Burri-Winkler Katrin, Auderset Anne C, Hahnloser Dieter, Burkhart Christoph S, Neuhaus Valentin, Gass Jörn-Markus, Vogt Andreas P, Prouse Giorgio, Winkens Judith, Haller Guy, Van Vegten Amanda, Kita Zuzanna, Finsterwald Monika, Schindler Christian, Streit Nico, Willms Lisa M, Steiner Luzius A, Clack Lauren, Dell-Kuster Salome
Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
Department of Clinical Research, University of Basel, Basel, Switzerland.
BMJ Open Qual. 2025 May 30;14(2):e003286. doi: 10.1136/bmjoq-2024-003286.
INTRODUCTION & AIM: Intraoperative adverse events (iAEs) increase postoperative complications, which are devastating to patients and costly to healthcare systems. To optimise patient outcomes, the WHO Surgical Safety Checklist (WHO SSC) was introduced in 2008, but adherence, especially to its third part (sign-out), is low, and iAEs are currently not routinely assessed. This gap between evidence supporting the use of the WHO SSC, current inconsistent sign-out practice and the lack of standardised reporting of iAEs warrants applying an implementation science approach. Hence, this project aims to simultaneously evaluate the effectiveness and implementation of the sign-out, including systematic recording and discussion of iAEs during the sign-out.
METHODS & ANALYSIS: Using a hybrid effectiveness-implementation approach, this prospective before-and-after-cohort project includes five surgical disciplines within nine Swiss hospitals. Following an extensive context analysis, this project is set up in three phases: (1) recruitment of 40 patients per surgical discipline and site (approx. 900 in total) for baseline assessment; (2) implementation based on a multifaceted, tailored implementation strategy (including formation of implementation teams, comprehensive education of healthcare professionals, top-down leadership, regular feedback rounds and tailoring implementation to local needs); and (3) recruitment of 40 patients per discipline to assess the changes after implementation (approx. 900). Implementation (eg, checklist fidelity composed of completion and quality) and effectiveness outcomes (ie, clinical patient outcomes) will be analysed using a mixed regression model.
DISCUSSION & CONCLUSION: By enhancing adherence to the WHO SSC sign-out, including standardised reporting of iAEs, we expect to further improve perioperative patient outcomes. Based on the context analysis, we will provide a widely applicable implementation plan to support and sustain the required behavioural change, which will support roll-out in further hospitals. Meanwhile, clinical and implementation science expertise is meeting the challenges of the complex environment of perioperative care.
术中不良事件（iAEs）会增加术后并发症，这对患者来说是灾难性的，对医疗系统而言成本高昂。为了优化患者预后，世界卫生组织手术安全核对表（WHO SSC）于2008年推出，但遵守情况，尤其是对其第三部分（手术结束核查）的遵守率较低，并且目前并未对术中不良事件进行常规评估。在支持使用WHO SSC的证据、当前不一致的手术结束核查实践以及术中不良事件缺乏标准化报告之间的这一差距，使得有必要采用实施科学方法。因此，本项目旨在同时评估手术结束核查的有效性和实施情况，包括在手术结束核查期间对术中不良事件进行系统记录和讨论。
采用有效性 - 实施混合方法，这个前瞻性队列前后对照项目涵盖瑞士9家医院的5个外科学科。在进行广泛的背景分析之后，本项目分三个阶段开展：（1）每个外科学科和地点招募40名患者（总共约900名）进行基线评估；（2）基于多方面、量身定制的实施策略进行实施（包括组建实施团队、对医疗专业人员进行全面培训、自上而下的领导、定期反馈环节以及根据当地需求调整实施方式）；（3）每个学科再招募40名患者以评估实施后的变化（约900名）。将使用混合回归模型分析实施情况（例如，由完整性和质量组成的核对表依从性）和有效性结果（即临床患者结局）。
通过提高对WHO SSC手术结束核查的遵守情况，包括对术中不良事件进行标准化报告，我们期望进一步改善围手术期患者结局。基于背景分析，我们将提供一个广泛适用的实施计划，以支持并维持所需的行为改变，这将有助于在更多医院推广。同时，临床和实施科学专业知识正在应对围手术期护理复杂环境带来的挑战。
