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Calvache JA, Benavides E, Echeverry S, Agredo F, Stolker RJ, Klimek M. Psychometric Properties of the Latin American Spanish Version of the Hospital Survey on Patient Safety Culture Questionnaire in the Surgical Setting. J Patient Saf 2021; 17:e1806-e1813. [PMID: 32011426 PMCID: PMC8612909 DOI: 10.1097/pts.0000000000000644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Hospital Survey on Patient Safety Culture (HSPSC) was designed to assess staff views on patient safety and has been translated and validated into several languages and settings. This study developed a Latin American Spanish version of the HSPSC for use in perioperative settings and examines its psychometric properties. METHODS After translation and adjustments, a web-based questionnaire was administered to all health care personnel at operating room in a public university-affiliated hospital in Popayán, Colombia. Descriptive statistics, internal reliability, confirmatory and exploratory factor analysis, and intercorrelations among survey composites were calculated. RESULTS Confirmatory factor analysis showed inadequate model fit for the original 12-factor structure of the HSPSC. Rather, a 9-factor, 36-item instrument showed acceptable factor loadings, internal consistency, and psychometric properties. Five factors were formed with minor changes. Adjusted factors emerged, like "staffing and work pressure" and "supervisor/manager expectations and actions promoting patient safety," "organizational learning-continuous improvement," and "hospital management support for safety," as well as "repeated errors and perception of safety." Internal consistency for each remaining composite met or exceeded a Cronbach α value of 0.60. CONCLUSIONS Psychometric analyses provided overall support for 9 of the 12 initial factors of patient safety culture. Our findings suggest that more validation studies need to be conducted before applying safety dimensions from the original HSPSC to perioperative settings only. By providing this initial tool, we hope to stimulate further studies and the patient safety research agenda in this part of the world.
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Affiliation(s)
- Jose Andres Calvache
- From the Anesthesiology Department, Erasmus University Medical Center, Rotterdam, the Netherlands
- Departamento de Anestesiología, Universidad del Cauca, Popayán, Colombia
| | - Edison Benavides
- Departamento de Anestesiología, Universidad del Cauca, Popayán, Colombia
| | | | - Francisco Agredo
- Departamento de Anestesiología, Universidad del Cauca, Popayán, Colombia
| | - Robert Jan Stolker
- From the Anesthesiology Department, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Markus Klimek
- From the Anesthesiology Department, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abraham J, Meng A, Holzer KJ, Brawer L, Casarella A, Avidan M, Politi MC. Exploring patient perspectives on telemedicine monitoring within the operating room. Int J Med Inform 2021; 156:104595. [PMID: 34627112 PMCID: PMC10627166 DOI: 10.1016/j.ijmedinf.2021.104595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/24/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Clinical decision support systems and telemedicine for remote monitoring can together support clinicians' intraoperative decision-making and management of surgical patients' care. However, there has been limited investigation on patient perspectives about advanced health information technology use in intraoperative settings, especially an electronic OR (eOR) for remote monitoring and management of surgical patients. PURPOSE Our study objectives were: (1) to identify participant-rated items contributing to patient attitudes, beliefs, and level of comfort with eOR monitoring; and (2) to highlight barriers and facilitators to eOR use. METHODS We surveyed 324 individuals representing surgical patients across the United States using Amazon Mechanical Turk, an online platform supporting internet-based work. The structured survey questions examined the level of agreement and comfort with eOR for remote patient monitoring. We calculated descriptive statistics for demographic variables and performed a Wilcoxon matched-pairs signed-rank test to assess whether participants were more comfortable with familiar clinicians from local hospitals or health systems monitoring their health and safety status during surgery than clinicians from hospitals or health systems in other regions or countries. We also analyzed open-ended survey responses using a thematic approach informed by an eight-dimensional socio-technical model. RESULTS Participants' average age was 34.07 (SD = 10.11). Most were white (80.9%), male (57.1%), and had a high school degree or more (88.3%). Participants reported a higher level of comfort with clinicians they knew monitoring their health and safety than clinicians they did not know, even within the same healthcare system (z = -4.012, p < .001). They reported significantly higher comfort levels with clinicians within the same hospital or health system in the United States than those in a different country (z = -10.230, p < .001). Facilitators and barriers to eOR remote monitoring were prevalent across four socio-technical dimensions: 1) organizational policies, procedures, environment, and culture; 2) people; 3) workflow and communication; and 4) hardware and software. Facilitators to eOR use included perceptions of improved patient safety through a safeguard system and perceptions of streamlined care. Barriers included fears of incorrect eOR patient assessments, decision-making conflicts between care teams, and technological malfunctions. CONCLUSIONS Participants expressed significant support for intraoperative telemedicine use and greater comfort with local telemedicine systems instead of long-distance telemedicine systems. Reservations centered on organizational policies, procedures, environment, culture; people; workflow and communication; and hardware and software. To improve the buy-in and acceptability of remote monitoring by an eOR team, we offer a few evidence-based guidelines applicable to telemedicine use within the context of OR workflow. Guidelines include backup plans for technical challenges, rigid care, and privacy standards, and patient education to increase understanding of telemedicine's potential to improve patient care.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States; Institute for Informatics, Washington University School of Medicine, St Louis, MO, United States.
| | - Alicia Meng
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Luke Brawer
- Wallace H. Coulter Department of Biomedical Engineering Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Aparna Casarella
- Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Michael Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, United States
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, United States
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Kasatpibal N, Sirakamon S, Punjasawadwong Y, Chitreecheur J, Chotirosniramit N, Pakvipas P, Whitney JD. Satisfaction and Barriers of Surgical Safety Checklist Implementation in a Nonmandatory Adoption Resource-Limited Country. J Patient Saf 2021; 17:e1255-e1260. [PMID: 34852416 DOI: 10.1097/pts.0000000000000453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES A surgical safety checklist has been a globally implemented and mandated adoption in several countries. However, its use is not mandatory in Thailand. This study aimed to evaluate the perceptions of surgical personnel on surgical complications and safety and to examine the satisfaction and barriers of surgical safety checklist implementation. METHODS A survey study was performed between November 2013 and February 2015 in 61 Thai hospitals. A questionnaire capturing demographics, perceptions related to surgical complications and safety, and the satisfaction and barriers of surgical safety checklist implementation was distributed to surgical personnel. RESULTS A total of 2024 surgical personnel were recruited. Nearly all of them reported experience or knowledge of an adverse surgical event (99.6%). Most thought that it could be preventable (98.2%) and quality care improvement could help reduce the occurrence of adverse events (97.7%). Overall, respondents reported a high level of satisfaction with the checklist (mean [SD] = 3.79 [0.71]). The three areas of highest satisfaction were benefit to the patient (mean [SD] = 4.11 [0.69]), benefit to the organization (mean [SD] = 4.05 [0.68]), and reduction in adverse events (mean [SD] = 4.02 [0.69]). Overall, the barrier for implementation of the checklist was rated as moderate (mean [SD] = 2.52 [0.99]). However, the means of barriers in each period, sign in, time out, and sign out, were rated as low (means [SD] = 2.41 [1.07], 2.50 [1.03], and 2.34 [1.01], respectively). CONCLUSIONS The data document that the satisfaction with the checklist are fairly high. However, some barriers were identified. Efforts to increase understanding through more rigorous policy enforcement and strategic support may lead to improving the checklist implementation.
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Affiliation(s)
| | | | | | | | - Narain Chotirosniramit
- Division of Surgical Critical Care and Trauma, Department of Surgery, Faculty of Medicine
| | - Parichat Pakvipas
- Operating Room and Recovery Room Service, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - JoAnne D Whitney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA
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Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Compliance with the Surgery Safety Checklist: An Update on the Status. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:1-9. [PMID: 34773633 DOI: 10.1007/5584_2021_661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHO has recommended the implementation of the Surgery Safety Checklist (SSC) to reign in often simple logistic errors that lead to numerous complications, some of them being fatal, in the perioperative period. This study aims to discuss doubts presented in the medical literature concerning the effectiveness of SSC in the currently existing form. The article is based on the literature search performed in PubMed using the command phrase "Surgery Safety Checklist". The search yielded 1,476 articles up to March 2021. Out of this group, we selected 811 articles for further detailed analysis. The selection was based on the meritorious SSC-related topicality and scrutinized content of the articles. Out of these articles, we identified 59 studies that specifically raised the issue of the effectiveness of SSC use in its current form, which we discussed herein in detail. The review distinctly indicates that the SSC reduces perioperative complications including fatalities. However, there are issues reported with the itemized content of the checklist that hardly corresponds to the diverseness of patients' conditions and operating room settings. Further, it is unclear if a reduction in the complications stems from the use of SSC or the algorithms for performing procedures it contains. The consensus arises that SSC should be periodically updated so that it would catch up with the advances in medical knowledge and the emerging technologies, which would safeguard the SSC from becoming just another paperwork nuisance for the operating room staff.
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Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczyslaw Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
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Transition from trainee to educator in the operating room: A needs assessment and framework to support junior faculty. Am J Surg 2021; 223:1112-1119. [PMID: 34799075 DOI: 10.1016/j.amjsurg.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transitioning from trainee to attending surgeon requires learners to become educators. The purpose of this study is to evaluate educational strategies utilized by surgeons, define gaps in preparation for operative teaching, and identify opportunities to support this transition. METHODS A web-based, Association of Surgical Education approved survey was distributed to attending surgeons. RESULTS There were 153 respondents. Narrating actions was the most frequently reported educational model, utilized by 74% of junior faculty [JF] (0-5yrs) and 63% of senior faculty [SF] (>6yrs). Other models used included educational time-outs (29% JF, 27% SF), BID teaching model (36% JF, 51% SF), and Zwisch model (13% JF, 25% SF). Compared with 91% JF, 65% SF reported struggling with instruction (p < 0.001). Five themes emerged as presenting difficulty during the resident to attending transition: lack of relationships, ongoing learning, systems-based, cognitive load, impression management. CONCLUSIONS Our results represent a needs assessment in the transition from learner to educator in the OR.
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Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery. Am J Obstet Gynecol 2021; 225:B43-B49. [PMID: 34324878 DOI: 10.1016/j.ajog.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The routine use of surgical safety checklists can reduce perioperative complications. Generic surgical safety checklists are insufficient for cesarean delivery because each cesarean delivery involves 2 patients (the mother and the fetus or newborn), each with separate care teams and health and safety considerations. To address the added complexity of care coordination and communication inherent in cesarean delivery, the Society for Maternal-Fetal Medicine presents sample standard surgical safety checklists for cesarean delivery that include elements of care for both the mother and newborn. In addition, we present an alternative checklist for time-critical emergency cesarean deliveries in which there is no time to safely perform the standard checklist and a sample preoperative checklist for use before moving the patient to the operating room. We also recommend steps for implementation of the checklists at individual facilities.
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The PATH to patient safety. Br J Anaesth 2021; 127:830-833. [PMID: 34635288 DOI: 10.1016/j.bja.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/22/2022] Open
Abstract
Communication is critical to safe patient care. In this issue of the British Journal of Anaesthesia, Jaulin and colleagues show that use of a Post-Anaesthesia Team Handover (PATH) checklist is associated with fewer hypoxaemia events in the PACU, reduced handover interruptions, and other important metrics related to improved communication. The PATH checklist provides a link within a broader chain of safety checklists and other interventions that comprise a perioperative chain of survival.
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Geva A, Albert BD, Hamilton S, Manning MJ, Barrett MK, Mirchandani D, Harty M, Morgan EC, Kleinman ME, Mehta NM. eSIMPLER: A Dynamic, Electronic Health Record-Integrated Checklist for Clinical Decision Support During PICU Daily Rounds. Pediatr Crit Care Med 2021; 22:898-905. [PMID: 33935271 PMCID: PMC8490208 DOI: 10.1097/pcc.0000000000002733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration. DESIGN Before-after quality-improvement study. SETTING Quaternary PICU in an academic, free-standing children's hospital. PATIENTS All patients in the PICU during daily morning rounds. INTERVENTIONS Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAIN RESULTS The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88-98%] vs eSIMPLER: 98% [95% CI, 92-100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures-discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function-improved during the eSIMPLER phase. CONCLUSIONS eSIMPLER, a dynamic, electronic health record-informed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the "Five Rights" of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER's effectiveness and its impact on patient outcomes need to be examined.
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Affiliation(s)
- Alon Geva
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Ben D. Albert
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Susan Hamilton
- Department of Cardiovascular and Critical Care Nursing, Medical-Surgical Intensive Care Unit, Boston Children’s Hospital, Boston, MA
| | - Mary-Jeanne Manning
- Department of Cardiovascular and Critical Care Nursing, Medical-Surgical Intensive Care Unit, Boston Children’s Hospital, Boston, MA
| | - Megan K. Barrett
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Dimple Mirchandani
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Matthew Harty
- Anesthesia Information Services, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Erin C. Morgan
- Anesthesia Information Services, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
| | - Monica E. Kleinman
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
| | - Nilesh M. Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA
- Department of Anaesthesia, Harvard Medical School, Boston, MA
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Urban D, Burian BK, Patel K, Turley NW, Elam M, MacRobie AG, Merry AF, Kumar M, Hannenberg A, Haynes AB, Brindle ME. Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey. ANNALS OF SURGERY OPEN 2021; 2:e075. [PMID: 36590849 PMCID: PMC9770110 DOI: 10.1097/as9.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
To assess health care professionals' attitudes on the Surgical Safety Checklist ("the Checklist") in resource-rich health systems and provide insights on strategies for optimizing Checklist use. Background In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. Methods An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. Results A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). Conclusions While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.
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Affiliation(s)
- Denisa Urban
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Kripa Patel
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan W. Turley
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Meagan Elam
- School of Public Health, Boston University, Boston, MA
| | - Ali G. MacRobie
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alan F. Merry
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Manoj Kumar
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Alexander Hannenberg
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
| | | | - Mary E. Brindle
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
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Ngonzi J, Bebell LM, Boatin AA, Owaraganise A, Tiibajuka L, Fajardo Y, Lugobe HM, Wylie BJ, Jacquemyn Y, Obua C, Haberer JE, Geertruyden JPV. Impact of an educational intervention on WHO surgical safety checklist and pre-operative antibiotic use at a referral hospital in southwestern Uganda. Int J Qual Health Care 2021; 33:6352323. [PMID: 34390247 DOI: 10.1093/intqhc/mzab089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/31/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) recommends adherence to its surgical safety checklist (SSC) to optimize patient safety and reduce cesarean surgical site infection (SSI). Educational interventions combined with audit and feedback mechanisms on the checklist use by clinicians have the potential to improve adherence and clinical outcomes. Despite the increase in cesarean delivery rates, there is a paucity of data on how such interventions can improve adherence in resource-limited settings. OBJECTIVE We performed a quality improvement project to measure the impact of an educational intervention with daily audit and feedback procedures on rates of WHO SSC adherence, including pre-operative antibiotic administration and SSI at Mbarara Regional Referral Hospital maternity ward in Uganda. METHODS The study involved chart abstraction of WHO SSC and pre-operative antibiotic use during cesarean deliveries and signs of subsequent SSI in three phases. First, we conducted a retrospective review of all charts from May to June 2018 (pre-intervention phase). Second, we instituted an educational intervention on the WHO SSC and pre-operative antibiotics use, followed by a daily audit of charts and feedback to clinicians from July to August 2018 (the intervention phase). Third, we reviewed charts from September to October 2018 (the post-intervention phase). The WHO SSC adherence, pre-operative antibiotic administration and SSI rates were measured as the proportion of the total cesarean deliveries per study phase and then compared across the three phases. RESULTS We reviewed 678 patients' charts (200 in the pre-intervention phase, 230 in the intervention phase and 248 in the post-intervention phase). The mean patient age was 25 years. The use of the WHO SSC was 7% in the pre-intervention phase compared to 92% in the intervention phase (P < 0.001), and 77% in the post-intervention phase (P < 0.001). Pre-intervention antibiotic receipt was 18% compared to 90% in the intervention phase (P < 0.001) and 84% in the post-intervention phase (P < 0.001). The documented SSI rate in the pre-intervention phase was 15% compared to 7% in the intervention phase (P = 0.02) and 11% in the post-intervention phase (P = 0.20). CONCLUSIONS An educational intervention, daily audit and feedback to clinicians increased the use of the WHO SSC and prophylactic antibiotics for cesarean delivery-although the rates waned with time. Research to understand factors influencing the checklist use and antibiotic prophylaxis including prescriber knowledge, motivation and clinical process is required. Implementation interventions to sustain usage and impact on clinical outcomes need to be explored.
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Affiliation(s)
- Joseph Ngonzi
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Lisa M Bebell
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Adline A Boatin
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Aspihas Owaraganise
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Leevan Tiibajuka
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Yarine Fajardo
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda +256
| | - Blair J Wylie
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
| | - Yves Jacquemyn
- Global Health Institute, University of Antwerp, Wilrijkstraat 10; 2650 Edegem, Antwerp, Belgium
| | - Celestino Obua
- Mbarara University of Science and Technology, P.O BOX 1410, Mbarara +256, Uganda
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, 125 Nashua St, Suite 722, Boston, MA 02114, USA
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Liu LQ, Mehigan S. A Systematic Review of Interventions Used to Enhance Implementation of and Compliance With the World Health Organization Surgical Safety Checklist in Adult Surgery. AORN J 2021; 114:159-170. [PMID: 34314014 DOI: 10.1002/aorn.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/16/2020] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
The focus of this systematic review is to identify and synthesize the evidence for effectiveness of interventions to increase compliance with the World Health Organization Surgical Safety Checklist (SSC) for adult surgery. We searched a variety of databases and identified 24 peer-reviewed articles of either a quantitative (n = 17), qualitative (n = 4), or mixed-methods design (n = 3) published in English from January 1, 2008, to July 8, 2020. Interventions included modifying the ways of delivering the SSC, integrating or tailoring the SSC to local context or existing practice, promoting clinician awareness and engagement, and managing policies. Despite a lack of common outcome measures, all quantitative and mixed-methods study results showed a significant positive effect on SSC compliance. A few researchers reported nonsignificant or negative changes in certain aspects with the interventions. Additional research is needed to address SSC compliance measures globally and outcomes in developing countries.
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Moore MR, Mitchell SJ, Weller JM, Cumin D, Cheeseman JF, Devcich DA, Hannam JA, Merry AF. A retrospective audit of postoperative days alive and out of hospital, including before and after implementation of the WHO surgical safety checklist. Anaesthesia 2021; 77:185-195. [PMID: 34333761 DOI: 10.1111/anae.15554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Abstract
We implemented the World Health Organization surgical safety checklist at Auckland City Hospital from November 2007. We hypothesised that the checklist would reduce postoperative mortality and increase days alive and out of hospital, both measured to 90 postoperative days. We compared outcomes for cohorts who had surgery during 18-month periods before vs. after checklist implementation. We also analysed outcomes during 9 years that included these periods (July 2004-December 2013). We analysed 9475 patients in the 18-month period before the checklist and 10,589 afterwards. We analysed 57,577 patients who had surgery from 2004 to 2013. Mean number of days alive and out of hospital (95%CI) in the cohort after checklist implementation was 1.0 (0.4-1.6) days longer than in the cohort preceding implementation, p < 0.001. Ninety-day mortality was 395/9475 (4%) and 362/10,589 (3%) in the cohorts before and after checklist implementation, multivariable odds ratio (95%CI) 0.93 (0.80-1.09), p = 0.4. The cohort changes in these outcomes were indistinguishable from longer-term trends in mortality and days alive and out of hospital observed during 9 years, as determined by Bayesian changepoint analysis. Postoperative mortality to 90 days was 228/5686 (4.0%) for Māori and 2047/51,921 (3.9%) for non-Māori, multivariable odds ratio (95%CI) 0.85 (0.73-0.99), p = 0.04. Māori spent on average (95%CI) 1.1 (0.5-1.7) fewer days alive and out of hospital than non-Māori, p < 0.001. In conclusion, our patients experienced improving postoperative outcomes from 2004 to 2013, including the periods before and after implementation of the surgical checklist. Māori patients had worse outcomes than non-Māori.
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Affiliation(s)
- M R Moore
- University of Auckland, Auckland, New Zealand
| | - S J Mitchell
- University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - J M Weller
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand
| | - D Cumin
- University of Auckland, Auckland, New Zealand
| | | | - D A Devcich
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand
| | - J A Hannam
- Department of Pharmacology and Clinical Pharmacology, University of Auckland, Auckland, New Zealand
| | - A F Merry
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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Gong J, Sheng B, Bian C, Yang L. A survey of surgical team members' awareness and perceptions toward the implementation of the surgical safety checklist in gynecological and obstetrical operations. Medicine (Baltimore) 2021; 100:e26731. [PMID: 34397710 PMCID: PMC8322558 DOI: 10.1097/md.0000000000026731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/30/2021] [Indexed: 01/04/2023] Open
Abstract
The World Health Organization Surgical Safety Checklist was developed to improve communication in perioperative care, reduce mortality and complications of patients, and ensure the consistent use of procedures for safe surgery. Despite the increased awareness of the checklist, the implementation compliance is reported as low and the degree of completeness varies. This study aimed to explore the possible supportive factors for the effective implementation and to identify potential awareness and barriers to its implementation in gynecological and obstetrical operation.A survey using a cross-sectional design that included surgeons, anesthetists, and operating room nurses was performed. We used an online link to distribute the survey to all eligible surgical team members in our hospital. The survey contained various aspects of perceptions on the Surgical Safety Checklist and an open-ended question that allowed respondents to offer their opinions on the topic.The overall self-reported awareness of the checklist within each professional group was high. The awareness of surgeons was lower than that of operating room nurses, particularly in the Time-out section. Most participants believed that operating room nurses ranked the highest compliance to the protocols, while surgeons stayed the lowest. Active leadership with experienced operating room nurses, good training for surgical team members, and simplification of the checklist would be the positive factors for the effective implementation.Although there is a high acceptance and adequate self-reported awareness of the Surgical Safety Checklist, it is not always possible to implement it successfully. Our findings suggest that with experienced and effective leadership, barriers to implementation can be overcome. With positive perception and commitment, the Surgical Safety Checklist is easy to implement and it can make a profound improvement on the safety of surgical care. Moreover, a strategy of repetitive training and assessment on the part of the involved health care professionals may be necessary to further improve patients' safety during surgery.
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Affiliation(s)
- Junming Gong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Central Operating Unit, West China Second University Hospital
- West China School of Nursing
| | - Bo Sheng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Anesthesiology, West China Second University Hospital
| | - Ce Bian
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingyun Yang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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64
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Merry AF, Weller JM. Communication and team function affect patient outcomes in anaesthesia: getting the message across. Br J Anaesth 2021; 127:349-352. [PMID: 34330413 DOI: 10.1016/j.bja.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 06/27/2021] [Accepted: 06/27/2021] [Indexed: 11/18/2022] Open
Abstract
A study in this edition of the Journal has added to data showing that failures in communication in the operating room contribute to patient harm. These data support the view that multidisciplinary teamwork and communication training should be part of the continuous professional development of all members of the perioperative team. Achieving change will require efforts to win the hearts and minds of all concerned, but these data also support an expectation that engagement in initiatives and techniques to enhance communication and teamwork should not be optional.
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Affiliation(s)
- Alan F Merry
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
| | - Jennifer M Weller
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand; Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Implementation of an Intrahospital Transport Checklist for Emergency Department Admissions to Intensive Care. Pediatr Qual Saf 2021; 6:e426. [PMID: 34235354 PMCID: PMC8225371 DOI: 10.1097/pq9.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/02/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Intrahospital transports (IHTs) are high-risk activities with the potential for adverse outcomes. Suboptimal care of a patient in our emergency department (ED) needing IHT to the pediatric intensive care unit (ICU) identified improvement opportunities. We describe implementing a novel checklist (Briefing ED-to-ICU Transport To Exit Ready: BETTER) for improving the IHT safety of pediatric ED patients admitted to the pediatric ICU. Methods A multidisciplinary team used the Model for Improvement to create a key driver diagram and process map. An evidence-based IHT checklist was implemented on July 23, 2019 after multiple plan-do-study-act checklist revisions. The specific aim was a ≥80% checklist completion rate for 6 months and maintaining that rate for 6 months. An anonymous, voluntary survey of ED nurses and physicians, 9 months postimplementation, evaluated perceived improvements in IHT safety. The outcome measure was the proportion of IHT-related incident reports, per ED-to-pediatric ICU admission, comparing baseline (2-year preimplementation) and intervention (1-year postimplementation) periods. Balancing measures included a quantitative assessment for any throughput measure delays and a survey question on perceived delays. Results From July 23, 2019 to July 22, 2020, 335 (84%) of 400 ED-to-ICU admissions had completed IHT checklists. Ninety percent of survey respondents (84% response rate) agreed that the checklist improved IHT safety. The incident report rate was lower in the intervention period (0.5% versus 2.3%; P = 0.03), with special cause improvement on T-chart analysis. Balancing measures did not indicate any delays secondary to checklist implementation. Conclusions This IHT checklist was feasible and associated with improvements in perceived safety and incident event reporting. Further studies are needed to assess generalizability.
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Hildenbrand T, Krahe A, Ketterer MC, Offergeld C. [Objective and subjective assessment of a structured approach to computed tomography scans of the paranasal sinuses]. HNO 2021; 69:562-567. [PMID: 32430669 PMCID: PMC8233259 DOI: 10.1007/s00106-020-00889-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sound knowledge of individual anatomy is essential in sinus surgery to prevent potentially serious complications. For the paranasal sinuses, computed tomography (CT) is the imaging technique of choice to preoperatively analyze individual anatomy and the extent of disease. OBJECTIVE The purpose of this study was to evaluate the usefulness of a CT checklist to identify relevant anatomic variants in CTs of the paranasal sinuses. MATERIALS AND METHODS Junior and senior otolaryngology residents were asked to assess sinus CT scans for anatomic variants before and after implementation of the CLOSE mnemonic (cribriform plate, lamina papyracea, Onodi cell, sphenoid sinus pneumatization, and [anterior] ethmoidal artery). The rate of correctly identified variants was calculated. A questionnaire was distributed for subjective evaluation of the usefulness of the checklist. RESULTS Six junior and six senior residents were included in the study. The rate of correctly identified anatomic variations significantly improved from 23.1 to 50.9% and 24 to 39.8%, respectively, after implementation of the CLOSE mnemonic. The subjective evaluation of the CLOSE criteria showed very positive results. CONCLUSION The structured approach to sinus CT scans using CT criteria can improve identification of critical anatomic variants in CT scans of the paranasal sinuses and is rated highly positively by residents in training.
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Affiliation(s)
- T Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - A Krahe
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - M C Ketterer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - C Offergeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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Messina A, Robba C, Calabrò L, Zambelli D, Iannuzzi F, Molinari E, Scarano S, Battaglini D, Baggiani M, De Mattei G, Saderi L, Sotgiu G, Pelosi P, Cecconi M. Perioperative liberal versus restrictive fluid strategies and postoperative outcomes: a systematic review and metanalysis on randomised-controlled trials in major abdominal elective surgery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:205. [PMID: 34116707 PMCID: PMC8194047 DOI: 10.1186/s13054-021-03629-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/06/2021] [Indexed: 12/12/2022]
Abstract
Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03629-y.
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Affiliation(s)
- Antonio Messina
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Chiara Robba
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
| | - Lorenzo Calabrò
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | - Daniel Zambelli
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | - Francesca Iannuzzi
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Edoardo Molinari
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Silvia Scarano
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Denise Battaglini
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy
| | - Marta Baggiani
- Anesthesia and Intensive Care Medicine, Maggiore Della Carità University Hospital, Novara, Italy
| | - Giacomo De Mattei
- Anesthesia and Intensive Care Medicine, Azienda Sanitaria Universitaria Integrata Udine, Udine, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental, University of Sassari, Sassari, Italy
| | - Paolo Pelosi
- Anaesthesia and Intensive Care, IRCCS for Oncology and Neuroscience, San Martino Policlinico Hospital, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Genoa, Italy
| | - Maurizio Cecconi
- Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Höppchen I, Ullrich C, Wensing M, Poß-Doering R, Suda AJ. [Safety culture in orthopedics and trauma surgery : A qualitative study of the physicians' perspective]. Unfallchirurg 2021; 124:481-488. [PMID: 33170311 PMCID: PMC8159809 DOI: 10.1007/s00113-020-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hintergrund Krankenhäuser in Deutschland betreiben ein Risikomanagement, welches die Prävention und systematische Aufarbeitung unerwünschter Ereignisse unterstützen kann. Ein wichtiger Aspekt davon ist die Etablierung einer Sicherheitskultur. Die Erhebung der Sicherheitskultur findet im deutschsprachigen Raum bisher selten und fast ausschließlich durch quantitative Instrumente statt. Im Fachbereich Orthopädie und Unfallchirurgie ist in Deutschland eine hohe Zahl an bestätigten Behandlungsfehlern und Risikoaufklärungsmängeln verzeichnet. Deshalb untersucht die vorliegende Studie die Sicherheitskultur in diesem Fachbereich. Fragestellung (I) Wie nehmen Ärzte der Orthopädie und Unfallchirurgie den Umgang mit unerwünschten Ereignissen im klinischen Alltag wahr, und (II) was sind die relevanten Bestandteile einer Sicherheitskultur aus ärztlicher Perspektive? Material und Methoden Es wurden 14 Einzelinterviews mit Ärzten der Orthopädie und Unfallchirurgie geführt. Die Interviews wurden audioaufgezeichnet, transkribiert und anhand der Thematic Analysis nach Braun und Clarke und des Yorkshire Contributory Factors Framework analysiert. Zur Organisation der Daten wurde die Software MAXQDA verwendet. Ergebnisse Es konnte ein starker Einfluss der Führungskräfte auf den Umgang mit unerwünschten Ereignissen im ärztlichen Team festgestellt werden. Von Chefärzten wurde erwartet, eine gute Sicherheitskultur vorbildhaft vorzuleben, da sie durch ihr Verhalten die Handlungsweisen des Teams in sicherheitsrelevanten Situationen beeinflussen. Diskussion Der Einbezug von Chefärzten in die Entwicklung von Maßnahmen zur Verbesserung der Sicherheitskultur in der Orthopädie und Unfallchirurgie sollte aufgrund der Bedeutsamkeit hierarchischer Strukturen in Betracht gezogen werden. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00113-020-00917-0) enthält weitere Informationen zu Material und Methoden der Studie. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- Isabel Höppchen
- Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität, Strubergasse 21, 5020, Salzburg, Österreich. .,Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
| | - Charlotte Ullrich
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Michel Wensing
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Regina Poß-Doering
- Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
| | - Arnold J Suda
- Abteilung für Orthopädie und Traumatologie, AUVA Unfallkrankenhaus Salzburg, Akademisches Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Dr. Franz-Rehrl-Platz 5, 5010, Salzburg, Österreich
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Avery P, Morton S, Raitt J, Lossius HM, Lockey D. Rapid sequence induction: where did the consensus go? Scand J Trauma Resusc Emerg Med 2021; 29:64. [PMID: 33985541 PMCID: PMC8116824 DOI: 10.1186/s13049-021-00883-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.
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Affiliation(s)
- Pascale Avery
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
| | - Sarah Morton
- Essex & Herts Air Ambulance, Flight House, Earls Colne, Colchester, Essex, CO6 2NS, UK
| | - James Raitt
- Thames Valley Air Ambulance Stokenchurch House, Oxford Rd, Stokenchurch, High Wycombe, HP14 3SX, UK
| | | | - David Lockey
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.,Blizard Institute, Queen Mary University, Whitechapel, London, E1 2AT, UK
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70
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Bossong O, Goldblum D, Schartau PJ, Wellner F, Rosenthal R, Steiner LA, Hasler PW, Dell-Kuster S. [Prospective Cohort Study of In-Hospital Patients Undergoing Ophthalmic Surgery for the Validation of ClassIntra: Classification of Intraoperative Adverse Events]. Klin Monbl Augenheilkd 2021; 238:510-520. [PMID: 33930927 DOI: 10.1055/a-1440-1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND To the best of our knowledge, there is no validated classification to assess intraoperative adverse events (iAEs) in ophthalmic surgery. ClassIntra is a newly developed classification for surgery- and anaesthesia-related iAEs that has been recently validated in various surgical disciplines, but not in ophthalmic surgery. We aim to assess the validity and practicability of ClassIntra in patients undergoing ophthalmic surgery. METHODS A consecutive sample of in-hospital patients undergoing any type of ophthalmic surgery was included in this single-centre prospective cohort study. iAEs were classified using ClassIntra, consisting of 5 severity grades according to the symptoms of the patient and the required treatment. All patients were followed for two weeks to record all postoperative adverse events according to Clavien-Dindo. The primary endpoint was the risk-adjusted association between the most severe iAE and the weighted sum of all postoperative adverse events within the two-week follow-up using the Comprehensive Complication Index (CCI). In addition, ophthalmologists and anaesthesiologists were asked to complete an online survey assessing the severity of iAEs for 10 fictitious clinical case scenarios. Reliability was assessed by comparing the clinicians' ratings to the prespecified benchmark rating of the study team. RESULTS In this study, 100 in-hospital patients with an average age of 64 years (SD 15) were included. The majority of all patients were ASA II (n = 53, 53%) or III (n = 42, 42%). Thirty-two iAEs were recorded in 22 patients (17 grade I, 12 grade II, 3 grade III). Ninety-four postoperative adverse events occurred in 50 patients (44 grade I, 36 grade II, 14 grade IIIa). We found a mean difference in CCI of 2,1 (95% confidence interval [CI] - 2,5 to 6,8) per one unit increase in severity grades of ClassIntra. Fifty ophthalmologists and anaesthesiologists completed the online survey (response rate 54%). The intraclass correlation coefficient was 0,79 (95% CI 0,64 to 0,94). CONCLUSIONS The application of ClassIntra during daily routine in ophthalmic surgery showed the usefulness and practicability of this classification for the standardised assessment of intraoperative adverse events. Although construct validity could not be demonstrated, the good reliability in the survey's rating underlines the criterion validity of this newly developed classification in ophthalmic surgery.
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Affiliation(s)
| | | | | | | | | | - Luzius A Steiner
- Anästhesie, Universitätsspital Basel, Schweiz.,Departement Klinische Forschung, Universitätsspital Basel, Schweiz
| | | | - Salome Dell-Kuster
- Anästhesie, Universitätsspital Basel, Schweiz.,Institut für Klinische Epidemiologie und Biostatistik, Universität Basel, Schweiz
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Abstract
BACKGROUND Since the WHO release of the Safe Surgery Saves Lives Program in 2008, peri-operative checklists minimise errors and improve patient safety worldwide. Anaesthesia professionals are often reluctant to use these checklists in front of patients because they fear causing patients' discomfort before anaesthesia and surgery. OBJECTIVE To assess and compare the subjective level of patient discomfort caused by the use of pre-induction checklists with the patient discomfort estimated by anaesthesia providers. DESIGN Prospective observational study. SETTING The current single-centre trial included 110 anaesthesia providers and 125 nonpremedicated ear, nose and throat or maxillofacial surgery patients in Switzerland from June to August 2016. Inclusion criterion: signed general research consent. EXCLUSION CRITERIA received premedication, less than 18 years old, day-care patients, dementia or other mental illnesses. INTERVENTIONS Anaesthesia healthcare providers and patients before surgery and on the first postoperative day were asked to rate three statements: MAIN OUTCOME MEASURES: All statements were rated on a 100-mm visual analogue scale, where 0 meant no agreement and 100 meant total agreement. RESULTS Patients overwhelmingly agreed that anaesthesia providers should use checklists in front of them. Anaesthesia providers rated the patient discomfort much higher than actually perceived by patients. Both, patients and anaesthesia providers rated the possibility of reducing the risk of errors high. CONCLUSION Patients experience far less discomfort observing the use of pre-induction checklists than anaesthesia providers expect. Patients value the potential safety benefit significantly higher than anaesthesia providers. These results further support the implementation of peri-operative checklists in the operating room environment. TRIAL REGISTRATION The current observational study had no intervention, therefore, was not registered.
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Keller N, Bosse G, Memmert B, Treskatsch S, Spies C. Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU. BMJ Open Qual 2021; 9:bmjoq-2019-000668. [PMID: 32565419 PMCID: PMC7311016 DOI: 10.1136/bmjoq-2019-000668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/10/2020] [Accepted: 04/08/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Standardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit. MATERIALS AND METHODS The VA was constructed and implemented via a brief (<1 min) training of anaesthesiologic staff during the operation. Ease of implementation was measured by amount of information transferred, handover duration and handover structure. 50 handovers were audio recorded before intervention and 50 after intervention. External validity was evaluated by blinded assessment of the recordings by experienced anaesthesiologists (n=10) on 10-point scales. RESULTS The brief intervention resulted in increased information transfer (9.0-14.8 items, t(98)=7.44, p<0.0001, Cohen's d=1.59) and increased handover duration (81.3-192.8 s, t(98)=6.642, p=0.013, Cohen's d=1.33) with no loss in structure (1.60-1.56, t(98)=0.173, p=0.43). Blinded assessment on 10-point scales by experienced anaesthesiologists showed improved overall handover quality from 7.1 to 7.8 (t(98)=1.89, p=0.031, Cohen's d=0.21) and improved completeness of information (t(98)=2.42, p=0.009, Cohen's d=0.28) from 7.3 to 8.3. CONCLUSIONS An intervention consisting of a simple VA and <1 min instructions significantly increased overall quality and amount of information transferred during ICU/postanaesthetic care unit handovers.
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Affiliation(s)
- Niklas Keller
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum and Charité Centrum Mitte (CVK/CCM), Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Berlin, Germany .,Simply Rational - The Decision Institute, Berlin, Germany
| | - Götz Bosse
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum and Charité Centrum Mitte (CVK/CCM), Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Berlin, Germany
| | - Belinda Memmert
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum and Charité Centrum Mitte (CVK/CCM), Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Berlin, Germany
| | - Sascha Treskatsch
- Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin Berlin, Corporate Member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow Klinikum and Charité Centrum Mitte (CVK/CCM), Charité Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Berlin, Germany
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73
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Verholen N, Vogt L, Klasen M, Schmidt M, Beckers S, Marx G, Sopka S. Do Digital Handover Checklists Influence the Clinical Outcome Parameters of Intensive Care Unit Patients? A Randomized Controlled Pilot Study. Front Med (Lausanne) 2021; 8:661343. [PMID: 33959627 PMCID: PMC8093756 DOI: 10.3389/fmed.2021.661343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Clinical handovers have been identified as high-risk situations for medical treatment errors. It has been shown that handover checklists lead to a reduced rate of medical errors and mortality. However, the influence of handover checklists on essential patient outcomes such as prevalence of sepsis, mortality, and length of hospitalization has not yet been investigated in a randomized controlled trial (RCT). Objectives: The aim of the present pilot study was to estimate the effect of two different handover checklists on the 48 h sepsis-related organ failure assessment (SOFA) score and the feasibility of a respective clinical RCT. Methods: Outcome parameters and feasibility were investigated implementing and comparing an intervention with a control checklist. Design: Single center two-armed cluster randomized prospective crossover pilot study. Setting: The study took place over three 1-month periods in an intensive care unit (ICU) setting at the University Hospital Aachen. Patients/Participants: Data from 1,882 patients on seven ICU wards were assessed, of which 1,038 were included in the analysis. Intervention: A digital standardized handover checklist (ISBAR3) was compared to a control checklist (VICUR). Main Outcome Measures: Primary outcome was the 2nd 24 h time window sepsis-related organ failure assessment (SOFA) score. Secondary outcomes were SOFA scores on the 3rd and 5th 24 h time window, mortality, reuptake, and length of stay; handover duration, degree of satisfaction, and compliance as feasibility-related outcomes. Results: Different sepsis scores were observed only for the 1st 24 h time window after admission to the ICU, with higher values for ISBAR3. With respect to the patient-centered outcomes, both checklists achieved similar results. Average handover duration was shorter for VICUR, whereas satisfaction and compliance were higher for ISBAR3. However, overall compliance was low (25.4% for ISBAR3 and 15.8% for VICUR). Conclusions: Based on the results, a stratified randomization procedure is recommended for following RCTs, in which medical treatment errors should also be investigated as an additional variable. The use of control checklists is discouraged due to lower acceptance and compliance among healthcare practitioners. Measures should be undertaken to increase compliance with the use of checklists. Clinical outcome parameters should be carefully selected. Trial Registration:ClinicalTrials.gov, Identifier [NCT03117088]. Registered April 14, 2017.
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Affiliation(s)
- Nina Verholen
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Lina Vogt
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Martin Klasen
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Michelle Schmidt
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Stefan Beckers
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Saša Sopka
- Department of Anaesthesiology, Medical Faculty, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.,AIXTRA-Competence Center for Training and Patient Safety, Medical Faculty, Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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74
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Araujo SEA, Kim NJ, Cendoroglo NM, Klajner S. Value of Nontechnical Skills in Minimally Invasive Surgery. Clin Colon Rectal Surg 2021; 34:131-135. [PMID: 33814993 DOI: 10.1055/s-0040-1718688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nontechnical skills are of increasing importance in surgery and surgical training. The main studies on its impact on the safety and effectiveness of surgical interventions were mainly published in the first decade of the 2000s. Due to the significant technical complexity and great diversity of instruments for nontechnical skills evaluation, the interest in training and in measuring the impact on surgical safety has relatively decreased. However, the advent of minimally invasive surgery and its peculiar technical characteristics of sophisticated technique and constant innovation through the adoption of new materials and drugs has rekindled interest in this expertise area. In the present review, we have revisited the main instruments available to measure nontechnical skill of surgical teams and analyzed the role of the main competencies on which they are based, such as situational awareness, leadership and communication skills, and the consistency of the intraoperative decision-making process. We conclude that despite the great consensus that exists among all members of the health team on the importance of nontechnical skills for the surgical team in minimally invasive surgery, the reproducible evidence on the subject is scarce and laborious to obtain. To the extent that protecting and expanding nontechnical skills is fundamental to the path toward the high reliability of health institutions, it is possible to anticipate here the role of these institutions as promoters of continuity and new research models in this area of knowledge, especially in minimally invasive surgery, an access route to which more and more patients undergoing surgical treatment in these same institutions are submitted.
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Affiliation(s)
| | - Nam Jin Kim
- Hospital Israelita Albert Einstein, São Paulo, Brasil
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75
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Houssaini K, Majbar MA, Souadka A, Lahnaoui O, El Ahmadi B, Ghannam A, Houssain Belkhadir Z, Mohsine R, Benkabbou A. Liver resection safety in a developing country: Analysis of a collective learning curve. J Visc Surg 2021; 159:5-12. [PMID: 33744246 DOI: 10.1016/j.jviscsurg.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To analyze the collective learning curve in the performance of safe liver resections, using the decrease of severe postoperative complications (SPC) as a proxy for overall safety competency. MATERIAL AND METHODS This was a retrospective analysis of a prospective database in the setting of a liver surgery program implementation in a tertiary center in Morocco. The 100 first consecutive cases of elective liver resections starting from January 1st, 2018 were included in the analysis. SPC were defined as CD>IIIa during the first 90 postoperative days. We used a cumulative sum (CUSUM) technique to determine the number of cases required to achieve safety competency. We then compared case characteristics before and after the learning curve completion. RESULTS SPC occurred in 15 cases (15%), including 5 deaths (5%). The CUSUM chart revealed a learning curve completion at the 49th case, marked by an inflection point towards the decrease in SPC (24.5% vs 5.9%; P=0.009). In period 2 (after), cases were associated with less diabetes, less synchronous digestive resection, more cirrhosis, and more prolonged preoperative chemotherapy. The rates of major resection (30.6% vs 29.9%; P=0.89) and biliary reconstruction were comparable, as were the operating time, and estimated blood loss. CONCLUSION Approximately 50 cases were required to complete the learning curve and improve the overall safety of liver resection. In our setting, the learning curve chronology was consistent with collective measures, including team stabilization and protocol development.
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Affiliation(s)
- K Houssaini
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - M A Majbar
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Souadka
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - O Lahnaoui
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - B El Ahmadi
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | - A Ghannam
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | | | - R Mohsine
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Benkabbou
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
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Abstract
Mortality after visceral surgery has decreased owing to progress in surgical techniques, anesthesiology and intensive care. Mortality occurs in 5-10% of patients after major surgery and remains a topic of interest. However, the ratio of mortality after postoperative complications in relation to overall complications varies between hospitals because of failure to rescue at the time of the complication. There are multiple factors that lead to complication-related mortality: they are patient-related, disease-related, but are related, above all, to the timeliness of diagnosis of the complication, the organisational aspects of management in private or public hospitals, hospital volume that corresponds to the centralisation of initial management or to the concept of referral centre in case of complications, to the team spirit, to communication between the health care providers and to the management of the complication itself. Several organisational advances are to be considered, such as the development of shorter hospitalisations and notably ambulatory surgery, as well as enhanced recovery programs. Remote monitoring and the contribution of artificial intelligence must also be evaluated in this context. The reduction of mortality after visceral surgery rests on several tactics: prevention of potentially lethal complications, the all-important reduction of failure to rescue, and risk management before, during and after hospitalisations that are increasingly shorter.
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Storesund A, Haugen AS, Flaatten H, Nortvedt MW, Eide GE, Boermeester MA, Sevdalis N, Tveiten Ø, Mahesparan R, Hjallen BM, Fevang JM, Størksen CH, Thornhill HF, Sjøen GH, Kolseth SM, Haaverstad R, Sandli OK, Søfteland E. Clinical Efficacy of Combined Surgical Patient Safety System and the World Health Organization's Checklists in Surgery: A Nonrandomized Clinical Trial. JAMA Surg 2021; 155:562-570. [PMID: 32401293 PMCID: PMC7221852 DOI: 10.1001/jamasurg.2020.0989] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Question Does patient safety improve when adding the preoperative and postoperative Surgical Patient Safety System checklists to the World Health Organization’s established surgical safety checklist? Findings In this stepped-wedge cluster nonrandomized clinical trial with parallel controls that included 9009 surgical procedures, reductions in complications and emergency reoperations occurred when the preoperative Surgical Patient Safety System was added to the surgical safety checklist. The postoperative Surgical Patient Safety System reduced readmissions, whereas overall increased complications were found in the 9678 parallel controls. Meaning These findings suggest that joint use of the preoperative and postoperative Surgical Patient Safety System with the intraoperative surgical safety checklist is beneficial for patients. Importance Checklists have been shown to improve patient outcomes in surgery. The intraoperatively used World Health Organization surgical safety checklist (WHO SSC) is now mandatory in many countries. The only evidenced checklist to address preoperative and postoperative care is the Surgical Patient Safety System (SURPASS), which has been found to be effective in improving patient outcomes. To date, the WHO SSC and SURPASS have not been studied jointly within the perioperative pathway. Objective To investigate the association of combined use of the preoperative and postoperative SURPASS and the WHO SSC in perioperative care with morbidity, mortality, and length of hospital stay. Design, Setting, and Participants In a stepped-wedge cluster nonrandomized clinical trial, the preoperative and postoperative SURPASS checklists were implemented in 3 surgical departments (neurosurgery, orthopedics, and gynecology) in a Norwegian tertiary hospital, serving as their own controls. Three surgical units offered additional parallel controls. Data were collected from November 1, 2012, to March 31, 2015, including surgical procedures without any restrictions to patient age. Data were analyzed from September 25, 2018, to March 29, 2019. Interventions Individualized preoperative and postoperative SURPASS checklists were added to the intraoperative WHO SSC. Main Outcomes and Measures Primary outcomes were in-hospital complications, emergency reoperations, unplanned 30-day readmissions, and 30-day mortality. The secondary outcome was length of hospital stay (LOS). Results In total, 9009 procedures (5601 women [62.2%]; mean [SD] patient age, 51.7 [22.2] years) were included, with 5117 intervention procedures (mean [SD] patient age, 51.8 [22.4] years; 2913 women [56.9%]) compared with 3892 controls (mean [SD] patient age, 51.5 [21.8] years; 2688 women [69.1%]). Parallel control units included 9678 procedures (mean [SD] patient age, 57.4 [22.2] years; 4124 women [42.6%]). In addition to the WHO SSC, adjusted analyses showed that adherence to the preoperative SURPASS checklists was associated with reduced complications (odds ratio [OR], 0.70; 95% CI, 0.50-0.98; P = .04) and reoperations (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Adherence to the postoperative SURPASS checklists was associated with decreased readmissions (OR, 0.32; 95% CI, 0.16-0.64; P = .001). No changes were observed in mortality or LOS. In parallel control units, complications increased (OR, 1.09; 95% CI, 1.01-1.17; P = .04), whereas reoperations, readmissions, and mortality remained unchanged. Conclusions and Relevance In this nonrandomized clinical trial, adding preoperative and postoperative SURPASS to the WHO SSC was associated with a reduction in the rate of complications, reoperations, and readmissions. Trial Registration ClinicalTrials.gov Identifier: NCT01872195
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Affiliation(s)
- Anette Storesund
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Arvid Steinar Haugen
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hans Flaatten
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Monica W Nortvedt
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Nick Sevdalis
- Center for Implementation Science, Health Service and Population Research Department, King's College, London, United Kingdom
| | - Øystein Tveiten
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Ruby Mahesparan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | - Jonas Meling Fevang
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - Gunnar Helge Sjøen
- Department of Anesthesiology, Haugesund Hospital, Health Trust Fonna, Haugesund, Norway
| | - Solveig Moss Kolseth
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Eirik Søfteland
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Aaberg OR, Hall-Lord ML, Husebø SIE, Ballangrud R. A human factors intervention in a hospital - evaluating the outcome of a TeamSTEPPS program in a surgical ward. BMC Health Serv Res 2021; 21:114. [PMID: 33536014 PMCID: PMC7856763 DOI: 10.1186/s12913-021-06071-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 01/09/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient safety in hospitals is being jeopardized, since too many patients experience adverse events. Most of these adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months. Systems Engineering Initiative for Patient Safety 2.0 was used as a conceptual framework for the study. METHODS This study had a pre-post design with measurements at baseline and after 6 and 12 months of intervention. The intervention was conducted in a urology and gastrointestinal surgery ward in Norway, and the study site was selected based on convenience and the leaders' willingness to participate in the project. Survey data from healthcare professionals were used to evaluate the intervention. The organizational outcomes were measured by the unit-based sections of the Hospital Survey of Patient Safety Culture Questionnaire, and professional outcomes were measured by the TeamSTEPPS Teamwork Perceptions Questionnaire and the Collaboration and Satisfaction about Care Decisions in Teams Questionnaire. A paired t-test, a Wilcoxon signed-rank test, a generalized linear mixed model and linear regression analysis were used to analyze the data. RESULTS After 6 months, improvements were found in organizational outcomes in two patient safety dimensions. After 12 months, improvements were found in both organizational and professional outcomes, and these improvements occurred in three patient safety culture dimensions and in three teamwork dimensions. Furthermore, the results showed that one of the significant improved teamwork dimensions "Mutual Support" was associated with the Patient Safety Grade, after 12 months of intervention. CONCLUSION These results demonstrate that the team training program had effect after 12 months of intervention. Future studies with larger sample sizes and stronger study designs are necessary to examine the causal effect of a team training intervention in this context. TRIAL REGISTRATION NUMBER ISRCTN13997367 (retrospectively registered).
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Affiliation(s)
- Oddveig Reiersdal Aaberg
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Universitetsveien 25 A, 4630 Kristiansand, Norge
- Department of Health Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, 2815 Gjøvik, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 41, 4036 Stavanger, Norway
| | - Marie Louise Hall-Lord
- Department of Health Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, 2815 Gjøvik, Norway
- Department of Health Sciences, Faculty of Health, Science and Technology, Karlstad University, Universitetsgatan 2, 651 88 Karlstad, Sweden
| | - Sissel Iren Eikeland Husebø
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 41, 4036 Stavanger, Norway
- Research Group of Nursing and Health Care Sciences, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway
| | - Randi Ballangrud
- Department of Health Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Teknologivegen 22, 2815 Gjøvik, Norway
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79
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Read J, Perry W, Rossaak JI. Ward round checklist improves patient perception of care. ANZ J Surg 2021; 91:854-859. [PMID: 33459481 DOI: 10.1111/ans.16543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Checklists have been shown to reduce morbidity and mortality in medicine by improving documentation and reducing errors. In the modern era of care, where patients are the centre of decision-making, this study examines patient perception of care and error prevention with the use of ward round checklist. METHODS We conducted a prospective stepped-wedge cluster randomized controlled checklist intervention study using a standardized questionnaire to investigate patients' perception of ward rounds before and after implementation of a ward round checklist. RESULTS A total of 124 patients completed the questionnaire. The overall percentage of items endorsed increased significantly by 5.1% from 64.8% to 70.0% (P = 0.014). Statistically significant improvements were seen in patients knowing their diagnosis (P = 0.027), the day's plan (P = 0.038), observing a medication chart (P < 0.001) and observation chart review (P = 0.008). CONCLUSION Our study indicates that the use of a ward round checklist leads to patient-perceived improvements in aspects of quality of care.
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Affiliation(s)
- Joshua Read
- Department of Surgery, The University of Otago, Dunedin, New Zealand
| | - William Perry
- Department of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy I Rossaak
- Department of Surgery, Tauranga Hospital, Tauranga, New Zealand.,Department of Health Sciences, The University of Auckland, Auckland Hospital, Auckland, New Zealand
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80
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Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Causes and Effects of Introducing Surgery Safety Checklist: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1335:53-62. [PMID: 33797735 DOI: 10.1007/5584_2021_631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The medical treatment process, particularly surgery, is inescapably bound to potential complications or undesirable adverse events. This narrative review aims to present the causes and effects of the introduction of the WHO Surgery Safety Checklist (SSC), the use of which is expected to reduce the number of perioperative errors, complications, and mortality. To achieve this objective, we performed a bibliometric analysis of medical citations indexed in the PubMed database using the SSC subject heading. Findings revealed a total of 1441 articles meeting inclusion status, with 1171 published during the last decade. After the screening of titles and abstracts, the members of the research team selected 75 articles, deemed most relevant for inclusion in the review, which were then thoroughly analyzed. All in all, the findings were that the use of SSC appreciably reduced the number of simple logistic errors in the perioperative period decreasing the frequency of resulting complications and mortality.
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Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczysław Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
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81
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Grozdanovic D, Janackovic GL, Grozdanovic M, Mitkovic MB, Mitkovic MM. The Selection of Main Surgical Work Factors in Operating Rooms. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211067497. [PMID: 34908506 PMCID: PMC8689611 DOI: 10.1177/00469580211067497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main component of error minimization in operating rooms (ORs) is to maintain high reliability of surgical teams. The analysis of adverse events in the OR reveals deficiencies in cognitive and interpersonal skills as the main factors influencing surgeons’ errors. Therefore, research of these additional factors is necessary, besides factors related to surgeons’ clinical knowledge and technical skills. In this paper, the key factors for evaluating activities in surgical operating rooms are identified. Fuzzy analytic hierarchy process is used for identification of key factors. Fifteen key factors are identified for evaluating activities in surgical operating rooms to improve the efficiency of surgical operations. For each group of activities (surgical “capabilities,” operating room characteristics, and non-technical skills), five factors are identified. As the most important, the following factors are obtained: communication, indoor environment standardization, and tool handle design. The aim of the analysis of these key factors is surgeons’ work capability enhancement, rational design of operating rooms, and advancement of operators’ cognitive and interpersonal skills.
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Affiliation(s)
| | | | - Miroljub Grozdanovic
- Faculty of Occupational Safety, Full member of Engineering Academy of Serbia, University of Nis, Nis, Serbia
| | - Milorad B. Mitkovic
- Faculty of Medicine, Full member of Serbian Academy of Science and Arts, University of Nis, Nis, Serbia
| | - Milan M. Mitkovic
- Clinical Centre Nis, Nis, Serbia; Faculty of Medicine, University of Nis, Nis, Serbia
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Hawker WTG, Singh A, Gibson TWG, Giuffrida MA, Weese JS. Use of a surgical safety checklist after implementation in an academic veterinary hospital. Vet Surg 2020; 50:393-401. [PMID: 33378549 DOI: 10.1111/vsu.13561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/06/2020] [Accepted: 11/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN Voluntary online survey and retrospective study. SAMPLE POPULATION All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.
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Affiliation(s)
- William T G Hawker
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas W G Gibson
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | | | - J Scott Weese
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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83
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The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients. J Clin Med 2020; 9:jcm9124006. [PMID: 33322347 PMCID: PMC7763652 DOI: 10.3390/jcm9124006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.
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84
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De Bie AJR, Mestrom E, Compagner W, Nan S, van Genugten L, Dellimore K, Eerden J, van Leeuwen S, van de Pol H, Schuling F, Lu X, Bindels AJGH, Bouwman ARA, Korsten EHHM. Intelligent checklists improve checklist compliance in the intensive care unit: a prospective before-and-after mixed-method study. Br J Anaesth 2020; 126:404-414. [PMID: 33213832 DOI: 10.1016/j.bja.2020.09.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds. METHODS We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range). RESULTS Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement. CONCLUSIONS A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU. CLINICAL TRIAL REGISTRATION NCT03599856.
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Affiliation(s)
- Ashley J R De Bie
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Eveline Mestrom
- Department of Internal Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Wilma Compagner
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Shan Nan
- Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | - Lenneke van Genugten
- Department of Brain, Behaviour and Cognition, Philips Research, Eindhoven, The Netherlands
| | - Kiran Dellimore
- Department of Patient Care and Measurements, Philips Research, Eindhoven, The Netherlands
| | - Jacco Eerden
- Department of Philips Design, Eindhoven, The Netherlands
| | | | - Harald van de Pol
- Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Xudong Lu
- College of Biomedical Engineering and Instrumental Science, Zhejiang University, Hangzhou, China
| | | | - Arthur R A Bouwman
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Anaesthesiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Erik H H M Korsten
- Department of Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Healthcare Intelligence, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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85
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Mitchell SJ. Improving outcomes for surgical patients. BMJ 2020; 371:m3929. [PMID: 33148633 DOI: 10.1136/bmj.m3929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Simon J Mitchell
- Department of Anaesthesiology, University of Auckland, Auckland 1142, New Zealand
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86
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Abstract
The literature overwhelmingly supports standardized, evidence-based care to improve patient safety in the surgical setting, including checklists and enhanced recovery programs. Although local culture, patient complexity, and hospital setting can represent barriers to implanting standardized practices, they can be overcome with thoughtful strategies.
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Affiliation(s)
- Elizabeth Lancaster
- Department of Surgery, University of California, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA
| | - Elizabeth Wick
- Department of Surgery, University of California, 513 Parnassus Avenue, S-321, San Francisco, CA 94143, USA.
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87
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Berg KM, Cheng A, Panchal AR, Topjian AA, Aziz K, Bhanji F, Bigham BL, Hirsch KG, Hoover AV, Kurz MC, Levy A, Lin Y, Magid DJ, Mahgoub M, Peberdy MA, Rodriguez AJ, Sasson C, Lavonas EJ. Part 7: Systems of Care: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S580-S604. [PMID: 33081524 DOI: 10.1161/cir.0000000000000899] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Survival after cardiac arrest requires an integrated system of people, training, equipment, and organizations working together to achieve a common goal. Part 7 of the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care focuses on systems of care, with an emphasis on elements that are relevant to a broad range of resuscitation situations. Previous systems of care guidelines have identified a Chain of Survival, beginning with prevention and early identification of cardiac arrest and proceeding through resuscitation to post-cardiac arrest care. This concept is reinforced by the addition of recovery as an important stage in cardiac arrest survival. Debriefing and other quality improvement strategies were previously mentioned and are now emphasized. Specific to out-of-hospital cardiac arrest, this Part contains recommendations about community initiatives to promote cardiac arrest recognition, cardiopulmonary resuscitation, public access defibrillation, mobile phone technologies to summon first responders, and an enhanced role for emergency telecommunicators. Germane to in-hospital cardiac arrest are recommendations about the recognition and stabilization of hospital patients at risk for developing cardiac arrest. This Part also includes recommendations about clinical debriefing, transport to specialized cardiac arrest centers, organ donation, and performance measurement across the continuum of resuscitation situations.
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88
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Abbott LE, Andes A, Pattani AC, Mabrouk PA. Authorship Not Taught and Not Caught in Undergraduate Research Experiences at a Research University. SCIENCE AND ENGINEERING ETHICS 2020; 26:2555-2599. [PMID: 32410102 DOI: 10.1007/s11948-020-00220-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students' limited epistemic development, the busy-ness of the faculty, and the faculty's failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified.
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Affiliation(s)
- Lauren E Abbott
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, 02115, USA
| | - Amy Andes
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, 02115, USA
| | - Aneri C Pattani
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, 02115, USA
| | - Patricia Ann Mabrouk
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, 02115, USA.
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89
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Emond YEJJM, Wolff AP, Peters YAS, Bloo GJA, Westert GP, Damen J, Calsbeek H, Wollersheim HC. Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals. Implement Sci Commun 2020; 1:49. [PMID: 32885205 PMCID: PMC7427904 DOI: 10.1186/s43058-020-00037-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 04/29/2020] [Indexed: 01/02/2023] Open
Abstract
Background To improve perioperative patient safety, guidelines for the preoperative, peroperative, and postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline adherence and to explore what can be learned for future implementation projects in complex organizations. Methods We developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. for classifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument for measuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviews with quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. The target group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on a five-point Likert scale (which were classified into the seven categories of the framework: factors relating to the intervention, society, implementation, organization, professional, patients, and social factors), respondents were invited to rank their three most important barriers in a separate, extra open-ended question. Results Ninety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered to be barriers, relating to social factors (N = 5), the organization (N = 4), the professional (N = 4), the patient (N = 1), and the intervention (N = 1). An integrated information system was considered an important facilitator (70.4%) as well as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly all categories. The most frequently reported barriers were as follows: time pressure (16% of the total number of barriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%). Conclusions We identified a wide range of barriers that are believed to hinder the use of the perioperative safety guidelines, while an integrated information system and local data collection and feedback will also be necessary to engage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementation strategies. These results may also be of relevance for guideline implementation in general in complex organizations. Trial registration Dutch Trial Registry: NTR3568.
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Affiliation(s)
- Yvette E J J M Emond
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.,Radboudumc, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.,Radboudumc, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500 HB Nijmegen, The Netherlands
| | - André P Wolff
- University Medical Center Groningen, University of Groningen, Department of Anesthesiology, Pain Center, Groningen, The Netherlands
| | - Yvonne A S Peters
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Gerrit J A Bloo
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.,Radboudumc, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Gert P Westert
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Johan Damen
- Radboudumc, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Hiske Calsbeek
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Hub C Wollersheim
- Radboudumc, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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90
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Lützeler R, Uerlich M, Ronellenfitsch U, Pieper D. [Improvement in the Quality of the OP Surgery Checklist by Optimisation of Content and Structural, as well as Measures to Promote Compliance]. Zentralbl Chir 2020; 146:58-67. [PMID: 32838444 DOI: 10.1055/a-1209-3552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Complications occur in 3 to 16% of surgical procedures. According to experts, about 50% of these adverse events are avoidable. It is empirically proven that mortality and complication rates can be reduced by introducing checklists. MATERIAL AND METHOD In this study, the quality of completion of the new checklist, which has already been used for several years, was compared with a checklist optimised by the Quality and Clinical Risk Management Department. The new surgical checklist was introduced at the beginning of January 2017 in a hospital providing primary and regular care. In addition, compliance-promoting measures (training, etc.) were carried out to encourage the use of the new checklist. RESULTS A total of 293 surgical safety checklists each (pre and post) were evaluated. With the introduction of the new checklist for a total of 8 items, the quality of the surgical safety checklists consisting of 11 items improved. In the course of the implementation of the new surgical safety checklist, there was no item for which the quality of completion was reduced compared to the old list. CONCLUSION It was proven that the introduction of these optimised surgical safety checklists in connection with compliance promoting measures resulted in a significantly improved quality of completion. However, in view of the literature on this topic, it can also be stated that the compliance-promoting measures made an important contribution to this result.
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Affiliation(s)
- Robert Lützeler
- Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
| | | | - Ulrich Ronellenfitsch
- Universitätsklinik und Poliklinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle (Saale), Deutschland
| | - Dawid Pieper
- Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
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91
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The concept of peri-operative medicine to prevent major adverse events and improve outcome in surgical patients: A narrative review. Eur J Anaesthesiol 2020; 36:889-903. [PMID: 31453818 DOI: 10.1097/eja.0000000000001067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Peri-operative Medicine is the patient-centred and value-based multidisciplinary peri-operative care of surgical patients. Peri-operative stress, that is the collective response to stimuli occurring before, during and after surgery, is, together with pre-existing comorbidities, the pathophysiological basis of major adverse events. The ultimate goal of Peri-operative Medicine is to promote high quality recovery after surgery. Clinical scores and/or biomarkers should be used to identify patients at high risk of developing major adverse events throughout the peri-operative period. Allocation of high-risk patients to specific care pathways with peri-operative organ protection, close surveillance and specific early interventions is likely to improve patient-relevant outcomes, such as disability, health-related quality of life and mortality.
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92
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Beaumont A, Beaumont J, Osler FG, Piscione TD, Gooi A. Peri-Operative Patient Safety - An Interactive Workshop for Section 3 CPD Credits Developed in Collaboration with the CMPA. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:479-484. [PMID: 32753997 PMCID: PMC7354081 DOI: 10.2147/amep.s231351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Royal College of Physicians and Surgeons of Canada requires physicians to collect credit in continuing professional development courses including Section 3 credits which require feedback and self-assessment. This study aims to examine the effectiveness of offering Section 3 credits in a conference setting using an interactive workshop on peri-operative patient safety developed in collaboration with the Canadian Medical Protective Association (CMPA). Both the knowledge gained and the attitudes towards the conference were analysed. METHODS This was a pre/post-test study design. An interactive case studies workshop was implemented on medicolegal issues for patient care, before, during, and after surgery at the Canadian Society of Otolaryngology Head and Neck Surgery annual meeting. The workshop used small group and large interactive group educational strategies to gauge knowledge of both pre and post cases. Participants completed a questionnaire at the end of the workshop comparing their attitudes before and after the workshop. RESULTS There were 22 participants in the workshop. A little over half knew the requirements for Section 3 CPD credits (58%) but only 36% knew how to obtain them. The data demonstrated with 95% confidence intervals, statistically significant improvement in how participants felt about their ability to identify at-risk behaviours in surgical practice (2.10 to 2.90, 3-point Likert, p<0.001), to analyze the impact of at-risk behaviour on patient care (1.95 to 2.65, p<0.001), and to develop strategies to address at-risk behaviours in surgical practice and improve patient care (1.95 to 2.80, p<0.001). One hundred percent of participants felt similar workshops should be included in future annual meetings, and 94% felt that future meetings should include more opportunities to obtain Section 3 credits. CONCLUSION This study demonstrates the effectiveness of an interactive workshop in a conference setting to fulfill the need for Section 3 continuing professional development credits.
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Affiliation(s)
| | | | - F Gigi Osler
- Department of Otolaryngology - Head & Neck Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Tino D Piscione
- Canadian Medical Protective Association, Station “T”, Ottawa, Canada
| | - Adrian Gooi
- Department of Otolaryngology - Head & Neck Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
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93
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Almquist M, Tingstedt B. Checklists Combined-Achieving More Than the Sum of the Parts. JAMA Surg 2020; 155:571. [PMID: 32401289 DOI: 10.1001/jamasurg.2020.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Almquist
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Section of Endocrine Sarcoma, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Bobby Tingstedt
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Section of Hepatobiliarypancreatic Surgery, Department of Surgery, Skåne University Hospital, Lund, Sweden
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95
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Espin S, Indar A, Gross M, Labricciosa A, D'Arpino M. Processes and tools to improve teamwork and communication in surgical settings: a narrative review. BMJ Open Qual 2020; 9:bmjoq-2020-000937. [PMID: 32554445 PMCID: PMC7304801 DOI: 10.1136/bmjoq-2020-000937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | | | | | - Maryanne D'Arpino
- Safety Improvement and Capability Building, Canadian Patient Safety Institute, Ottawa, Ontario, Canada
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96
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Krupic F, Svantesson E, Seffo N, Westin O, Hamrin Senorski E. Use of the World Health Organization Checklist—Swedish Health Care Professionals' Experience: A Mixed-Method Study. J Perianesth Nurs 2020; 35:288-293. [DOI: 10.1016/j.jopan.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/16/2022]
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97
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Allard MA, Blanié A, Brouquet A, Benhamou D. Learning non-technical skills in surgery. J Visc Surg 2020; 157:S131-S136. [DOI: 10.1016/j.jviscsurg.2020.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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98
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Abstract
Supplemental digital content is available in the text. There have been epidemiological studies of adverse events (AEs) among general patients but those of patients cared by cardiologist are not well scrutinized. We investigated the occurrence of AEs and medical errors (MEs) among adult patients with cardiology in Japan.
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99
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Dekker-van Doorn C, Wauben L, van Wijngaarden J, Lange J, Huijsman R. Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study. BMC Health Serv Res 2020; 20:426. [PMID: 32410618 PMCID: PMC7227082 DOI: 10.1186/s12913-020-05306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals’ needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. Methods Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital’s OT. Results 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. Conclusions Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.
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Affiliation(s)
- Connie Dekker-van Doorn
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands. .,Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Linda Wauben
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - Jeroen van Wijngaarden
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
| | - Johan Lange
- Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
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Alfaqawi M, Böttcher B, Abuowda Y, Alaloul E, Elnajjar I, Elhout S, Abu-El-Noor M, Abu-El-Noor N. Treating patients in a safe environment: a cross-sectional study of patient safety attitudes among doctors in the Gaza Strip, Palestine. BMC Health Serv Res 2020; 20:388. [PMID: 32380987 PMCID: PMC7203848 DOI: 10.1186/s12913-020-05230-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes. METHODS Doctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace. RESULTS A total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain "Working hours as a cause of errors" (4.16) and the lowest score by "Importance of Patient Safety in the Curriculum" (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety. CONCLUSION Doctors in Gaza demonstrated relatively positive patient safety attitudes in areas of "team functioning" and "working hours as a cause for error", but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.
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Affiliation(s)
- Maha Alfaqawi
- Nasser Medical Complex, Palestinian Ministry of Health Khan Younis, Gaza Strip, Palestine
| | - Bettina Böttcher
- Nasser Medical Complex, Palestinian Ministry of Health Khan Younis, Gaza Strip, Palestine.
| | - Yousef Abuowda
- Faculty of Medicine, Islamic University of Gaza, PO Box 108, Remal Gaza, Gaza Strip, Palestine
| | - Enas Alaloul
- Alshifaa Medical Complex, Palestinian Ministry of Health, Gaza Strip, Palestine
| | - Ibrahem Elnajjar
- Faculty of Medicine, Islamic University of Gaza, PO Box 108, Remal Gaza, Gaza Strip, Palestine
| | - Somaya Elhout
- Alshifaa Medical Complex, Palestinian Ministry of Health, Gaza Strip, Palestine
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