Khalid Syed Yousaf, Sibghatullah Qazi Muhammad, Abdullah Muhammad Haroon, Farooq Omer, Ashraf Sandal, Ahmed Adeel, Arshad Ashhar, Nadeem Abdullah, Mumtaz Hassan, Saqib Muhammad
Department of Surgery, Letterkenny University Hospital, Letterkenny, Ireland.
Department of Surgery, District Headquarter Hospital, Rawalpindi, Pakistan.
Front Med (Lausanne). 2023 Jul 24;10:1204213. doi: 10.3389/fmed.2023.1204213. eCollection 2023.
Operating teams can decrease the likelihood of patient risk by using the WHO Surgical Safety Checklist. To ascertain the impact of demographic factors on behaviorally anchored ratings and investigate operating room (OR) staff attitudes toward checklist administration, we set out to better understand how OR personnel use the checklist in a tertiary care hospital in Pakistan.
A monocentric sequential mixed-methods study employing a quantitative approach of using World Health Organization Behaviorally Anchored Rating Scale (WHOBARS) assessments of surgical cases by OR personnel and two independent observers, who were certified surgeons having extensive experience in the rating of the WHOBARS scale for more than 1 year, followed by a qualitative approach of staff interviews were carried out in a tertiary care setting. In June and July 2022, over the period of 8 weeks, an intervention (training delivery) was implemented and evaluated. The information, skills, and behavior adjustments required to apply the checklist were taught in the course using lectures, videos, small group breakouts, participant feedback, and simulations.
After the introduction of WHOBARS, 50.81% of respondents reported always using the checklist, with another 30.81% using it in part. Participants' years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with always counting instruments (51.08%), patient identity (67.83%), difficult intubation risk (39.72%), the risk of blood loss (51.08%), prophylactic administration of an antibiotic (52.43%), and the use of pulse oximeter (46.75%). Interviewees felt that the checklist could promote teamwork and a safe culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone.
The use of a multi-disciplinary course for checklist implementation resulted in 50.81% of participants always using the checklist and an increase in counting surgical instruments. Successful checklist implementation was not predicted by the participant's length of medical service, hospital size, or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.
手术团队可通过使用世界卫生组织手术安全核对表降低患者风险。为确定人口统计学因素对行为锚定评分的影响，并调查手术室（OR）工作人员对核对表管理的态度，我们着手更好地了解巴基斯坦一家三级医院的手术室人员如何使用核对表。
一项单中心序贯混合方法研究，采用定量方法，由手术室人员和两名独立观察员使用世界卫生组织行为锚定评分量表（WHOBARS）对手术病例进行评估，这两名独立观察员是经验丰富的认证外科医生，在WHOBARS量表评分方面有超过1年的丰富经验，随后采用定性方法对三级医疗机构的工作人员进行访谈。在2022年6月和7月的8周时间里，实施并评估了一项干预措施（培训交付）。课程中通过讲座、视频、小组讨论、参与者反馈和模拟等方式教授应用核对表所需的信息、技能和行为调整。
引入WHOBARS后，50.81%的受访者表示始终使用核对表，另有30.81%的受访者部分使用核对表。参与者的执业年限、医院规模或手术量并不能预测核对表的使用情况。核对表的使用与始终清点器械（51.08%）、患者身份确认（67.83%）、困难插管风险（39.72%）、失血风险（51.08%）、预防性使用抗生素（52.43%）以及使用脉搏血氧仪（46.75%）相关。受访者认为核对表可促进团队合作和安全文化，特别是有助于直言不讳。高级工作人员在营造适当氛围方面至关重要。
使用多学科课程实施核对表，使50.81%的参与者始终使用核对表，并增加了手术器械清点。参与者的医疗服务年限、医院规模或手术量并不能预测核对表实施的成功与否。如果能在其他国家得以复制，那么在低收入和中等收入国家广泛实施将成为现实可能。
