Ibrahim M Muhammad, Maha F Valiyakathu, Gianluigi Zanovello, Stefan Haensel, Bhaskar Somani, Nicholas Raison
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引用次数: 0
Abstract
Background: Non-technical skills (NTS) such as teamwork, communication and leadership are essential for surgical safety, but their impact on patient outcomes is uncertain. This systematic review evaluated whether NTS interventions improve operative and patient outcomes in surgical settings.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, seven databases were searched for randomised and non-randomised studies of NTS interventions reporting patient or operative outcomes. Eligible interventions included team training, simulation, Crew Resource Management, Team Strategies and Tools to Enhance Performance and Patient Safety and in-theatre coaching. Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials and Risk Of Bias In Non-randomised Studies - of Interventions tools, and findings were synthesised both quantitatively and narratively.
Results: 13 studies met inclusion criteria. NTS interventions consistently improved teamwork, communication and checklist adherence, with a statistically significant gain in validated performance scores (mean difference (MD) 6.91 points, 95% CI 2.95 to 10.9). Clinical outcomes were less consistent: individual large, system-level programmes reported reductions in complications and mortality (relative reductions ≈15-20%), but pooled controlled analyses did not demonstrate statistically significant improvements in complications (OR 0.91, 95% CI 0.45 to 1.86), readmission (OR 0.90, 95% CI 0.61 to 1.33) or length of stay (MD -0.84 days, 95% CI -3.40 to 1.73).
Conclusions: NTS training reliably improves observed teamwork and communication behaviours in the operating theatre, but the current evidence for a resulting benefit to patients is weak and dominated by non-randomised, higher risk of bias studies; the sole randomised trial found no significant benefit. Sustained, system-wide implementation with ongoing reinforcement and cultural alignment was associated with more consistent behavioural gains, but adequately powered randomised trials are needed before firm practice recommendations can be made.
背景：非技术技能（NTS），如团队合作、沟通和领导是手术安全必不可少的，但它们对患者预后的影响是不确定的。本系统综述评估了NTS干预是否能改善外科手术和患者预后。方法：根据系统评价和荟萃分析（PRISMA） 2020指南的首选报告项目，检索7个数据库，寻找报告患者或手术结果的NTS干预措施的随机和非随机研究。合格的干预措施包括团队培训、模拟、机组资源管理、团队战略和工具，以提高绩效和患者安全，以及手术室指导。使用Cochrane随机试验的偏倚风险工具和非随机研究的干预工具评估偏倚风险，并对研究结果进行定量和叙述综合。结果：13项研究符合纳入标准。NTS干预持续改善团队合作、沟通和检查表依从性，在有效的表现得分上有统计学上显著的增加（平均差（MD） 6.91分，95% CI 2.95至10.9）。临床结果不太一致：单个大型系统级方案报告并发症和死亡率减少（相对减少≈15-20%），但合并对照分析未显示并发症（OR 0.91, 95% CI 0.45至1.86）、再入院（OR 0.90, 95% CI 0.61至1.33）或住院时间（MD -0.84天，95% CI -3.40至1.73）的统计学显著改善。结论：NTS训练可靠地改善了手术室中观察到的团队合作和沟通行为，但目前对患者产生益处的证据不足，且主要是非随机、偏倚风险较高的研究；唯一的随机试验没有发现显著的益处。持续的、全系统的实施、持续的强化和文化一致性与更一致的行为收益相关，但在提出坚定的实践建议之前，需要进行充分有力的随机试验。普洛斯彼罗注册号：CRD420250648285。
期刊介绍：
BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement.
The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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