運用團隊資源管理之訓練提升急救成效

Effectiveness of Team Resource Management on the Cardiopulmonary Resuscitation

吳永隆(Yung-Lung Wu)

指導教授 ： 蔡彥卿 ； 劉心才

國立臺灣大學/管理學院/會計與管理決策組/碩士(2016年)

https://doi.org/10.6342/NTU201602438

摘要

心肺復甦術是在病人突發心肺停止時所進行的緊急處置，需要醫療人員緊密的合作來完成此一急迫且複雜的急救措施。在急救過程中，即使是一項小小的疏忽或一點點時間的延遲都可能導致無可挽回的結果，甚至造成病人傷害或生命損失。依據國內外專家的文獻報告指出，團隊合作的訓練可以減少人為疏失，進而提升醫療處置的成效。本研究個案的醫院於2009年導入團隊合作的訓練課程-團隊資源管理，並應用於日常醫療處置過程中，藉以促進醫療團隊的合作及減少醫療疏失的發生。
本研究是觀察急診室醫療人員於心肺復甦過程中運用團隊合作技巧的情形，藉由錄影帶回顧及評量表的方式來評估醫療人員團隊合作技巧的執行率，並探討對急救成效的影響。本研究選取了20例於急診室進行心肺復甦術之到院前心跳停止個案，其中8例為急診室醫療人員在接受團隊資源管理訓練課程前之個案，12例為急診室醫療人員在接受團隊資源管理訓練課程後之個案。研究結果發現在此20個病例中，急診室醫療人員接受團隊資源管理訓練課程前運用團隊合作技巧的平均執行率為56.88% (最低45.63%及最高62.50%)，而急診室醫療人員接受團隊資源管理訓練課程後運用團隊合作技巧的平均執行率為67.83% (最低52.50%及最高81.94%)。經由團隊合作技巧的執行率的提升，病人心肺復甦術之成功率也由26.1% 增加到33.3%。本研究結果顯示團隊合作能促進急救品質。因此，醫院除了在急救知識技能的訓練外，應再持續加強醫療團隊合作之訓練以促進團隊合作效能。如此不但能減少醫療疏失，更可提供優質的醫療服務品質，進而促進病人安全與病人健康。

關鍵字

心肺復甦術 ； 團隊合作 ； 機組員資源管理 ； 團隊資源管理 ； 人為疏失

並列摘要

Cardiopulmonary Resuscitation (CPR) was performed when the patient was suffered from sudden cardiopulmonary arrest. It requires seamless cooperation of medical personnel to accomplish this urgent and complex emergency measures. In the first aid process, even a small error or delay may lead to irreversible results, and cause the patient harm or loss of life. According to the literatures, they pointed out that the team-training may reduce human errors and enhance the effectiveness of medical measures. The case hospital introduced the Team Resource Management (TRM) in 2009. Then the teamwork skills was used in daily medical process to promote teamwork and reduce medical errors occurred.
This study is to observe the emergency room medical personnel use teamwork skills in situations of cardiopulmonary resuscitation before and after TRM training. With video review and scorecard approach to assess the performance of teamwork. We randomly selected 20 patients(cases) who suffered from out of hospital cardiac arrest and followed CPR in the emergency room. The 8 pre-TRM training cases had an average performance score of 56.88 (a minimum of 45.63, and a maximum of 62.50) while the other 12 post-TRM training cases had an average performance score of 67.83 ( a minimum of 52.50, and a maximum of 81.94). By promoting implementation rate of teamwork skills, the successful rate of cardiopulmonary resuscitation increased to 33.3% from the 26.1%. The results of this study show teamwork improve quality of medical cares. In addition to medical knowledge and skills, it should strengthen teamwork training. The teamwork training not only reduce medical errors, but it also improves medical services to promote patient safety and healthcares.

並列關鍵字

Cardiopulmonary resuscitation ； Teamwork ； Crew resource management ； Team resource management ； Human error

參考文獻

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