Factors Associated with Effective Implementation of a Surgical Safety Checklist

与有效实施手术安全检查表相关的因素

• 批准号: 8017881
• 负责人: Sara Jean Singer
• 金额: $ 29.73万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8017881
• 关键词: Factors; Associated; Effective; Implementation; Surgical

DESCRIPTION (provided by applicant): In 2009, strict adherence to the WHO Surgical Safety Checklist, an inexpensive and easy-to-use tool, was found to reduce 30-day mortality from 1.5% to 0.8% and overall complications from 11% to 7% in eight diverse hospitals from Tanzania to the United States. Since then, the Checklist has been adopted by 3,200 hospitals in 93 countries. The benefits of the Checklist, however, depend upon the individual hospitals' ability to implement it effectively. Implementation is the process by which adopting organizations introduce innovations and encourages their use. Implementation may or may not be effective at producing consistent, high-quality utilization of a target innovation. The proposed study will examine implementation processes in a large group of US and international hospitals and will identify factors supportive of effective implementation. The study will also examine the relationship of effective implementation to teamwork, as an explanation for how the Checklist improves outcomes. In order to achieve these aims, data will be collected from 75 surgical units. Data on Checklist implementation processes will be obtained from implementation leaders and surgeons using a survey developed by drawing on prior instruments and preliminary research. Data on implementation effectiveness, teamwork, and Checklist outcomes will be obtained by direct nurse manager, patient safety officer and circulating nurse observations of surgical procedures. Cross-sectional and longitudinal comparisons will relate implementation processes to effective implementation and effective implementation to teamwork and Checklist outcomes. This study will make significant theoretical, methodological, practical and contributions to the field of implementation science. We will contribute to theory about innovation implementation and teamwork by demonstrating that effective Checklist implementation can lead to a virtuous cycle, affecting team dynamics in ways that can continuously improve implementation effectiveness and thus the benefits of the innovation. We will employ novel evaluation tools and training methods that can be applied broadly to increase the likelihood of effective implementation of the Checklist and in future studies of the implementation of similar innovations. For practical purposes, we will identify specific contextual factors and activities that lead to effective Checklist implementation, which can be emulated by other organizations implementing the Checklist and similar innovations. PUBLIC HEALTH RELEVANCE: A simple Surgical Safety Checklist has been shown to reduce complications and death from surgery by more than 30 percent. However, its impact will spread to the more than 200 million operations performed each year only if used consistently and correctly. This study will investigate how hospitals implement the Checklist and how differences in their implementation processes lead to differences in teamwork and, ultimately, the safety of surgical care.

描述（由申请人提供）：2009 年，严格遵守世界卫生组织手术安全检查表（一种廉价且易于使用的工具）被发现可以将 30 天死亡率从 1.5% 降低到 0.8%，将总体并发症从 11% 降低到从坦桑尼亚到美国的八家不同医院中，有 7% 的患者接受了这种治疗。自此，该清单已被 93 个国家的 3,200 家医院采用。然而，检查清单的好处取决于各个医院有效实施的能力。 实施是采用组织引入创新并鼓励其使用的过程。实施对于目标创新的一致、高质量利用可能有效，也可能无效。拟议的研究将检查大量美国和国际医院的实施过程，并将确定支持有效实施的因素。该研究还将探讨有效实施与团队合作的关系，以解释清单如何改善结果。 为了实现这些目标，将从 75 个手术室收集数据。有关清单实施流程的数据将通过利用先前工具和初步研究开展的调查从实施领导者和外科医生那里获得。有关实施有效性、团队合作和检查表结果的数据将通过直接护士经理、患者安全官员和循环护士对手术程序的观察来获得。横断面和纵向比较将实施过程与有效实施以及有效实施与团队合作和清单结果联系起来。 这项研究将为实施科学领域做出重大的理论、方法、实践和贡献。我们将通过证明有效的清单实施可以带来良性循环，以能够不断提高实施效率和创新效益的方式影响团队动力，为有关创新实施和团队合作的理论做出贡献。我们将采用可广泛应用的新颖的评估工具和培训方法，以增加有效实施清单以及未来实施类似创新的研究的可能性。出于实用目的，我们将确定导致有效实施清单的具体背景因素和活动，其他实施清单和类似创新的组织可以效仿这些因素和活动。 公共健康相关性：事实证明，简单的手术安全检查表可以将手术并发症和死亡人数减少 30% 以上。然而，只有一致且正确地使用，其影响才会波及每年执行的 2 亿多次操作。本研究将调查医院如何实施检查清单，以及实施流程的差异如何导致团队合作的差异，并最终导致手术护理的安全性差异。