Manuale per la sicurezza in sala operatoria - Azienda Sanitaria ...

Raccomandazioni per la sicurezza in sala operatoria - Ottobre 2009Tic NEW ENGLAHD JOURNAL «/MEDICINEwìth postintervention data and thè consecutiverecruitment of thè two groups of patients frorathè siine operating rooms at thè sanie hospitaìs,was chosen because fc was not possible to randomlyassign thè use of me checklist to specificoperating rooms without signifìcant cross-contamjnaiion.One clanger of thìs design is confbundìngby secolar trends. We thcrefoie confinedthè dutation of thè study to less tban 1 year, sincea dsange in outcoroes of thè observed magnitudeis unlikdy to occur in sudi a short period as aresult of secolar traoda alone. In addkion, utevahiatkm of thè American College of Surgeons'National SurgicsI Quality Improvement Programcohort in thè United States durine 2007 dM notreveal a substantial change in die rate of deathand complicaiions (Ashley S. persona! commuajcation,http:tfacsnsqip.org). We also fbund nochange in our study groups wirii regard to thèrates of nrgent cases, outpatient surgery, or useof generai anesthetic, and we fòund that changesin thè case mix had no efftct on thè signi ficaneeof thè outcomes. Other tempori! effects,«neh u seasonal variation and thè timing ofsurgìcaJ training periods, were mMgated, sincethè study skes are geograpfaìcally mjxed andhave djffèrent cydes of sorgkal training. Tberefoce,k is onlikeljr that a temperai trend was responsjfcàefot thè difference we observed betweenthè two groups in thìs study.Another limhation of thè study ie that datacoUection was restricted to inpatient compUcatìons.Ihe effect of thè ìnterventìon on outpatientcompi reations is not koown. This [imitation ispartjculaily rdevant to patients undergoing oatpatientprocedures, fbr whom thè coUectkm ofoutcome data ceased cn their discbarge frora thèhospitaJ oc thè day of thè procedare, resulùngin an underestimatìon of thè rates of complications.In addrtkm, data collectocs were trained inthè jdentificanon of compljcatjons and coHectionof compiications data at thè beginnìng of thèstudy. There may bave been a leaming curve inthè process of collectmg thè data. However, )f thiswere thè case, it is likety that increasing numbersof coraplicatioas would be identìfied as thèstudy progzessed, wttich would tàas thè results inthè dJrectkn of an underestjmatkxi of thè effectOne additìonal concern is bow fèa&ìble diecheddist Ìnterventìon mìght be fbr other hospjtals.Implementation proved neither cosdy norlengmjr. Ali sites were able to introduce thèchecklist orer a period of 1 week to 1 month.Only two of thè safety measures in thè cheddistentail me commitment of significane resources:use of poi se oiiraetry and use of propbylacticantìbfcrtics. Eoth were avaflable at ali me srtes,including Che low-income sites, befbre thè intervendati,although thetr use was JnconsJstent.SurgicaJ complications are a ccoaderable auseof death and disahiljty around thè worid* Tfaeyare devastating to patients, costar to health caresystems, and often preventaWe, though their preveotìontyptcaQyreauiresa change in systemsandindividuai befaavìor. In thìs study, a checktistbased program was assotìated with a significantdecline in thè rate of complications and deathtroni surgery in a diverse gronp of mstitutìonsaround thè wodd. Applied on a global basis, thischeddist program nas thè potential to preventlarge numbers of deaths and disabling complicatìons,although rurther study ts needed to determinethè precise mecbanisrn and durabilhy ofthè effect in specifìc settings.Snppoctedby gnau fmmtke Wodd H«3AOrj;aiUttóoo.caofiktof ùtnvtt ideiuit to tiii arride wai•Qw Binnbai ofàe Sde Snigajr Sam Lhm SBidyGicBpiwKii fbflow* AUTOMI,Jori» A.S. Bioaa^ AJ. Awamkh. Q.G. Sjdìdi;AMUH4,tta*Ze*m& AJ. Mer?, S.J. MtetnB, V. CodtEKM. A.-M. WBktoc», I Wtodior, H. lU*emoo. H. Snitfa, w. Oràde. V.Bearli; ffifcn,IkBBBtt: P. JObttah, B. feOu. IU Maycta, M. Cimila. W. Smatt, H. Pik: Looii»,Eagl«L A. Dnl K. Mootày. A.Vtti.R.D»^rH«f^M.Sac^M«h.PHMtT^fiT.»gtx^K^S. Jouepb, A. tana*. H. Sngb Quotai ; Sanie, WttbàgMi EJ. DeffiagCT, K.Ge*^To«»^CaMd«i Lt ReafctE.Tayiot, A.BUBI Bo^ontHiiMEfancn-i WJt, E«if, AJL Omaade, A.B. H^aa, S.JL Urprits, TJ3. Wriio; Cenni,SwfaerittubL. Douìdua,a Dò*», e. Philip; hkkMH^Muyfandi M. Makary; Ankn,Tirici L Si^ck; Sydncy, A««rrfft B. Btmdougb.•EFCBINCUI. Waier TG, Bj^q^agai SE. TfcompcoaETÀ «al. Aa «rtìmartoa of thè glaba!votame of tutfety. i modeìBngbaHEl oo anilaUcitett. Lancrt 2008^72:139-44.2. Ronimant C, Gnbam WJ.sicurezza dei pazientimoaalhy: wlw, whcn. wtee. and 57X Dei»! HT, Goiidio R. McGort C,