دانلود رایگان مقاله انگلیسی تأثیر بهبود کار گروهی بر نتایج بیماران در عمل جراحی - الزویر 2018

ABSTRACT

Background The aviation industry pioneered formalised crew training in order to improve safety and reduce consequences of non-technical error. This formalised training has been successfully adapted and used to in the field of surgery to improve post-operative patient outcomes. The need to implement teamwork training as an integral part of a surgical programme is increasingly being recognised. We aim to systematically review the impact of surgical teamwork training on post-operative outcomes. Methods Two independent researchers systematically searched MEDLINE and Embase in accordance with PRISMA guidelines. Studies were screened and subjected to inclusion/exclusion criteria. Study characteristics and outcomes were reported and analysed. Results Our initial search identified 2720 articles. Following duplicate removal, title and abstract screening, 107 titles full text articles were analysed. Eight articles met our inclusion criteria. Overall, three articles supported a positive effect of good teamwork on post-operative patient outcomes. We identified key areas in study methodology that can be improved upon, including small cohort size, lack of unified training programme, and short training duration, should future studies be designed and implemented in this field. Conclusion At present, there is insufficient evidence to support the hypothesis that teamwork training interventions improve patient outcomes. We believe that non-significant and conflicting results can be attributed to flaws in methodology and non-uniform training methods. With increasing amounts of evidence in this field, we predict a positive association between teamwork training and patient outcomes will come to light.

CONCLUSION

Our review shows there is limited positive evidence to suggest teamwork interventions improve patient outcomes. We discussed how certain elements of methodology (non-randomization, choice of outcome parameters) and study design (cohort size, training and follow-up times, training programme and subjects) may be the cause for non-significance. In order to justify future investment in teamwork training interventions, we call for more research using objective and standardised methodology.

Although cost-effectiveness of training interventions cannot be fully proven at present, a positive outcome should appear with the emergence of further high quality research. Promotion of teamwork training and teamwork mentality will also help to positively influence the culture within surgical training. Further reviews and metaanalyses should include quality studies, which can be assessed via scoring systems such as MERSQI or Newcastle-Ottawa Scale Education (NOS-E). We suggest that clinical outcome measures be used as endpoints, as they provide high threshold, objective and reproducible measures of effectiveness of interventional training, better than that of questionnaires or self-report scores. A unified, evidence-based training programme with consensus over training methodologies should then be established and adopted for widespread use. In particular, we suggest training time should be a minimum of two full days with a follow-up period of more than six months. There should be additional support and renewal of training material during this period.