Hace 1000 días, Anestesiología y Medicina del Dolor y un reducido grupo de colegas interesados en recibir información actualizada y gratuita dimos inicio al Proyecto Alpha. Desde entonces se han enviado 4,079,460 correos electrónicos conteniendo información científica útil en la práctica de especialidades afines: anestesiología, dolor, cuidados intensivos, urgencias, cirugía, medicina interna y otras muchas que complementan el concepto actual de la medicina perioperatoria.
Mil días parece un tiempo breve, periodo que ha sido de grandes satisfacciones para el grupo de colegas, amigos y familia que seguimos trabajando día con día para su actualización profesional. Los premios recibidos por este proyecto educativo no se comparan a las metas alcanzadas, y más que nada, a la satisfacción de colaborar de esta forma en el manejo integral de sus pacientes.
Los resultados han sido excelentes y nos comprometen a continuar con nuestra meta central de llevar el conocimiento disponible en el Internethasta su computadora. Le agredecemos que sea uno de los 3,308 especialistas que recibe día con dia esta información y se le invita a difundir este proyecto educativo.
Thousand days ago, Anestesiología y Medicina del Dolor and a small group of colleagues interested in receiving free updates started the Alpha Project. Since then we have sent 4,079,460 e-mails containing scientific information useful in the practice several specialties: anesthesiology, pain, intensive care, emergency, surgery, internal medicine and many others that complement the current concept of perioperative medicine.
A thousand days seems a short period of time, period that has been of great satisfaction for our group of colleagues, friends and family who continue to work every day for your professional update. The awards received by this educational project do not compare to the achievements, and most of all, to the satisfaction of working with you in the comprehensive management of many patients.
The results have been excellent and we pledge to continue our main goal of bringing the knowledge available on the Internet to your computer.
We appreciate you to be one of the 3,308 specialists who receives this information every day and invites you to spread this educational project.
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| Barreras del personal para adoptar listas de verificación de seguridad en cirugía |
Barriers to staff adoption of a surgical safety checklist.
Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E.
Quality Department, Institut Gustave Roussy, Villejuif cedex, France.aude.fourcade@igr.fr
BMJ Qual Saf. 2012 Mar;21(3):191-7. doi: 10.1136/bmjqs-2011-000094. Epub 2011 Nov 7.
Abstract
OBJECTIVE: Implementation of a surgical checklist depends on many organisational factors and on socio-cultural patterns. The objective of this study was to identify barriers to effective implementation of a surgical checklist and to develop a best use strategy. SETTING: 18 cancer centres in France. DESIGN: The authors first assessed use compliance and completeness rates of the surgical checklist on a random sample of 80 surgical procedures performed under general or loco-regional anaesthesia in each of the 18 centres. They then developed a typology of the organisational and cultural barriers to effective checklist implementation and defined each barrier's contents using data from collective and semi-structured individual interviews of key staff, the results of an email questionnaire sent to the 18 centres, and direct observations over 20 h in two centres. RESULTS: The study consisted of 1440 surgical procedures, 1299 checklists, and 28578 items. The mean compliance rate was 90.2% (0, 100). The mean completion rate was 61% (0, 84). 11 barriers to effective checklist implementation were identified. Their incidence varied widely across centres. The main barriers were duplication of items within existing checklists (16/18 centres), poor communication between surgeon and anaesthetist (10/18), time spent completing the checklist for no perceived benefit, and lack of understanding and timing of item checks (9/18), ambiguity (8/18), unaccounted risks (7/18) and a time-honoured hierarchy (6/18). CONCLUSIONS: Several of the barriers to the successful implementation of the surgical checklist depended on organisational and cultural factors within each centre. The authors propose a strategy for change for checklist design, use and assessment, which could be used to construct a feedback loop for local team organisation and national initiatives.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3285141/pdf/qhc-2011-000094.pdf
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| Lista de verificación de la OMS y su aplicación práctica en cirugía plástica |
WHO Surgical Checklist and Its Practical Application in Plastic Surgery. Abdel-Rehim S, Morritt A, Perks G. Department of Plastic Surgery, Nottingham University Hospitals NHS Trust, City Hospital Campus, Hucknall Road, Nottingham NG5 1PB, UK. Plast Surg Int. 2011;2011:579579. Epub 2011 Apr 27. Abstract The WHO surgical checklist was introduced to most UK surgical units following the WHO "Safe Surgery Saves Lives" initiative. The aim of this audit was to review patient's safety in the delivery of surgical care and to evaluate the practical application of the new WHO surgical checklist. We conducted a retrospective audit of patients who received operative treatment under general anaesthesia at our Plastic Surgery Department, involving a total number of 90 patients. The WHO form was compared to its former equivalents. Complications or incidents occurring during or after surgery were recorded. Using the department's previous surgical checklist, "Time out" was only performed in only 30% of cases. One patient arrived at theatre reception without a completed consent form, and two clinical incidents were reported without patients suffering harm. Following introduction of current WHO surgical checklist, "Time out" was recorded in 80% of cases. In all cases, the new WHO surgical checklist was used and no incidents were reported. The WHO surgical checklist provides a structured frame work that standardizes the delivery of care across hospitals and specialized units; however, it will take some time and practice for teams to learn to use the checklist effectively and reliably. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3335640/pdf/PSI2011-579579.pdf |
| Listas de control de la sala de operaciones: ¿ayuda u obstáculo? Un estudio cualitativo sobre las experiencias de los trabajadores de salud |
Checklists in the operating room: Help or hurdle? A qualitative study on health workers' experiences.
Thomassen O, Brattebø G, Heltne JK, Søfteland E, Espeland A.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. oyvt@helse-bergen.no
BMC Health Serv Res. 2010 Dec 20;10:342.
Abstract
BACKGROUND: Checklists have been used extensively as a cognitive aid in aviation; now, they are being introduced in many areas of medicine. Although few would dispute the positive effects of checklists, little is known about the process of introducing this tool into the health care environment. In 2008, a pre-induction checklist was implemented in our anaesthetic department; in this study, we explored the nurses' and physicians' acceptance and experiences with this checklist. METHOD: Focus group interviews were conducted with a purposeful sample of checklist users (nurses and physicians) from the Department of Anaesthesia and Intensive Care in a tertiary teaching hospital. The interviews were analysed qualitatively using systematic text condensation. RESULTS: Users reported that checklist use could divert attention away from the patient and that it influenced workflow and doctor-nurse cooperation. They described senior consultants as both sceptical and supportive; a head physician with a positive attitude was considered crucial for successful implementation. The checklist improved confidence in unfamiliar contexts and was used in some situations for which it was not intended. It also revealed insufficient equipment standardisation. CONCLUSION: Our findings suggest several issues and actions that may be important to consider during checklist use and implementation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009978/pdf/1472-6963-10-342.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009978/
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| Revisión sistemática de las listas de seguridad para uso por los equipos médicos en ¨hospitales agudos¨- Evidencia limitada de su efectividad |
Systematic review of safety checklists for use by medical care teams in acute hospital settings--limited evidence of effectiveness. Ko HC, Turner TJ, Finnigan MA. Centre for Clinical Effectiveness, Southern Health, Locked Bag 29, Clayton, Victoria, 3168, Australia. henry.ko@ctc.usyd.edu.auBMC Health Serv Res. 2011 Sep 2;11:211.Abstract BACKGROUND: Patient safety is a fundamental component of good quality health care. Checklists have been proposed as a method of improving patient safety. This systematic review, asked "In acute hospital settings, would the use of safety checklists applied by medical care teams, compared to not using checklists, improve patient safety?" METHODS: We searched the Cochrane Library, MEDLINE, CINAHL, and EMBASE for randomised controlled trials published in English before September 2009. Studies were selected and appraised by two reviewers independently in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. RESULTS: Nine cohort studies with historical controls studies from four hospital care settings were included-intensive care unit, emergency department, surgery, and acute care. The studies used a variety of designs of safety checklists, and implemented them in different ways, however most incorporated an educational component to teach the staff how to use the checklist. The studies assessed outcomes occurring a few weeks to a maximum of 12 months post-implementation, and these outcomes were diverse.The studies were generally of low to moderate quality and of low levels of evidence, with all but one of the studies containing a high risk of bias.The results of these studies suggest some improvements in patient safety arising from use of safety checklists, but these were not consistent across all studies or for all outcomes. Some studies showed no difference in outcomes between checklist use and standard care without a checklist. Due to the variations in setting, checklist design, educational training given, and outcomes measured, it was unfeasible to accurately summarise any trends across all studies. CONCLUSIONS: The included studies suggest some benefits of using safety checklists to improve protocol adherence and patient safety, but due to the risk of bias in these studies, their results should be interpreted with caution. More high quality and studies, are needed to enable confident conclusions about the effectiveness of safety checklists in acute hospital settings. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176176/pdf/1472-6963-11-211.pdf |
| Implementación de listas de verificación en el cuidado de la salud; aprendizaje de las organizaciones de alta fiabilidad. |
Implementation of checklists in health care; learning from high-reliability organisations. Thomassen Ø, Espeland A, Søfteland E, Lossius HM, Heltne JK, Brattebø G. Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway. Scand J Trauma Resusc Emerg Med. 2011 Oct 3;19:53.Abstract BACKGROUND: Checklists are common in some medical fields, including surgery, intensive care and emergency medicine. They can be an effective tool to improve care processes and reduce mortality and morbidity. Despite the seemingly rapid acceptance and dissemination of the checklist, there are few studies describing the actual process of developing and implementing such tools in health care. The aim of this study is to explore the experiences from checklist development and implementation in a group of non-medical, high reliability organisations (HROs). METHOD: A qualitative study based on key informant interviews and field visits followed by a Delphi approach. Eight informants, each with 10-30 years of checklist experience, were recruited from six different HROs. RESULTS: The interviews generated 84 assertions and recommendations for checklist implementation. To achieve checklist acceptance and compliance, there must be a predefined need for which a checklist is considered a well suited solution. The end-users ("sharp-end") are the key stakeholders throughout the development and implementation process. Proximity and ownership must be assured through a thorough and wise process. All informants underlined the importance of short, self-developed, and operationally-suited checklists. Simulation is a valuable and widely used method for training, revision, and validation. CONCLUSION: Checklists have been a cornerstone of safety management in HROs for nearly a century, and are becoming increasingly popular in medicine. Acceptance and compliance are crucial for checklist implementation in health care. Experiences from HROs may provide valuable input to checklist implementation in healthcare. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205016/pdf/1757-7241-19-53.pdf |
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