手术安全核查手术延迟原因
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摘要
目的探讨手术安全核查中手术延迟事件形成的原因并提出相应管理对策,为进一步提高医院的运行和管理效率提供依据。方法采用专人记录的方法,对医院某些科室的手术延迟情况进行调查记录,内容包括手术延迟的原因以及术前准备时间,进行统计学分析,探讨延迟事件形成的主要原因。结果参与调查科室的总延迟率为86.51%,其中安全核查所致手术延迟事件中,关节科所占比例最高(40.37%),外科医师晚到(34.08%)为手术延迟的主要原因,麻醉延迟开始(16.80%)为第二主要原因,术前准备中,关节科和泌尿外科术前准备时间最长,分别为86.78±31.74 min和85.68±22.79 min。结论手术安全核查中手术延迟事件频发,且手术延迟的主要原因是术前准备不足,但实施以来,患者手术室安全得到显著提高。因此,与各科室密切合作,共同制定出各科术前准备标准化流程,并逐步完善和持续改进,才可进一步提高手术室使用率,保障患者安全,提升医院的经济和社会效益。
Objective To explore the causes of delayed events in surgical safety verification, to put forward corresponding management measures and to provide basis for the hospital to improve its efficiency of operation and management. Methods Surgical delays were recorded in several departments of our hospital, including the causes of delayed operations and the preparing time before operations. Then, statistical analysis was conducted to explore the main causes of delayed events.Results The total delay rate of those departments involved in the investigation was 86.51%, and among the delayed operations examined by operation safety verification, the proportion of Joint Department accounted for the highest(40.37%). Late arrivals of surgeons(34.08%) were the main reason for the delay in surgery, and anesthetists' delayed start(16.80%) was the second main cause. The preoperative preparations of joint surgery and cardiac surgery accounted for the longest time, which were 86.78 + 31.74 min and 85.68 + 22.79 min respectively. Conclusion Surgical safety verification reveals high occurrence of delayed surgeries, and the main cause is inadequacy of preoperative preparation. The safety of operation has been significantly improved since the implementation of new measures. Therefore, to further improve the utilization rate of operation room and enhance the economic and social benefits of the hospital, it is necessary to work closely with other departments to formulate standardized procedures for preoperative preparation and to continually improve them to ensure the safety of patients.
Objective To explore the causes of delayed events in surgical safety verification, to put forward corresponding management measures and to provide basis for the hospital to improve its efficiency of operation and management. Methods Surgical delays were recorded in several departments of our hospital, including the causes of delayed operations and the preparing time before operations. Then, statistical analysis was conducted to explore the main causes of delayed events.Results The total delay rate of those departments involved in the investigation was 86.51%, and among the delayed operations examined by operation safety verification, the proportion of Joint Department accounted for the highest(40.37%). Late arrivals of surgeons(34.08%) were the main reason for the delay in surgery, and anesthetists' delayed start(16.80%) was the second main cause. The preoperative preparations of joint surgery and cardiac surgery accounted for the longest time, which were 86.78 + 31.74 min and 85.68 + 22.79 min respectively. Conclusion Surgical safety verification reveals high occurrence of delayed surgeries, and the main cause is inadequacy of preoperative preparation. The safety of operation has been significantly improved since the implementation of new measures. Therefore, to further improve the utilization rate of operation room and enhance the economic and social benefits of the hospital, it is necessary to work closely with other departments to formulate standardized procedures for preoperative preparation and to continually improve them to ensure the safety of patients.
引文
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[7] 山慈明.法国医院手术室提高使用效率的方法[J].中华护理杂志,2006,41(12):1146-1147.
[8] 杨莹,王卫,路庆.手术患者安全管理质控检查对首台择期手术医疗指标的效果评价[J].山西医药杂志,2017,46(13):1619-1621.
[9] 高兴莲,刘娟,马琼,等.手术安全核查实施的方法与效果[J].护理管理杂志,2014,14(10):748-749.
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[11] 张培丽,吴小华,陈尔英,等.实施手术安全核查制度的体会[J].广西医学,2013(6):801-802.
[12] Bentivegna R,Caminati A,Agnoletti V,et al.[OssERvare Project:direct observation of use of the Safety Surgery CheckList in the operating room.][J].Recenti progressi in medicina,2017,108(11):476-80.
[13] De Vries E N,Prins H A,Crolla R M,et al.SURPASS Collaborative Group.Effect of a comprehensive surgical safety system on patient outcomes[J].N Engl J Med,2010,363(20):1963-1965.
[14] Vats A,Vincent C A,Nagpal K,et al.Practical challenges of introducing WHO surgical checklist:UK pilot experience[J].BMJ,2010,340(5433):54-63.
[15] Edmondson A C,Bohmer R M,Pisano G P.Disrupted routines:team learning and new technology implementation in hospitals[J].Adm Sci Q,2001,46(4):685-716.
[16] 殷杰,叶庆,廖家智,等.基于HIS的手术全过程监管平台的构建与应用[J].中国数字医院,2015,10 (9):95-97.
[17] 姜雪,郎红娟,李瑞刚,等.流程优化对神经外科手术室工作效率的影响[J].护理学报,2013,20(4B):16-18.
[18] 高兴莲,苏法安,沈剑辉,等.信息技术在首台择期手术准点开始管理中的应用[J].护理学杂志,2014,29(8):47-49.
[19] 郭莉,刘晓光,文英,等.手术室加快手术台周转率的管理方法[J].中国护理管理,2012,12(9):85-87.
[20] 孙苗,钱跃飞,孙慧芳.浅谈手术室的标准化管理[J].医院管理论坛,2012,29(8):44-45.
[21] 姜雪,郎红娟,李娟,等.基于标准化管理的手术运行管理策略对手术室工作效率的影响[J].护理研究,2017,31(18):2297-2299.
[2] World Health Organization.Safe surgery saves lives.Geneva:WHO;2008.http://www.who.int/features/factfiles/safe_surgery/en/index.html.Accessed 14 February 2012.
[3] 陈虎,刘勇,王吉善,等.2011版三级综合医院评审标准设计思路与特点[J].中国卫生质量管理,2014,21(1):6-8.
[4] 陈永琴,田继书,向雪.我院护理部落实等级医院评审新标准的方法与效果[J].护理管理杂志,2013,13(9):637-638.
[5] Ginsburg L R,Tregunno D,Norton P G,et al.Not another safety culture survey:using the Canadian patient safety climate survey (CAN-PSCS) to measure provider perceptions of PSC across health settings[J].BMJ Qual Saf,2014,23(2):162-170.
[6] 张秀华,王惠琴,安梦滢,等.手术室择期手术延迟原因调查分析[J].护理学杂志,2012,27(16):49-51.
[7] 山慈明.法国医院手术室提高使用效率的方法[J].中华护理杂志,2006,41(12):1146-1147.
[8] 杨莹,王卫,路庆.手术患者安全管理质控检查对首台择期手术医疗指标的效果评价[J].山西医药杂志,2017,46(13):1619-1621.
[9] 高兴莲,刘娟,马琼,等.手术安全核查实施的方法与效果[J].护理管理杂志,2014,14(10):748-749.
[10] Melekie T B,Getahun G M.Compliance with Surgical Safety Checklist completion in the operating room of University of Gondar Hospital,Northwest Ethiopia[J].BMC research notes,2015(8):361.
[11] 张培丽,吴小华,陈尔英,等.实施手术安全核查制度的体会[J].广西医学,2013(6):801-802.
[12] Bentivegna R,Caminati A,Agnoletti V,et al.[OssERvare Project:direct observation of use of the Safety Surgery CheckList in the operating room.][J].Recenti progressi in medicina,2017,108(11):476-80.
[13] De Vries E N,Prins H A,Crolla R M,et al.SURPASS Collaborative Group.Effect of a comprehensive surgical safety system on patient outcomes[J].N Engl J Med,2010,363(20):1963-1965.
[14] Vats A,Vincent C A,Nagpal K,et al.Practical challenges of introducing WHO surgical checklist:UK pilot experience[J].BMJ,2010,340(5433):54-63.
[15] Edmondson A C,Bohmer R M,Pisano G P.Disrupted routines:team learning and new technology implementation in hospitals[J].Adm Sci Q,2001,46(4):685-716.
[16] 殷杰,叶庆,廖家智,等.基于HIS的手术全过程监管平台的构建与应用[J].中国数字医院,2015,10 (9):95-97.
[17] 姜雪,郎红娟,李瑞刚,等.流程优化对神经外科手术室工作效率的影响[J].护理学报,2013,20(4B):16-18.
[18] 高兴莲,苏法安,沈剑辉,等.信息技术在首台择期手术准点开始管理中的应用[J].护理学杂志,2014,29(8):47-49.
[19] 郭莉,刘晓光,文英,等.手术室加快手术台周转率的管理方法[J].中国护理管理,2012,12(9):85-87.
[20] 孙苗,钱跃飞,孙慧芳.浅谈手术室的标准化管理[J].医院管理论坛,2012,29(8):44-45.
[21] 姜雪,郎红娟,李娟,等.基于标准化管理的手术运行管理策略对手术室工作效率的影响[J].护理研究,2017,31(18):2297-2299.
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