Data from: Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

ObjectiveTo examine the effectiveness and meaningful use of pediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. Summary Background Data Since the launch of the World Health Organization SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the pediatric surgical environment. Methods A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing. Results 1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians, and may improve patient safety. Conclusions A SSC implementation strategy focused on pediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of pediatric surgical outcome is not well established but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.研究目的：通过开展叙事性整合的系统综述，探讨儿科手术安全核查表（Pediatric Surgical Safety Checklists, SSCs）的应用效果、实际应用价值及其实施策略。 背景资料概述：自世界卫生组织手术安全核查表（World Health Organization Surgical Safety Checklist, WHO SSC）推出以来，手术安全核查表已在全球范围内的手术诊疗体系中得到广泛应用，但目前针对儿科手术场景下SSCs落地实施的相关研究仍较为匮乏。 研究方法：本研究构建了全面的文献检索策略，检索数据库涵盖PubMed、Embase、护理及相关健康文献累积索引数据库（Cumulative Index to Nursing and Allied Health Literature, CINAHL）、Cochrane中心数据库、Web of Science、科学引文索引（Science Citation Index, SCI）以及会议论文引文索引（Conference Proceedings Citation Index, CPCI）。由两名研究者独立、重复开展文献摘要与全文的筛选以确定纳入标准。提取研究特征与结局指标后，通过亚组分析与主题关联分析生成研究主题并开展深入探讨。 研究结果：经标题与摘要初筛后，1921篇文献中排除1826篇（Kappa系数=0.77）；经全文复筛后再排除47篇（Kappa系数=0.86），最终纳入20篇质量符合叙事整合分析要求的研究。在未配套实施策略的研究中，手术安全核查表的应用未对临床结局产生显著影响。在发展中国家，采用全面的SSCs实施策略可显著改善高危手术患者的临床结局。叙事性整合分析显示，实际合规性的测量标准缺乏一致性，且实际达标率普遍较低；引入反馈机制可有效提升合规性；由利益相关方参与制定的实施策略（包括基于团队的教育培训）可获得更高的应用接受度。另有三项研究表明，患儿家长参与手术安全核查表流程的做法受到家长、护士与医师的一致认可，或可提升患者安全水平。 研究结论：针对儿科患者及其家属制定的SSCs实施策略，可获得较高的接受度与合规性。目前手术安全核查表在改善儿科手术结局指标方面的作用尚未得到明确证实，但在配套采用全面实施策略的前提下，其或可发挥有效临床作用，尤其适用于低资源环境下的高危手术患者。