手术安全清单的仪式化及其与患者安全目标的脱钩。

IF 2.7 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Sociology of health & illness Pub Date : 2024-07-01 Epub Date: 2024-02-01 DOI:10.1111/1467-9566.13746
Marcia Facey, Nancy Baxter, Melanie Hammond Mobilio, Carol-Anne Moulton, Elise Paradis
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引用次数: 0

摘要

患者伤害、患者安全及其管理一直是政策制定者、医疗服务提供者和公众关注的问题。为了应对高发的不良事件/医疗差错,世界卫生组织(WHO)提倡使用外科安全检查表(SSC)来提高外科护理的安全性。加拿大卫生当局随后将使用 SSC 作为一项强制性的组织实践,并将公开报告安全指标的合规性与预先存在的立法和外科手术的报销挂钩。SSC 被认为是解决手术室社会技术问题的良药,与之相关的研究主要集中在评估临床和经济效益、工作人员的看法、态度以及实施障碍等方面。结果不理想的原因在于实施过程中忽略了具体情况。我们利用在一家城市教学医院(C&C)进行的 SSC 研究中获得的人种学数据、批判性视角以及仪式和典礼的概念,研究了 SSC 的使用方式,并对其使用的性质和影响进行了理论分析。C&C的SSC仪式由两个仪式组成,一个是即兴表演,一个是剧本表演。即兴表演产生了错位,而脚本化的验证做法则改善了这种错位。该仪式与患者安全目标之间产生了因果关系上的不透明联系,并再现了手术室/医疗文化。我们将讨论该研究的理论贡献以及对患者安全的影响。
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The ritualisation of the surgical safety checklist and its decoupling from patient safety goals.

Patient harm, patient safety and their governance have been ongoing concerns for policymakers, care providers and the public. In response to high rates of adverse events/medical errors, the World Health Organisation (WHO) advocated the use of surgical safety checklists (SSC) to improve safety in surgical care. Canadian health authorities subsequently made SSC use a mandatory organisational practice, with public reporting of safety indicators for compliance tied to pre-existing legislation and to reimbursements for surgical procedures. Perceived as the antidote for socio-technical issues in operating rooms (ORs), much of the SSC-related research has focused on assessing clinical and economic effectiveness, worker perceptions, attitudes and barriers to implementation. Suboptimal outcomes are attributed to implementations that ignored contexts. Using ethnographic data from a study of SSC at an urban teaching hospital (C&C), a critical lens and the concepts of ritual and ceremony, we examine how it is used, and theorise the nature and implications of that use. Two rituals, one improvised and one scripted, comprised C&C's SSC ceremony. Improvised performances produced dislocations that were ameliorated by scripted verification practices. This ceremony produced causally opaque links to patient safety goals and reproduced OR/medical culture. We discuss the theoretical contributions of the study and the implications for patient safety.

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来源期刊
CiteScore
6.10
自引率
6.90%
发文量
156
期刊介绍: Sociology of Health & Illness is an international journal which publishes sociological articles on all aspects of health, illness, medicine and health care. We welcome empirical and theoretical contributions in this field.
期刊最新文献
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