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在资源有限的环境中改善外科结果:对非计划的剧院回归进行质量改善方法
Sarah Al-Musawi1, Kamal Al-Jawdah2, Firas Mahmood Rashid Al-Musawi3
1Obstetrics and Gynecology, University Hospitals of Northamptonshire, Northampton, GBR.
一个低成本的质量改进计划显著减少了伊拉克手术室 (RTT) 计划外的返回. 该倡议侧重于外科手术技术,检查清单遵守和监督,改善资源有限的环境中的患者安全.
科学领域:
- 改善外科手术的质量
- 患者安全 患者安全
- 卫生系统研究 卫生系统研究
背景情况:
- 无计划返回剧院 (RTT) 是手术护理中的一个关键问题,与并发症和效率低下有关.
- 质量改进 (QI) 策略在资源丰富的环境中建立,但在资源稀缺的环境中不太探索.
研究的目的:
- 评估多模体QI计划对一般外科和产科/妇科的RTT率的影响.
- 评估该计划在伊拉克两家三级医院的有效性.
主要方法:
- 这是一项两中心的准实验性研究,涉及1133例手术病例,分两个周期 (追溯基线和前性干预后).
- 干预措施包括手术结结技术培训,加强世卫组织手术安全清单的遵守,以及对高风险手术的强制性顾问监督.
主要成果:
- 整体RTT率显著下降,从7.9%降至3.7% (p=0.004).
- 在整体外科 (6.3%至3.0%) 和产科/妇科 (10.5%至4.8%) 均有显著的减少.
- 败血症,伤口脱光和出血是RTT的主要原因;不完整的检查清单使用和紧急手术与RTT有关.
结论:
- 一个结构化,低成本的QI计划有效地降低了伊拉克医院的RTT率.
- 手术技术培训,检查清单遵守和顾问监督是改善资源有限的环境中手术结果的关键干预措施.
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