解决外科手术安全检查清单使用方面的知识差距:对埃塞俄比亚一项外科手术质量改善计划的统计过程控制分析
Maia R Nofal1,2,3,4, Nichole Starr3,4,5, Tihitena Negussie Mammo4,6
1Department of Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
The British journal of surgery
|August 8, 2023
概括
教育研讨会改善了经验丰富的埃塞俄比亚医院的外科安全检查清单使用情况. 然而,新加入检查清单的医院几乎没有看到好处,这凸显了需要更广泛的干预措施的需要.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
- 全球手术全球手术
背景情况:
- 世界卫生组织的手术安全检查清单对于减少手术发病率和死亡率至关重要.
- 检查清单的采用不一致,特别是在低收入国家.
- 这项研究评估了教育研讨会对埃塞俄比亚医院检查清单使用的影响.
研究的目的:
- 评估质量改进倡议的有效性,特别是关于符合外科手术安全清单的教育研讨会.
- 确定这些研讨会在不同程度的医院之前的检查列表经验的影响.
主要方法:
- 在埃塞俄比亚五家医院实施了为期6个月的外科质量改善计划,包括研讨会.
- 统计过程控制和时间序列分析 (概括估计方程Poisson回归) 用于评估清单的合规性.
- 合规性被定义为正确完成登录,截止时间和退出程序.
主要成果:
- 干预后,平均每周遵守检查清单的比例从27.3%增加到41.2% (P = 0.001).
- 符合基线水平较高的医院显示显著改善 (>50%),而表现不佳的医院没有改善.
- 分析了2767次手术 (1940年干预前,827次干预后) 的数据.
结论:
- 手术安全检查清单研讨会有效地提高了医院对检查清单现有的熟悉度的遵守.
- 研讨会对以前没有检查清单经验的医院的影响很小,这表明需要多因素干预和文化变革.
- 有针对性的研讨会可以加快在接受性医疗保健环境中的行为改变.
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