OBJECT:Quality and safety are basic concerns in any medical practice. Especially in daily surgical practice, with increasing turnover and shortened procedure times, attention to these topics needs to be assured. Starting in 2007, the authors used a perioperative checklist in all elective procedures and extended the checklist in January 2011 according to the so-called team time-out principles, with additional assessment of patient identity and the planned surgical procedure performed immediately before skin incision, including the emergency cases. METHODS:The advanced perioperative checklist includes parts for patient identification, preoperative assessments, team time-out, postoperative treatment, and imaging controls. All parts are signed by the responsible physician except for the team time-out, which is performed and signed by the theater nurse on behalf of the surgeon immediately before skin incision. RESULTS:Between January 2007 and December 2010, 1 wrong-sided bur hole in an emergency case and 1 wrong-sided lumbar approach in an elective case (of 8795 surgical procedures) occurred in the authors' department. Using the advanced perioperative checklist including the team time-out principles, no error occurred in 3595 surgical procedures (January 2011-June 2012). In the authors' department all team members appreciate the chance to focus on the patient, the surgical procedure, and expected difficulties. The number of incomplete checklists and of patients not being transferred into the operating room was lowered significantly (p = 0.002) after implementing the advanced perioperative checklist. CONCLUSIONS:In the authors' daily experience, the advanced perioperative checklist developed according to the team time-out principles improves preoperative workup and the focus of the entire team. The focus is drawn to the procedure, expected difficulties of the surgery, and special needs in the treatment of the particular patient. Especially in emergency situations, the team time-out synchronizes the involved team members and helps to improve patient safety.

译文

对象:质量和安全性是任何医学实践中的基本问题。尤其是在日常外科手术中,随着人员流动的增加和手术时间的缩短,需要确保对这些主题的关注。从2007年开始,作者根据所谓的小组超时原则在所有选修程序中使用了围手术期检查表,并于2011年1月扩展了检查表,并进一步评估了患者的身份,并在皮肤切开之前立即进行了计划的手术程序,包括紧急情况。
方法:围手术期高级检查表包括患者识别,术前评估,团队超时,术后治疗和影像控制的部分。除团队超时外,所有部件均由负责的医生签名,团队超时是由手术室护士在皮肤切开之前代表外科医生执行并签名的。
结果:在2007年1月至2010年12月期间,在提交人的科室发生了1例紧急情况下的错牙钻洞和1例选择性情况下的腰椎错位入路手术(共8795次手术)。使用包括团队超时原则在内的高级围手术期检查表,在3595例外科手术程序中未发生任何错误(2011年1月至2012年6月)。在作者部门,所有团队成员都很高兴有机会专注于患者,手术程序和预期的困难。实施高级围手术期检查清单后,不完整检查清单的数量和未转移到手术室的患者的人数显着降低(p = 0.002)。
结论:根据作者的日常经验,根据团队超时原则制定的高级围手术期检查清单可改善术前检查和整个团队的工作重点。重点放在手术过程,手术的预期困难以及对特定患者的治疗中的特殊需求。尤其是在紧急情况下,团队超时可以同步参与团队的成员,并有助于提高患者的安全性。

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