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Safer paediatric surgical teams: A 5-year evaluation of crew resource management implementation and outcomes

Artikel i vetenskaplig tidskrift
Författare CARL SAVAGE
F. ANDREW GAFFNEY
Laith Hussain-Alkhateeb
PIA OLSSON ACKHEIM
GUNILLA HENRICSON
IRINI ANTONIADOU
MATS HEDSKÖLD
KARIN PUKK HÄRENSTAM
Publicerad i International Journal for Quality in Health Care
Volym 29
Nummer/häfte 4
ISSN 1464-3677
Publiceringsår 2017
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri
Språk en
Länkar doi.org/10.1093/intqhc/mzx113
Ämnesord crew resource management, surgical safety checklist, paediatric surgery, safety culture, clinical process redesign
Ämneskategorier Pediatrik

Sammanfattning

Objective Evaluate longitudinal changes in technical and non-technical skills (teamwork, situation monitoring, communication and leadership), safety culture, and clinical outcomes before and after implementation of a crew resource management (CRM) safety program. Design A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts. Setting Large university paediatric surgical service. Participant(s) All 153 managers and staff. Interventions Training of staff in CRM, systematic risk assessments, and the redesign of work practices captured and reinforced through the development, implementation and refinement of SOPs. Main Outcome Measure(s) Data were collected related to: 1) Relevance of CRM training (survey), 2) Safety culture (survey), 3) Team behaviours in clinical practice (non-participatory observations with MedPACT protocol) and 4) Effects on perioperative care for laparoscopic appendectomies—a representative and frequently performed surgical procedure (electronic medical records and administrative data for length of stay, unplanned readmissions and returns to the Operating Room). Results Non-technical skills, the use of safety tools, as well as adherence to guidelines for appendectomies all improved significantly over time. Significant safety culture improvements were found in teamwork across and within units, supervisors’ expectations and actions, non-punitive response to adverse events, and perceptions of overall patient safety. Unplanned readmissions following appendectomy declined significantly. Conclusions Implementation of a comprehensive CRM program including associated safety tools created sustained adherence to new work practices and improved non-technical and technical skills, surgical outcomes and safety culture.

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