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时间 : 2013-12-14 08:21来源 : VOA官网 收听下载次数 :
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Study: Teamwork makes surgery safer

by Liz Szabo / (c) 2010, USA TODAY International. Distributed by Tribune Media Services International.

Training doctors and nurses to work as teams─using safety techniques borrowed from the aviation industry─cut the death rate from surgery by 18 percent, a new study shows.

Surgical teams in the study, which included 108 hospitals around the country, focused on low-tech techniques, such as holding briefings and debriefings before and after each operation, says study author and former astronaut James Bagian, a professor at the University of Michigan's medical and engineering schools.

These briefings, which are routinely conducted before airplane flights, allow crews to anticipate and prepare for potential safety risks, Bagian says.

Briefings helped surgical teams make important discoveries, such as learning that patients were on blood thinners, which increase the risk for serious bleeding during surgery. "You don't want to be surprised in the middle of surgery," he says.

Researchers trained operating room staff at 74 hospitals. Teams learned to recognize red flags, challenge each when they found safety risks and develop presurgical checklists, according to the study in the Journal of the American Medical Association. The more training surgical teams received, the safer they became, Bagian says.

But Bagian notes his study has limitations. The 34 hospitals that hadn't yet undergone training at the time of the study also improved, reducing their surgical m ortality rate by 7 percent, he says. And the design of his study prevents him from concluding that training actually caused the drop in mortality, although the link seems strong.

But the study is also the largest and most rigorously designed of its kind, says Peter Pronovost, a doctor and safety advocate.

"For decades, surgery and anesthesiology have focused on the technical work," Pronovost says. "But the harm that's occurring [from surgery] is happening due to teamwork failure, not technical failures. This is something every hospital can do."

研究指出:团队合作可提高外科手术的安全性

一项新研究指出,训练医生与护士团队合作──采用借自航空业的安全技巧──可让手术死亡率降低百分之十八。

研究报告作者是曾任太空人的密西根大学医学院与工学院教授詹姆斯.巴吉恩。他表示,这项研究调查的手术团队包括了全国一百零八家医院,焦点则是放在低科技的措施上,诸如每次手术的术前简报与术后报告。

巴吉恩指出,飞机航班出发前照例都会举行这类简报,有助于机组人员为可能发生的安全风险预做准备。

简报有助于手术团队获得重要发现,例如病患如果服用血液稀释剂,在手术中发生严重出血的风险就会提高,而这种资讯即可从简报中得知。「你可不想在手术中才被突如其来的状况吓得手足失措,」他表示。

研究人员在七十四所医院训练了手术室的医护人员。这些团队学会了辨识各种警讯,只要发现安全风险就会互相提醒,也发展出术前检查表,《美国医学会期刊》刊登的这份研究报告指出。

手术团队接受的训练愈多,手术就愈安全,巴吉恩表示。

不过,巴吉恩指出,自己的研究仍然有其局限。研究期间还没接受训练的三十四所医院也有所改善,手术死亡率降低了百分之七,他如此表示。此外,他这项研究的设计方式也导致他无法确认训练是否确是死亡率降低的原因,尽管两者之间似乎具有强烈关联。

不过,这项研究仍是同类型研究中规模最大而且设计也最严谨的一个,医师暨安全倡导者彼得.普罗诺佛斯表示。

「数十年来,外科医学与麻醉学都把关注焦点集中在技术方面,」普罗诺佛斯表示: 「但手术造成的伤害来自团队缺失,而不是技术缺失。这点是每家医院都能着手处理之处。」

 

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