運用結構式「情報背景評估建議」技巧增進醫院併發症與死亡病例討論會教學品質

併發症與死亡病例討論會（Morbidity＆Mortality Conference，簡稱MMC）在醫療人員特別是醫師的養成訓練以及實際的醫療照護品質提升，長久以來都扮演著重要的角色，近年來發展的結構式討論方式可能有助於參與此MMC討論的成員在有關病人照護品質和安全性之重要問題的辨認和分析方面得以提升。我們在一家醫學中心的兩個單位進行了一個準實驗介入研究，讓參與者接受了使用結構式SBAR（situation-background assessment-recommendation）案例討論和分析方法以便在MMC過程中對案例進行結構化討論。SBAR的基本項目包括描述並產生當時的情境和處置，呈現案例的基本狀況，針對可能的錯誤進行分析討論並且分析可能的導致因素，以及根據文獻辨認出學習要點以避免再次發生類似併發症。研究人員提供SBAR的相關知識並示範SBAR所需的技能，並且強調結構式溝通方法的價值和重要性，並參加了MMC的每次會議以促進SBAR的應用。結果顯示介入前後相比，在所有的15個衡量題項皆有顯著改善，參與回應人員人數亦有增加。因此我們認為併發症與死亡病例討論會上使用SBAR的技巧進行結構化的討論和分析方式，可以提高其討論的成效，並有助於以積極的態度改善照護品質和提升病人安全，並且增加會議的參與度和參與意願。

關鍵字

併發症與死亡病例討論會；結構化討論；教學；品質

並列摘要

The morbidity and mortality conference (MMC) plays an important role in helping medical personnel, especially physicians develop medical competence and improve clinical care. Recently, a well-designed structured discussion model might help to identify important problems during care in the MMC and provide opportunities to improve care quality. In this quasi-experimental intervention at two units of a medical center, the participants of MMCs were educated for the use of the SBAR methods for a structured discussion of the cases during the MMC, providing knowledge and demonstrated the SBAR (situation-background-assessmentrecommendation) skills. Basic component for the SBAR method included the Situation of the adverse condition encountered by the healthcare worker and the management provided, the Background relevant data of the patient, the Assessment and analysis of the problem and the possible cause for the adverse condition, and the Recommendation based on the summary from reviewing the literature to prevent further similar events to occur. The investigators participated in every session of the MMC to facilitate the application of SBAR for presentation and discussions among the attendee. Pre- and post-intervention surveys regarding the observations and attitudes toward patient safety were performed. Surveys on healthcare workers showed significant changes towards better directions in all of the 15 survey items (p ＜ 0.05) with an increase of responders. We conclude that the SBAR method for structured discussion in MMC is feasible tool to enhance MMC productivity and might contribute to improved quality of care with a positive attitude without compromising the attendance or attitudes of the participants.

並列關鍵字

morbidity & mortality conference ； structured discussion ； teaching, quality

參考文獻

Lilford R, Pronovost P: Using hospital mortality rates to judge hospital performance: a bad idea that just won't go away. BMJ 2010;340:c2016. doi: 10.1136/bmj.c2016

Drye EE, Normand S-LT, Wang Y, et al: Comparison of hospital risk-standardized mortality rates calculated by using in-hospital and 30-day models: an observational study with implications for hospital profiling. Ann Intern Med 2012;156:19-26. doi: 10.7326/

Prince JM, Vallabhaneni R, Zenati MS, et al: Increased interactive format for morbidity & mortality conference improves educational value and enhances confidence. J Surg Edu 2007;64:266-72. doi: 10.1016/j.jsurg.2007.06.007

Higginson J, Walters R, Fulop N: Mortality and morbidity meetings: an untapped resource for improving the governance of patient safety? BMJ Qual Saf 2012:bmjqs-2011-000603. doi: 10.1136/bmjqs-2011-000603

Orlander JD, Fincke BG: Morbidity and mortality conference: a survey of academic internal medicine departments. J Gen Intern Med 2003;18:656. doi: 10.1046/j.1525-1497.2003.20824.x

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運用結構式「情報背景評估建議」技巧增進醫院併發症與死亡病例討論會教學品質

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