHODS
This study was divided into 2 phases. The first used qualitative methods to (1) characterize intraoperative handoff processes across surgery, nursing, anesthesia, and perfusion, and (2) identify cultural factors that shaped handoff practices. Data for phase one were collected over 38 observation days and 41 brief interviews. Phase 2, informed by phase 1, used a modified Delphi process to create a tool for use during intraoperative handoff. Data were analyzed iteratively.
RESULTS
Handoff practices were not standardized and rarely involved the entire team. In addition we uncovered cultural factors-specifically assumptions held by participants-that hindered team communication during handoff. Assumptions included: (1) team members are interchangeable, (2) trained individuals are able to determine when it is appropriate to handoff without consulting the OR team. Despite claims of improved teamwork resulting from the SSC, many participants held a fragmented view of the OR team, resulting in communication challenges during handoff. Findings from both phases of our study informed the development of multidisciplinary intraoperative handoff tools to facilitate shared team situation awareness and a shared mental model.
CONCLUSIONS
Intraoperative handoff occurs frequently, and offers the opportunity for either renewed or fractured team SA beyond the SSC.
背景
手术安全检查表（SSC）被认为可以提高手术室团队的态势感知（SA）。尽管 SSC 可能在手术开始时支持团队的 SA，但术中交接提供了一个 SA 崩溃或更好的选择，即 SA 加强的机会。高功能的手术团队表现出高水平的持续 SA，而 SA 不足的团队更容易受到手术错误和不良事件的影响。迄今为止，除了 SSC 之外，没有任何跨专业的术中工具可以支持团队的 SA。
方法
本研究分为两个阶段。第一阶段采用定性方法（1）描述手术、护理、麻醉和灌注中的术中交接过程，（2）确定塑造交接实践的文化因素。第一阶段的数据是在 38 个观察日和 41 次简短访谈中收集的。第二阶段，根据第一阶段的结果，使用改良 Delphi 过程创建了一种用于术中交接的工具。数据是迭代分析的。
结果
交接实践没有标准化，很少涉及整个团队。此外，我们还发现了一些文化因素，特别是参与者持有的假设，这些假设阻碍了交接过程中的团队沟通。假设包括：（1）团队成员是可互换的，（2）受过训练的个人能够在不与 OR 团队协商的情况下确定何时进行交接。尽管 SSC 声称改善了团队合作，但许多参与者对 OR 团队持有碎片化的观点，导致交接过程中的沟通挑战。我们研究的两个阶段的发现为开发多学科的术中交接工具提供了信息，以促进共享团队的态势感知和共享心理模型。
结论
术中交接频繁发生，为 SSC 之外的团队 SA 提供了更新或破裂的机会。
Zotero 插件