Patton E N, Lisagors I, Tyrrell-Marsh I, Agarwal S, Wee L V, Darwish A, Smith S R
Manchester University NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2025 May;107(5):318-325. doi: 10.1308/rcsann.2024.0087. Epub 2024 Oct 22.
Deficiencies in non-technical skills can severely impede the functioning of teams in high-intensity scenarios, such as in damage control surgery for the critically injured trauma patient. Truncated preoperative checklists, modified from the standard World Health Organization preoperative checklist, and situational reporting at intervals during surgery are long-established practices in the military, and are recommended in the National Health Service guidelines on major incidents. These tools allow the multiprofessional team to create a shared mental model of the anaesthetic and operative plan, thereby improving team efficiency. Our aim was to establish whether adult major trauma centres in England are using truncated preoperative checklists and situational reporting for damage control surgery.
An online survey was devised and distributed via the national programme of care for trauma in November 2020.
Responses were received from all 23 adult major trauma centres in England. Nine centres (39.1%) reported using a truncated preoperative checklist for damage control surgery albeit in a variety of formats. Common components were blood products received and/or available, presence of allergies, tranexamic acid and antibiotic administration, availability of viscoelastic tests, equipment required, availability of cell saver, role allocation and reference to other personnel needed, and discussion of the plan. Twelve centres (52.2%) have formal policies in place for situational reporting. Again, these were in multiple formats but all focused on patient physiology to direct surgical planning.
We have identified key components to advanced communication aids for damage control surgery, providing a foundation on which other major trauma centres can build their own versions of these potentially lifesaving tools.
非技术技能的欠缺会严重阻碍团队在高强度场景下的运作，比如在为重伤创伤患者进行损伤控制手术时。从世界卫生组织标准术前检查表修改而来的简化术前检查表，以及手术期间定期进行的情况报告，是军队中由来已久的做法，并且在英国国民医疗服务体系重大事件指南中也有推荐。这些工具能让多专业团队创建关于麻醉和手术计划的共享心理模型，从而提高团队效率。我们的目的是确定英格兰的成人重大创伤中心是否在损伤控制手术中使用简化术前检查表和情况报告。
2020年11月通过国家创伤护理计划设计并分发了一项在线调查。
收到了英格兰所有23个成人重大创伤中心的回复。9个中心（39.1%）报告在损伤控制手术中使用简化术前检查表，不过形式多样。常见内容包括已接收和/或可用的血液制品、过敏情况、氨甲环酸和抗生素的使用、粘弹性测试的可用性、所需设备、细胞回收机的可用性、角色分配以及对所需其他人员的提及，还有计划讨论。12个中心（52.2%）制定了情况报告的正式政策。同样，这些政策形式多样，但都聚焦于患者生理状况以指导手术规划。
我们确定了损伤控制手术高级沟通辅助工具的关键组成部分，为其他重大创伤中心构建自己版本的这些可能挽救生命的工具奠定了基础。
