Checklisten & Co.: Instrumente zur Förderung der Patientensicherheit in der Chirurgie

In den letzten Jahren wurden zahlreiche Maßnahmen entwickelt, um die Patientensicherheit in der Chirurgie zu erhöhen. Ein Meilenstein hierbei war die Implementierung von OP-Checklisten und Team-Time-out in vielen Krankenhäusern, deren positive Auswirkungen durch die Reduktion von postoperativen Komplikationen und Mortalitätsraten bei konsequenter Umsetzung belegt ist. Ziel dieses Beitrags ist es, einen Überblick über die zentralen Anforderungen und Maßnahmen zur Gewährleistung und Verbesserung der Patientensicherheit mit Fokus auf die Chirurgie zu geben. Einen besonderen Schwerpunkt bilden hierbei der Einsatz von Checklisten für Routine- und für Notfallsituationen sowie die effektive Zusammenarbeit im Team.

• Literatur

• 1 Thomas EJ, Studdert DM, Burstin HR et al. Incidence and types of adverse events and negligent care in Utah and Colorado [see comments]. Med Care 2000; 38: 261-271
• 2 Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001; 322: 517-519
• 3 Davis P, Lay-Yee R, Briant R et al. Adverse events in New Zealand public hospitals II: preventability and clinical context. N Z Med J 2003; 116: U624
• 4 Baker RG, Norton PG, Flintoft V et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. Can Med Assoc J 2004; 11: 1678-1686
• 5 Sari AB, Sheldon TA, Cracknell A et al. Extent, nature and consequences of adverse events: results of a retrospective casenote review in a large NHS hospital. Qual Saf Health Care 2007; 16: 434-439
• 6 Zegers M, de Bruijne MC, Wagner C et al. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Qual Saf Health Care 2009; 18: 297-302
• 7 Zegers M, de Bruijne MC, de Keizer B et al. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf Surg 2011; 5: 13
• 8 Anderson O, Davis R, Hanna GB et al. Surgical adverse events: a systematic review. Am J Surg 2013; 206: 253-262
• 9 Haugen AS, Søfteland E, Almeland SK et al. Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 2015; 261: 821-828
• 10 Reason J. Human error: models and management. Br Med J 2000; 320: 768-770
• 11 High 5s Projekt. www.CIRSmedical.de, Fall-Nr.: 103063; Quelle: High 5s Projekt. Im Internet: http://www.aezq.de/high-5s-toolboxen/implementierungshandbuch.pdf Stand: 06.09.2016
• 12 Shekelle PG, Pronovost PJ, Wachter RM et al. The top patient safety strategies that can be encouraged for adoption now. Ann Intern Med 2013; 158: 365-368
• 13 World Health Organization – WHO. Safe surgery. Why safe surgery is important. Im Internet: http://www.who.int/patientsafety/safesurgery/en/ Stand: 06.09.2016
• 14 Marshall S. The use of cognitive aids during emergencies in anesthesia: a review of the literature. Anesth Analg 2013; 117: 1162-1171
• 15 Arriaga AF, Bader AM, Wong JM et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med 2013; 368: 246-253
• 16 Ärztliches Zentrum für Qualität in der Medizin – ÄZQ. High 5s Implementierungshandbuch OP-Checklisten. Im Internet: http://www.aezq.de/high-5s-toolboxen/implementierungshandbuch.pdf Stand: 06.09.2016
• 17 Gawande A. The Checklist Manifesto. How to get Things right. New York: Metropolitan Books; 2009
• 18 Balzer F, Spies C, Schaffartzik W et al. Patient safety in anaesthesia: assessment of status quo in the Berlin-Brandenburg area, Germany. Eur J Anaesthesiol 2011; 28: 749-752
• 19 Manser T, Frings J, Heuser G et al. The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015. Z Evid Fortbild Qual Gesundhwes 2016; 114: 28-38
• 20 Rothmund M, Kohlmann T, Heidecke CD et al. Einführung und Beurteilung von Maßnahmen zur Fehlerprävention in chirurgischen Kliniken: Ergebnisse einer aktuellen Online-Befragung. Z Evid Fortbild Qual Gesundhwes 2015; 109: 384-393
• 21 Haynes AB, Weiser TG, Berry WR et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491-499
• 22 De Vries EN, Prins HA, Crolla RM et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010; 363: 1928-1937
• 23 Sewell M, Adebibe M, Jayakumar P et al. Use of the WHO surgical safety checklist in trauma and orthopaedic patients. Int Orthop 2011; 35: 897-901
• 24 Yuan CT, Walsh D, Tomarken JL et al. Incorporating the World Health Organization Surgical Safety Checklist into practice at two hospitals in Liberia. Jt Comm J Qual Patient Saf 2012; 38: 254-260
• 25 Urbach DR, Govindarajan A, Saskin R et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014; 370: 1029-1038
• 26 Russ S, Rout S, Sevdalis N et al. Do safety checklists improve teamwork and communication in the operating room? A systematic review. Ann Surg 2013; 258: 856-871
• 27 Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiol Scand 2009; 53: 143-151
• 28 Flin R, Mitchell L eds. Safer Surgery: analysing Behaviour in the operating Theatre. Aldershot: Ashgate; 2009
• 29 Lingard L, Espin S, Whyte S et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care 2004; 13: 330-334
• 30 Yule S, Flin R, Maran N et al. Debriefing surgeons on non-technical skills (NOTSS). Cogn Tech Work 2008; 10: 265-274
• 31 Neily J, Mills PD, Young-Xu Y et al. Association between implementation of a medical team training program and surgical mortality. JAMA 2010; 304: 1693-1700
• 32 Manser T. Managing the aftermath of critical incidents: Meeting the needs of health-care providers and patients. Best Pract Res Clin Anaesthesiol 2011; 25: 169-179