101
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Neyens DM, Bayramzadeh S, Catchpole K, Joseph A, Taaffe K, Jurewicz K, Khoshkenar A, San D. Using a systems approach to evaluate a circulating nurse's work patterns and workflow disruptions. APPLIED ERGONOMICS 2019; 78:293-300. [PMID: 29609835 PMCID: PMC6165699 DOI: 10.1016/j.apergo.2018.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
The physical environment affects how work is done in operating rooms (OR). The circulating nurse (CN), in particular, requires access to and interacts with materials, equipment, and technology more than other OR team members. Naturalistic study of CN behavior is therefore valuable in assessing how OR space and physical configuration influences work patterns and disruptions. This study evaluated the CNs' work patterns and flow disruptions (FD) by analyzing 25 surgeries across three different ORs. The OR layouts were divided into transitional and functional zones, and the work of CNs was categorized into patient, equipment, material, and information tasks. The results reveal that information tasks involve less movement than other types of work, while across all ORs, CNs were more likely to be involved in layout and environmental hazard FDs when involved in patient, material, or equipment-related tasks compared to information tasks. Different CN work patterns and flow disruptions between ORs suggest a link between OR layout and a CN's work. Future studies should examine how specific layout elements influence outcomes.
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Affiliation(s)
- David M Neyens
- Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA.
| | - Sara Bayramzadeh
- Clemson University, School of Architecture, Lee 2, Clemson University, Clemson, SC 29634, USA.
| | - Kenneth Catchpole
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, Charleston, SC 29425, USA.
| | - Anjali Joseph
- Clemson University, School of Architecture, Lee 2, Clemson University, Clemson, SC 29634, USA.
| | - Kevin Taaffe
- Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA.
| | - Katherina Jurewicz
- Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA.
| | - Amin Khoshkenar
- Clemson University, Department of Industrial Engineering, 100 Freeman Hall, College of Engineering, Computing and Applied Sciences, Clemson, SC 29634, USA.
| | - Dee San
- Medical University of South Carolina, 169 Ashley Avenue, Suite 638, Charleston, SC 29625, USA.
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102
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Alban RF, Anania EC, Cohen TN, Fabri PJ, Gewertz BL, Jain M, Jopling JK, Maggio PM, Sanchez JA, Sax HC. Performance improvement in surgery. Curr Probl Surg 2019; 56:211-246. [PMID: 31155033 DOI: 10.1067/j.cpsurg.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/06/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Rodrigo F Alban
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Tara N Cohen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Bruce L Gewertz
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Monica Jain
- University of California San Francisco Medical Center, San Francisco, CA
| | | | | | - Juan A Sanchez
- St. Agnes Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harry C Sax
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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103
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Rodríguez LM, Posada M, Acuña J. Instrumentador Quirúrgico: eventos adversos intraoperatorios. REPERTORIO DE MEDICINA Y CIRUGÍA 2019. [DOI: 10.31260/repertmedcir.v28.n2.2019.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: el instrumentador quirúrgico cumple un papel importante en la atención del paciente quirúrgico, involucrándose en la manipulación de medicamentos que pueden generar incidentes y eventos adversos (EA). El presente estudio describe los EA publicados que ocurrieron durante la atención intraoperatoria. Materiales y métodos: revisión de la literatura en las plataformas Cochrane, MEDLINE, Embase y bases de datos de literatura de salud Pubmed, OVID, UptoDate y Scielo entre 2006 y 2017. Resultados: se localizaron 1.747 documentos eliminándose 1.697 por no cumplir con criterios de inclusión y de los 50 restantes se descartaron 41 por no contar con información de interés para el presente estudio. Conclusiones: aunque en los quirófanos los EA asociados con la manipulación de medicamentos no es infrecuente, se requieren más estudios con alto nivel de evidencia que permitan asociar la práctica asistencial del instrumentador quirúrgico con dichos EA intraoperatorios.
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104
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Birgand G, Haudebourg T, Grammatico-Guillon L, Ferrand L, Moret L, Gouin F, Mauduit N, Leux C, Le Manach Y, Lepelletier D, Tavernier E, Lucet JC, Giraudeau B. Improvement in staff behavior during surgical procedures to prevent post-operative complications (ARIBO 2): study protocol for a cluster randomised trial. Trials 2019; 20:275. [PMID: 31109343 PMCID: PMC6528209 DOI: 10.1186/s13063-019-3370-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Inappropriate staff behaviour during surgical procedures may disrupt the surgical performance and compromise patient safety. We developed an innovative monitoring and feedback system combined with an adaptive approach to optimise staff behaviour intraoperatively and prevent post-operative complications (POC) in orthopaedic surgery. METHODS/DESIGN This protocol describes a parallel-group, cluster randomised, controlled trial with orthopaedic centre as the unit of randomisation. The intervention period will last 6 months and will be based on the monitoring of two surrogates of staff behaviour: the frequency of doors opening and the level of noise. Both will be collected from incision to wound closure, using wireless sensors and sonometers, and recorded and analysed on a dedicated platform (Livepulse®). Staff from centres randomised to the intervention arm will be informed in real time on their own data through an interactive dashboard available in each operating room (OR), and a posteriori for hip and knee replacement POC. Aggregated data from all centres will also be displayed for benchmarking. A lean method will be applied in each centre by a local multidisciplinary team to analyse baseline situations, determine the target condition, analyse the root cause(s), and take countermeasures. The education and awareness of participants on the impact of their behaviour on patient safety will assist the quality improvement process. The control centres will be blinded to monitoring data and quality improvement approaches. The primary outcome will be any POC occurring during the 30 days post operation. We will evaluate this outcome using local and national routinely collected data from hospital discharge and disease databases. Thirty orthopaedic centres will be randomised for a total of 9945 hip and knee replacement surgical procedures. DISCUSSION The field of human factors and behaviour in the OR seems to offer potential room for improvement. An intervention providing goal-setting, monitoring, feedback and action planning may reduce the traffic flow and interruptions/distractions of the surgical team during procedures, preventing subsequent POCs. The results of this trial will provide important data on the impact of OR staff behaviour on patient safety, and promote best practice during surgical procedures. TRIAL REGISTRATION ClinicalTrials.gov, NCT03158181 .
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Affiliation(s)
- Gabriel Birgand
- CPias Pays de la Loire, Nantes University Hospital, CHU - Le Tourville, 5, rue du Pr Yves Boquien, 44093, Nantes, cedex, France. .,Health Protection Research Unit, Imperial College London, London, UK.
| | - Thomas Haudebourg
- CPias Pays de la Loire, Nantes University Hospital, CHU - Le Tourville, 5, rue du Pr Yves Boquien, 44093, Nantes, cedex, France
| | - Leslie Grammatico-Guillon
- Service de Santé Publique, Unité Régionale d'épidémiologie Hospitalière, CHU, Université de Tours, Tours, France
| | - Léa Ferrand
- Direction de la Recherche Clinique, Nantes University Hospital, Nantes, France
| | - Leila Moret
- Service de Santé Publique, Nantes University Hospital, Nantes, France
| | - François Gouin
- Service de Chirurgie Orthopédique, Nantes University Hospital, Nantes, France
| | - Nicolas Mauduit
- Service D'information Médicale, Nantes University Hospital, Nantes, France
| | - Christophe Leux
- Service D'information Médicale, Nantes University Hospital, Nantes, France
| | - Yannick Le Manach
- Perioperative Medicine and Surgical Research Unit, Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | | | - Elsa Tavernier
- INSERM CIC 1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM SPHERE U1246, Tours, France
| | - Jean-Christophe Lucet
- Unité d'hygiène et de lutte Contre L'infection Nosocomiale (UHLIN), AP-HP, Paris, France
| | - Bruno Giraudeau
- INSERM CIC 1415, CHRU de Tours, Tours, France.,Université de Tours, Université de Nantes, INSERM SPHERE U1246, Tours, France
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105
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Birdas TJ, Rozycki GF, Dunnington GL, Stevens L, Liali V, Schmidt CM. “Show Me the Data”: A Recipe for Quality Improvement Success in an Academic Surgical Department. J Am Coll Surg 2019; 228:368-373. [DOI: 10.1016/j.jamcollsurg.2018.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/01/2022]
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106
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Yang BW, Waters PM. Implementation of an Orthopedic Trauma Program to Safely Promote Resident Autonomy. J Grad Med Educ 2019; 11:207-213. [PMID: 31024655 PMCID: PMC6476100 DOI: 10.4300/jgme-d-18-00277.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/31/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is ongoing tension in graduate medical education between progressive resident autonomy with entrustable professional activities and the need for supervision to ensure patient safety. OBJECTIVE We implemented a pediatric orthopedic surgical trauma safety program that utilized a postcall review conference to provide residents graduated responsibility learning opportunities during overnight trauma call without compromising patient safety. METHODS In the program, all orthopedic trauma cases seen in our main tertiary hospital emergency department by the overnight orthopedic resident were reviewed in a case conference. For 1 year, we performed an analysis of all fracture patients who were treated in the emergency department by our orthopedic surgery residents. From June 1, 2016, through June 30, 2017, all care delivery encounters were reviewed for decision-making errors, technical errors, and complication rates. Two resident groups rotated through our institution over the course of the study. RESULTS During the year of analysis, all 1298 fracture patients seen overnight in the main tertiary hospital emergency department were reviewed. From the first to the second halves of their rotations, the rate of resident decision-making errors (3.1% [12 of 385] to 2.3% [9 of 399]) and technical errors (9.1% [35 of 395] to 7.3% [29 of 399]) decreased. Excluding decision-making and technical errors, the complication rate for patients discharged home was 3.4% (27 of 784). CONCLUSIONS Residents demonstrated decreased decision-making and technical error rates on overnight call while maintaining low complication rates.
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107
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van der Vliet WJ, Haenen SM, Solis-Velasco M, Dejong CHC, Neumann UP, Moser AJ, van Dam RM. Systematic review of team performance in minimally invasive abdominal surgery. BJS Open 2019; 3:252-259. [PMID: 31183440 PMCID: PMC6551413 DOI: 10.1002/bjs5.50133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Adverse events in the operating theatre related to non‐technical skills and teamwork are still an issue. The influence of minimally invasive techniques on team performance and subsequent impact on patient safety remains unclear. The aim of this review was to assess the methodology used to objectify and rate team performance in minimally invasive abdominal surgery. Methods A systematic literature search was conducted according to the PRISMA guidelines. Studies on assessment of surgical team performance or non‐technical skills of the surgical team in the setting of minimally invasive abdominal surgery were included. Study aim, methodology, results and conclusion were extracted for qualitative synthesis. Results Sixteen studies involving 677 surgical procedures were included. All studies consisted of observational case series that used heterogeneous methodologies to assess team performance and were of low methodological quality. The most commonly used team performance objectification tools were ‘construct’‐ and ‘incident’‐based tools. Evidence of validity for the assessed outcome was spread widely across objectification tools, ranging from low to high. Diverse and poorly defined outcomes were reported. Conclusion Team demands for minimally invasive approaches to abdominal procedures remain unclear. The current literature consists of studies with heterogeneous methodology and poorly defined outcomes.
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Affiliation(s)
- W J van der Vliet
- Department of Hepatobiliary and Pancreatic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - S M Haenen
- Department of Hepatobiliary and Pancreatic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Solis-Velasco
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
| | - C H C Dejong
- Department of Hepatobiliary and Pancreatic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - U P Neumann
- Department of Hepatobiliary and Pancreatic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Surgery, Universitätsklinikum Aachen, Aachen, Germany
| | - A J Moser
- Pancreas and Liver Institute, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
| | - R M van Dam
- Department of Hepatobiliary and Pancreatic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
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108
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Baggaley A, Robb L, Paterson-Brown S, McGregor RJ. Improving the working environment for the delivery of safe surgical care in the UK: a qualitative cross-sectional analysis. BMJ Open 2019; 9:e023476. [PMID: 30679292 PMCID: PMC6347853 DOI: 10.1136/bmjopen-2018-023476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to identify current problems and potential solutions to improve the working environment for the delivery of safe surgical care in the UK. DESIGN Prospective, questionnaire-based cross-sectional study. SETTING/PARTICIPANTS Following validation, an electronic questionnaire was distributed to postgraduate local education and training board distribution lists, the Royal College of Surgeons of Edinburgh (RCSEd) mailing lists and trainee organisations. This consisted of a single open-ended question inviting five open-ended responses. Throughout the 13-week study period, the survey was also published on a number of social media platforms. RESULTS A total of 505 responders completed the survey, of which 35% were consultants, 30% foundation doctors, 17% specialty trainees, 11% specialty doctors, 5% core trainees and <1% surgical nurse practitioners. A total of 2238 free-text answers detailed specific actions to improve the working environment. These responses were individually coded and then grouped into nine categories (staff resources, non-staff resources, support, working conditions, communication and team work, systems improvement, patient centred, training and education, and miscellaneous). CONCLUSIONS The results of this study have identified a number of key areas that, if addressed, may improve the environment for the delivery of safer surgical care. Common themes that emerged across all grades included: increased front-line staff; a return to a 'firm' structure to improve team continuity; greater senior support; and improved hospital facilities to help staff rest and recuperate. While unlimited funding remains unrealistic, many of the suggestions could be implemented in a cost-neutral fashion and include insightful ideas for remodelling or restructuring the workforce to improve the efficiency of the surgical team. The findings of this study formed the basis of a set of recommendations published by the RCSEd as a discussion paper.
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Affiliation(s)
- Alice Baggaley
- Department of Surgery, Homerton University Hospital, London, UK
| | - Lydia Robb
- Clinical Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
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109
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Tanaka K, Eriksson L, Asher R, Obermair A. Incidence of adverse events, preventability and mortality in gynaecological hospital admissions: A systematic review and meta-analysis. Aust N Z J Obstet Gynaecol 2019; 59:195-200. [PMID: 30663036 DOI: 10.1111/ajo.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adverse events (AEs) are unintended consequences of healthcare management that result in temporary or permanent disability, death or prolonged hospital stay. The incidence of AEs has been reported to be higher in surgical specialties compared to medical specialties but information on the incidence of AEs in gynaecology is sparse. AIMS To collect evidence on the incidence, preventability and mortality of AEs in gynaecological hospital admissions by conducting a systematic review and meta-analysis. MATERIALS AND METHODS A systematic search of the PubMed, EMBASE, and CINAHL electronic medical databases was performed. Identified articles were screened and a full-text review was conducted by two independent reviewers. RESULTS Of the 49 studies assessed for eligibility, three studies were included in this systematic review. Meta-analysis showed that the incidence of AEs in gynaecological hospital admissions was 10.8% (95% CI 9.4-12.1%), preventability was 52.5% (95% CI 47.3-57.7%) and mortality was 1.2% (95% CI 0-2.5%). CONCLUSIONS Evidence on AEs in gynaecological hospital admissions is limited. Available evidence suggests that approximately one in ten gynaecological inpatients suffer at least one AE and half of AEs are considered preventable. Further research is needed to determine strategies regarding how the incidence of preventable AEs can be reduced.
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Affiliation(s)
- Keisuke Tanaka
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia
| | - Lars Eriksson
- UQ Library, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Andreas Obermair
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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110
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Ribeiro L, Fernandes GC, Souza EGD, Souto LC, Santos ASPD, Bastos RR. Checklist de cirurgia segura: adesão ao preenchimento, inconsistências e desafios. Rev Col Bras Cir 2019; 46:e20192311. [DOI: 10.1590/0100-6991e-20192311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar a adesão ao checklist de cirurgia segura, a partir do seu preenchimento, em um hospital geral de referência do interior do Estado de Minas Gerais, bem como, verificar os fatores associados à sua utilização. Métodos: trata-se de estudo transversal, documental, retrospectivo de abordagem quantitativa. A coleta de dados foi realizada por meio da revisão retrospectiva de prontuários de uma amostra de pacientes operados no período de um ano. Foram incluídos os atendimentos de pacientes cirúrgicos de todas as especialidades, com idade de 18 anos ou mais, e período de internação igual ou maior do que 24 horas. A amostra probabilística foi de 423 casos. Resultados: o checklist estava presente em 95% dos prontuários. Porém, apenas 67,4% deles estavam com preenchimento completo. A presença do checklist no prontuário apresentou associação significativa com o risco anestésico do paciente. Não houve diferença no percentual de preenchimento entre os três momentos do checklist: antes da indução anestésica (sign in), antes da incisão cirúrgica (time out ou parada cirúrgica) e antes do paciente deixar a sala de cirurgia (sign out). Também não foram encontradas diferenças significativas em relação ao percentual de preenchimento dos itens de responsabilidade do cirurgião. Considerando o procedimento cirúrgico realizado, foram encontradas incoerências no item lateralidade. Conclusão: apesar do elevado percentual de prontuários com checklist, a presença de incompletude e incoerência pode comprometer os resultados esperados na segurança do paciente cirúrgico.
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111
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A prospective study of the safety and usefulness of a new miniature wide-angle camera: the "BirdView camera system". Surg Endosc 2019; 33:199-205. [PMID: 29967996 DOI: 10.1007/s00464-018-6293-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The performance of endoscopic surgery has quickly become widespread as a minimally invasive therapy. However, complications still occur due to technical difficulties. In the present study, we focused on the problem of blind spots, which is one of the several problems that occur during endoscopic surgery and developed "BirdView," a camera system with a wide field of view, with SHARP Corporation. METHODS In the present study, we conducted a clinical trial (Phase I) to confirm the safety and usefulness of the BirdView camera system. We herein report the results. RESULTS In this study, surgical adverse events were reported in 2 cases (problems with ileus and urination). There were no cases of device failure, damage to the surrounding organs, or mortality. CONCLUSIONS We evaluated the safety of the BirdView camera system. We believe that this camera system will contribute to the performance safe endoscopic surgery and the execution of robotic surgery, in which operators do not have the benefit of tactile feedback.
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112
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Saarinen I, Malmivaara A, Miikki R, Kaipia A. Systematic review of hospital-wide complication registries. BJS Open 2018; 2:293-300. [PMID: 30263980 PMCID: PMC6156167 DOI: 10.1002/bjs5.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022] Open
Abstract
Background An institutional registry covering all surgical specialties could be an implementation tool in quality benchmarking between hospitals and aid determination of their cost‐effectiveness. The objective of this systematic literature review was to evaluate original articles on existing prospective surgical registries that can be used by single institutions across surgical specialties. Method A systematic review of the literature using PRISMA guidelines was conducted for articles focusing on hospital‐wide surgical registries. Single‐specialty retrospective registries, non‐defined outcome measures or system protocols, and studies not in English were excluded. Results Five articles were included for analysis. Evaluation of the articles revealed wide methodological heterogeneity in the classification and categorization of complications and data collection methods. Conclusion Ideal surgical quality monitoring systems should be real‐time, contain patient‐related risk factors, and encompass all surgical specialties. At present, such institutional registries are rarely reported and no consensus exists on their standard definitions and methodology.
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Affiliation(s)
- I Saarinen
- Department of Surgery Satakunta Central Hospital Pori Finland
| | - A Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare Helsinki Finland
| | - R Miikki
- Centre for Health and Social Economics, National Institute for Health and Welfare Helsinki Finland
| | - A Kaipia
- Department of Surgery Satakunta Central Hospital Pori Finland.,Department of Urology Tampere University Hospital Tampere Finland
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113
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Boet S, Larrigan S, Martin L, Liu H, Sullivan KJ, Etherington N. Measuring non-technical skills of anaesthesiologists in the operating room: a systematic review of assessment tools and their measurement properties. Br J Anaesth 2018; 121:1218-1226. [PMID: 30442248 DOI: 10.1016/j.bja.2018.07.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/25/2018] [Accepted: 07/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Non-technical skills, such as communication or leadership, are integral to clinical competence in anaesthesia. There is a need for valid and reliable tools to measure anaesthetists' non-technical performance for both initial and continuing professional development. This systematic review aims to summarise the measurement properties of existing assessment tools to determine which tool is most robust. METHODS Embase (via OVID), Medline and Medline in Process (via OVID), and reference lists of included studies and previously published relevant systematic reviews were searched (through August 2017). Quantitative studies investigating the measurement properties of tools used to assess anaesthetists' intraoperative non-technical skills, either in a clinical or simulated environment, were included. Pairs of independent reviewers determined eligibility and extracted data. Risk of bias was assessed using the COSMIN checklist. RESULTS The search yielded 978 studies, of which 14 studies describing seven tools met the inclusion criteria. Of these, 12 involved simulated crisis settings only. The measurement properties of the Anaesthetists' Non-Technical Skills (ANTS) tool were most commonly assessed (n=9 studies), with studies of two types of validity (content, concurrent) and two types of reliability (internal consistency, interrater). Most of these studies, however, were at serious risk of bias. CONCLUSIONS Though there are seven tools for assessing the non-technical skills of anaesthetists, only ANTS has been extensively investigated with regard to its measurement properties. ANTS appears to have acceptable validity and reliability for assessing non-technical skills of anaesthetists in both simulated and clinical settings. Future research should consider additional clinical contexts and types of measurement properties.
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Affiliation(s)
- S Boet
- Department of Anaesthesiology and Pain Medicine, Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Innovation in Medical Education, University of Ottawa, ON, Canada.
| | - S Larrigan
- Translational and Molecular Medicine Program, ON
| | | | | | - K J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - N Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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114
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Crafoord MT, Mattsson J, Fagerdahl AM. Operating Room Nurses' Perceptions of the Clinical Learning Environment: A Survey Study. J Contin Educ Nurs 2018; 49:416-423. [PMID: 30148539 DOI: 10.3928/00220124-20180813-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Authors commonly agree that the clinical learning environment significantly affects student learning. Studies of how operating room nurses perceive the clinical learning environment during their specialist studies are sparse. METHOD This study aimed to examine newly graduated operating room nurses' perceptions of the clinical learning environment during their specialist education. Fifty newly graduated operating room nurses answered a questionnaire gaging their perceptions of clinical education. RESULTS Most participants perceived the clinical learning environment as good and highly associated with the supervisor's ability to supervise, enjoy supervision, and show interest in the participants' degree project. The management at the clinical setting, which was perceived to emphasize the importance of supervision, time allocated especially for supervision, and perceived cooperation between the University and hospital, also had an impact. CONCLUSION Social interactions and structures within the operating room affect how the clinical learning environment is perceived. J Contin Educ Nurs. 2018;49(9):416-423.
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115
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Panuganti B, Qiu Y, Messing B, Lee G, Fakhry C, Blanco R, Ha P, Messer K, Califano JA. Effects of a Comprehensive Performance Improvement Strategy on Postoperative Adverse Events in Head and Neck Surgery. Otolaryngol Head Neck Surg 2018; 160:799-809. [DOI: 10.1177/0194599818793887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives We aimed to demonstrate the efficacy of a multifaceted performance improvement regimen to reduce the incidence of adverse events following a spectrum of head and neck surgical procedures. Methods We conducted a chart review of patients who underwent a head and neck procedure between January 1, 2013, and October 30, 2015, at our institution, including 392 patients (450 procedures) before the quality improvement regimen was implemented (October 1, 2013) and 942 patients (1136 procedures) after implementation. Multivariate statistical models were used to investigate the association of clinical parameters and the intervention with postoperative adverse event rate. Results The incidence of adverse events decreased from 12.9% to 7.2% (95% CI, 2.46%-9.38%) after the intervention. Male sex (adjusted odds ratio [ORadj] = 1.57; 95% CI, 1.06-2.31) and the intervention (ORadj = 0.51; 95% CI, 0.35-0.74) were predictive of overall adverse event incidence by univariate and multivariate analyses. Although patient comorbid status, quantified with the Charlson Comorbidity Index, was not found to affect overall adverse event risk, each 1-point increase in index score was associated with a 17% relative increase (ORadj = 1.17; 95% CI, 1.03-1.33) in the odds of a high-grade adverse event. Discussion Comprehensive performance improvement programs can improve perioperative adverse event risk in head and neck surgery. Patient comorbid status and sex are considerations during assessment of the likelihood of high-grade and overall adverse event risk, respectively. Implications for Practice Given the cost of surgical complications, a comprehensive approach to perioperative risk mitigation is warranted.
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Affiliation(s)
- Bharat Panuganti
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California–San Diego, San Diego, CA, USA
| | - Yuqi Qiu
- Division of Biostatistics and Bioinformatics, University of California–San Diego, San Diego, California, USA
| | - Barbara Messing
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Gregory Lee
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Carole Fakhry
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Raymond Blanco
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Patrick Ha
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Karen Messer
- Division of Biostatistics and Bioinformatics, University of California–San Diego, San Diego, California, USA
| | - Joseph A. Califano
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of California–San Diego, San Diego, CA, USA
- Milton J. Dance Head and Neck Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Moores Cancer Center, University of California–San Diego, San Diego, California, USA
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Bergs J, Lambrechts F, Desmedt M, Hellings J, Schrooten W, Vlayen A, Vandijck D. Seen through the patients' eyes: surgical safety and checklists. Int J Qual Health Care 2018; 30:118-123. [PMID: 29340625 DOI: 10.1093/intqhc/mzx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022] Open
Abstract
Objective We sought to explore the views patients have towards surgical safety and checklists. As a secondary aim, we explored if previous experience of error or other patient characteristics influence these views. Design A cross-sectional survey study design was applied. Participants The Flemish Patients' Platform network and social media were used to recruit participants. Main outcome measure(s) An 11-item questionnaire was designed to assess the following constructs: perception of surgical safety, attitudes towards the WHO surgical safety checklist and attitudes regarding checklist usage. Results Respondents' view (N = 444) on the risk of an adverse event showed considerable variation. Respondents were positive towards the checklist, strongly agreeing that it would impact positively on their safety. However, this positive perception did not translate into an attitude where patients will actively inform themselves whether a checklist is used. The majority of respondents have no difficulty with repetitive verification of identity, procedure and location of the surgery. Respondents with a clinical background were the least anxious. Views were divided regarding hearing discussions around blood loss or airway problems. Conclusions Patients perceive the checklist as a reliable safety tool. They do not mind repetitive verification of identity and procedure. However, hearing staff discussing specific, explicit, risks could cause anxiousness in some patients. Building a supportive and collaborative environment is needed to involve and empower patients to contribute in the realization of a safe hospital environment.
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Affiliation(s)
- Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Frank Lambrechts
- Faculty of Busines Economics, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,AZ Delta Hospital, General Management, Rode-kruisstraat 20, 8800 Roeselare, Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Gent, Belgium
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Somasundram K, Spence H, Colquhoun AJ, Mcilhenny C, Biyani CS, Jain S. Simulation in urology to train non-technical skills in ward rounds. BJU Int 2018; 122:705-712. [PMID: 29777617 DOI: 10.1111/bju.14402] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To report our experience of an exercise designed to train newly appointed urology trainees in non-technical skills on ward rounds as a part of a simulation 'boot camp', through a qualitative analysis of participant feedback on the utility of this method of training. PATIENTS AND METHODS The simulations took place in a high-fidelity simulated ward bay. Forty-eight doctors with formal urology training ranging between 2 and 60 months (mean 19.1 ± 11.6 months) took part. Thirty-one participants were on a formal urology specialty training pathway. The remaining participants were core (pre-specialty) surgical trainees. The entry requirement was that participants must be junior-level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play patients and a simulated 'switchboard' for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology-related scenario. 'Freeze-frames' were used to 'pause' the ward round, whereby observing consultants provided feedback on performance. After the simulated exercises, a whole-group structured debriefing took place. Non-Technical Skills for Surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two-part feedback form. Part one involved nine questions scored on a Likert scale, and part two required free-text responses. RESULTS The mean (±sd) itemized NOTSS scores for situational awareness, decision-making, communication and teamwork, and leadership were 3.01 (±0.15), 2.95 (±0.16), 3.05 (±0.19), and 2.98 (±0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of actors as patients and real staff, and the use of freeze-frames for immediate feedback. Residents also provided suggestions for distractions to be considered in the future. CONCLUSIONS This simulated ward round was generally well received by participants, and the obtained feedback provides an insight into how this can be adapted to maximize the benefits for new specialty residents. The mean NOTSS scores indicated that non-technical skills performances could be improved. This supports our rationale to train non-technical skills in a safe environment to bolster career transition into positions of greater decision-making autonomy.
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Rodella S, Mall S, Marino M, Turci G, Gambale G, Montella MT, Bonilauri S, Gelmini R, Zuin P. Effects on Clinical Outcomes of a 5-Year Surgical Safety Checklist Implementation Experience: A Large-scale Population-Based Difference-in-Differences Study. Health Serv Insights 2018; 11:1178632918785127. [PMID: 30046243 PMCID: PMC6056784 DOI: 10.1177/1178632918785127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/24/2018] [Indexed: 11/17/2022] Open
Abstract
The adoption of a surgical checklist is strongly recommended worldwide as an effective
practice to improve patient safety; however, several studies have reported mixed results
and a number of issues are still unresolved. The main objective of this study was to
explore the impact of the first 5-year period of a surgical checklist-based intervention
in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a
retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public
hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011
and 2013 through a computerized database. The effects of the intervention were explored
through multivariable logistic regression and difference-in-differences (DID) approaches,
based on current administrative data sources. In-hospital and 30-days mortality, 30-days
readmissions and length-of-stay (LOS) ⩾8 days were the observed outcomes. Adherence to the
checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis
detected statistically significant differences between surgical interventions performed in
hospitals with higher adherence to the checklist (⩾75% of the surgeries) and those
performed in other hospitals, as for the 30-days readmissions rate (odds
ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS ⩾ 8 days rate (OR:
0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID
analysis. No association was observed with mortality outcomes. On the whole, our study
attained mixed results. Although a protective effect of the surgical
checklist use could not be proved over the first 5 years of this regional implementation
experience, our research offers some methodological insights for practical use in the
evaluation process of large-scale implementation projects.
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Affiliation(s)
- Stefania Rodella
- Agenzia Sanitaria e Sociale Regionale-Emilia-Romagna, Bologna, Italy
| | - Sabine Mall
- Public Health Department, Azienda USL Bologna-Emilia-Romagna, Bologna, Italy
| | - Massimiliano Marino
- Clinical governance, Azienda USL Reggio Emilia- IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | | | - Giorgio Gambale
- ‡Anesthesia and Intensive Care, Azienda USL Romagna-Emilia-Romagna, Cesena, Italy
| | - Maria Teresa Montella
- Operation Management Unit, Azienda USL Reggio Emilia-IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Department of General Surgery, General and Emergency Surgery, Azienda USL Reggio Emilia- IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | - Roberta Gelmini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Policlinico of Modena, University of Modena and Reggio Emilia-Emilia-Romagna, Modena, Italy
| | - Piera Zuin
- Azienda Ospedaliera - Universitaria Policlinico of Modena-Emilia-Romagna, Modena, Italy
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Gillespie BM, Harbeck EL, Lavin J, Hamilton K, Gardiner T, Withers TK, Marshall AP. Evaluation of a patient safety programme on Surgical Safety Checklist Compliance: a prospective longitudinal study. BMJ Open Qual 2018; 7:e000362. [PMID: 30057963 PMCID: PMC6059267 DOI: 10.1136/bmjoq-2018-000362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/02/2018] [Accepted: 06/14/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Surgical Safety Checklists (SSC) have been implemented widely across 132 countries since 2008. Yet, despite associated reductions in postoperative complications and death rates, implementation of checklists in surgery remains a challenge. The aim of this study was to assess the impact of a patient safety programme over time on SSC use and incidence of clinical errors. DESIGN A prospective longitudinal design over three time points and a retrospective secondary analysis of clinical incident data was undertaken. METHODS We implemented a patient safety programme over 4 weeks to improve surgical teams' use of the SSC. We undertook structured observations to assess surgical teams' checklist use before and after programme implementation and conducted a retrospective audit of clinical incident data 12 months before and 12 months following implementation of the programme. RESULTS There were significant improvements in the observed use of the SSC across all phases, particularly in sign-out where completion rates ranged from 79.3% to 94.5% (p<0.0001) following programme implementation. Across clinical incident audit periods, 33 019 surgical procedures were performed. Based on a subsample of 64 cases, clinical incidents occurred in 22/16 264 (0.13%) before implementation and 42/16 755 (0.25%) cases after implementation. The most predominant incident after programme implementation was inadequate tissue specimen labelling (23/42, 54.8%). Clinical incidents resulted in minimal or no harm to the patient. CONCLUSIONS The benefit in using a surgical checklist lies in the potential to enhance team communications and the promotion of a team culture in which safety is the priority.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Research & Education Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
| | - Emma L Harbeck
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
| | - Joanne Lavin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mount Gravatt, Queensland, Australia
| | - Therese Gardiner
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Teresa K Withers
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Research & Education Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
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Georgiou Ε, Mashini M, Panayiotou I, Efstathiou G, Efstathiou CI, Charalambous M, Irakleous I. Barriers and facilitators for implementing the WHO's safety surgical checklist: A focus group study among nurses. J Perioper Pract 2018; 28:339-346. [PMID: 29911920 DOI: 10.1177/1750458918780120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health's Organization's safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list's implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.
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Affiliation(s)
- Εvanthia Georgiou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Maria Mashini
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Irene Panayiotou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Georgios Efstathiou
- 3 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | | | - Melanie Charalambous
- 5 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus,
| | - Iraklis Irakleous
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
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Yule J, Hill K, Yule S. Development and evaluation of a patient-centred measurement tool for surgeons' non-technical skills. Br J Surg 2018; 105:876-884. [DOI: 10.1002/bjs.10800] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/19/2017] [Accepted: 11/04/2017] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Non-technical skills are essential for safe and effective surgery. Several tools to assess surgeons' non-technical skills from the clinician's perspective have been developed. However, a reliable measurement tool using a patient-centred approach does not currently exist. The aim of this study was to translate the existing Non-Technical Skills for Surgeons (NOTSS) tool into a patient-centred evaluation tool.
Methods
Data were gathered from four cohorts of patients using an iterative four-stage mixed-methods research design. Exploratory and confirmatory factor analyses were performed to establish the psychometric properties of the tool, focusing on validity, reliability, usability and parsimony.
Results
Some 534 patients were recruited to the study. A total of 24 patient-centred non-technical skill items were developed in stage 1, and reduced to nine items in stage 2 using exploratory factor analysis. In stage 3, confirmatory factor analysis demonstrated that these nine items each loaded on to one of three factors, with excellent internal consistency: decision-making, leadership, and communication and teamwork. In stage 4, validity testing established that the new tool was independent of physician empathy and predictive of surgical quality. Surgical leadership emerged as the most dominant skill that patients could recognize and evaluate.
Conclusion
A novel nine-item assessment tool has been developed. The Patients' Evaluation of Non-Technical Skills (PENTS) tool allows valid and reliable measurement of surgeons' non-technical skills from the patient perspective.
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Affiliation(s)
- J Yule
- D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts, USA
| | - K Hill
- Babson College, Wellesley, Massachusetts, USA
| | - S Yule
- Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Boston, Massachusetts, USA
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Bui AH, Guerrier S, Feldman DL, Kischak P, Mudiraj S, Somerville D, Shebeen M, Girdusky C, Leitman IM. Is video observation as effective as live observation in improving teamwork in the operating room? Surgery 2018; 163:1191-1196. [PMID: 29625708 DOI: 10.1016/j.surg.2018.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 12/03/2017] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Teamwork in the operating room decreases the risk of preventable patient harm. Observation in the operating room allows for evaluation of compliance with best-practice surgical guidelines. This study examines the relative ability of video and live observation to promote operating room teamwork. METHODS Video and audio cameras were installed in 2014 into all operating rooms at an 875-bed, urban teaching hospital. Recordings were chosen at random for review by an internal quality improvement team. Concurrently, live observers were deployed into a random selection of operations. A customized tool was used to evaluate compliance to TeamSTEPPS skills during surgical briefs and debriefs. RESULTS A total of 1,410 briefs were evaluated: 325 (23%) through live observation and 1,085 (77%) through video; 1,398 debriefs were evaluated: 166 (12%) live and 1,232 (88%) video. For briefs, greater compliance was observed under live observation compared to video for recognition of team membership (87% vs 44%, P<.001), anticipation of complex procedural events (61% vs 45%, P<.001), and monitoring of resources (58% vs 42%, P<.001). For debriefs, greater compliance was observed under live observation for determination of team structure (90% vs 60%, P<.001), establishment of a leader (70% vs 51%, P<.001), postoperative planning (77% vs 48%, P<.001), case review and feedback (49% vs 33%, P<.001), team engagement (64% vs 41%, P<.001), and check back (61% vs 46%, P<.001) compared to video. CONCLUSION Video observations may not be as effective as evaluating live performance in promoting teamwork in the OR. Live observation enables immediate feedback, which may improve behavior and decrease barriers to compliance with surgical safety practices.
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Affiliation(s)
- Anthony H Bui
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanice Guerrier
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David L Feldman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Hospitals Insurance Company, New York, NY, USA
| | | | | | | | - Minimole Shebeen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cynthia Girdusky
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - I Michael Leitman
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Thesleff T, Niskakangas T, Luoto T, Iverson GL, Öhman J, Ronkainen A. Preventable diagnostic errors in fatal cervical spine injuries: a nationwide register-based study from 1987 to 2010. Spine J 2018; 18:430-438. [PMID: 28822822 DOI: 10.1016/j.spinee.2017.08.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fall-induced injuries in patients are increasing in number, and they often lead to serious consequences, such as cervical spine injuries (CSI). CSI diagnostics remain a challenge despite improved radiological services. PURPOSE Our aim is to define the incidence and risk factors for diagnostic errors among patients who died following a CSI. STUDY DESIGN/SETTING A retrospective death certificate-based study of the whole population of Finland was carried out. PATIENT SAMPLE We identified 2,041 patients whose death was, according to the death certificate, either directly or indirectly caused by a CSI. OUTCOME MEASURES Demographics, injury- and death-related data, and adverse event (AE)-related data were the outcome measures. METHODS All death certificates between the years 1987 and 2010 from Statistics Finland that identified a CSI as a cause death were reviewed to identify preventable AEs with the emphasis on diagnostic errors. RESULTS Of the 2,041 patients with CSI-related deaths, 36.5% (n=744) survived at least until the next day. Errors in CSI diagnostics were found in 13.8% (n=103) of those who died later than the day of injury. Those with diagnostic errors were significantly older (median age 79.4 years, 95% confidence interval 75.9-80.1 vs. 74.9, 95% confidence interval 70.2-72.9, p<.001) and the mechanism of injury was significantly more often a fall (86.4%, n=89 vs. 69.7%, n=447, p=.002) compared with those who did not have a diagnostic error. The incidence of diagnostic errors increased slightly during the 24-year study period. CONCLUSIONS Cervical spine injury diagnostics remain difficult despite improved radiological services. The majority of the patients subjected to diagnostic errors are fragile elderly people with reduced physical capacity. In our analysis, preventable AEs and diagnostic errors were most commonly associated with ground-level falls.
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Affiliation(s)
- Tuomo Thesleff
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
| | - Tero Niskakangas
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Teemu Luoto
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA, 02129, Massachusetts, USA
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
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Chrouser KL, Xu J, Hallbeck S, Weinger MB, Partin MR. The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework. Am J Surg 2018. [PMID: 29525056 DOI: 10.1016/j.amjsurg.2018.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of intraoperative stressors may be critical to reducing adverse events and improving outcomes. DATA SOURCES We searched MEDLINE, psycINFO, EMBASE, Business Source Premier, and CINAHL databases (1996-2016) to assess the relationship between negative (emotional and behavioral) responses to acute intraoperative stressors and provider performance or patient surgical outcomes. RESULTS/CONCLUSIONS Drawing on theory and evidence from reviewed studies, we present the Surgical Stress Effects (SSE) framework. This illustrates how emotional and behavioral responses to stressors can influence individual surgical provider (e.g. surgeon, nurse) performance, team performance, and patient outcomes. It also demonstrates how uncompensated intraoperative threats and errors can lead to adverse events, highlighting evidence gaps for future research efforts.
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Affiliation(s)
- Kristin L Chrouser
- Minneapolis VA Health Care Center, 1 Veterans Dr, Minneapolis, MN 55417, USA; The University of Minnesota, Dept of Urology, 420 Delaware St SE, Minneapolis, MN 55455, USA.
| | - Jie Xu
- Center for Psychological Science, Zhejiang University, China; Vanderbilt University School of Medicine, Dept of Anesthesiology, 1121 21st Avenue S., MAB Suite 732, Nashville, TN 37212, USA.
| | - Susan Hallbeck
- Mayo Clinic Health Sciences Research Department, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Matthew B Weinger
- Vanderbilt University School of Medicine, Dept of Anesthesiology, 1121 21st Avenue S., MAB Suite 732, Nashville, TN 37212, USA.
| | - Melissa R Partin
- Minneapolis VA Health Care Center, Center for Chronic Disease Outcomes Research, 1 Veterans Dr (152/Bldg 9), Minneapolis, MN 55417, USA.
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Effects of the Smartphone Application "Safe Patients" on Knowledge of Patient Safety Issues Among Surgical Patients. Comput Inform Nurs 2018; 35:639-646. [PMID: 28691932 DOI: 10.1097/cin.0000000000000374] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, the patient's role in preventing adverse events has been emphasized. Patients who are more knowledgeable about safety issues are more likely to engage in safety initiatives. Therefore, nurses need to develop techniques and tools that increase patients' knowledge in preventing adverse events. For this reason, an educational smartphone application for patient safety called "Safe Patients" was developed through an iterative process involving a literature review, expert consultations, and pilot testing of the application. To determine the effect of "Safe Patients," it was implemented for patients in surgical units in a tertiary hospital in South Korea. The change in patients' knowledge about patient safety was measured using seven true/false questions developed in this study. A one-group pretest and posttest design was used, and a total of 123 of 190 possible participants were tested. The percentage of correct answers significantly increased from 64.5% to 75.8% (P < .001) after implementation of the "Safe Patients" application. This study demonstrated that the application "Safe Patients" could effectively improve patients' knowledge of safety issues. This will ultimately empower patients to engage in safe practices and prevent adverse events related to surgery.
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Rezaei F, Yarmohammadian M, Molavi Taleghani Y, Sheikhbardsiri H. Research Paper: Risk Assessment of Surgical Procedures in a Referral Hospital. HEALTH IN EMERGENCIES & DISASTERS QUARTERLY 2017. [DOI: 10.29252/nrip.hdq.3.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Han K, Bohnen JD, Peponis T, Martinez M, Nandan A, Yeh DD, Lee J, Demoya M, Velmahos G, Kaafarani HMA. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study. J Am Coll Surg 2017; 224:1048-1056. [PMID: 28093300 DOI: 10.1016/j.jamcollsurg.2016.12.039] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/15/2016] [Accepted: 12/13/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND An intraoperative adverse event (iAE) is often directly attributable to the surgeon's technical error and/or suboptimal intraoperative judgment. We aimed to examine the psychological impact of iAEs on surgeons as well as the surgeons' attitude about iAE reporting. STUDY DESIGN We conducted a web-based cross-sectional survey of all surgeons at 3 major teaching hospitals of the same university. The 29-item questionnaire was developed using a systematic closed and open approach focused on assessing the surgeons' personal account of iAE incidence, emotional response to iAEs, available support systems, and perspective about the barriers to iAE reporting. RESULTS The response rate was 44.8% (n = 126). Mean age of respondents was 49 years, 77% were male, and 83% performed >150 procedures/year. During the last year, 32% recalled 1 iAE, 39% recalled 2 to 5 iAEs, and 9% recalled >6 iAEs. The emotional toll of iAEs was significant, with 84% of respondents reporting a combination of anxiety (66%), guilt (60%), sadness (52%), shame/embarrassment (42%), and anger (29%). Colleagues constituted the most helpful support system (42%) rather than friends or family; a few surgeons needed psychological therapy/counseling. As for reporting, 26% preferred not to see their individual iAE rates, and 38% wanted it reported in comparison with their aggregate colleagues' rate. The most common barriers to reporting iAEs were fear of litigation (50%), lack of a standardized reporting system (49%), and absence of a clear iAE definition (48%). CONCLUSIONS Intraoperative AEs occur often, have a significant negative impact on surgeons' well-being, and barriers to transparency are fear of litigation and absence of a well-defined reporting system. Efforts should be made to support surgeons and standardize reporting when iAEs occur.
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Affiliation(s)
- Kelsey Han
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jordan D Bohnen
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Thomas Peponis
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Myriam Martinez
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Anirudh Nandan
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daniel D Yeh
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jarone Lee
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Marc Demoya
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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Rutberg H, Borgstedt-Risberg M, Gustafson P, Unbeck M. Adverse events in orthopedic care identified via the Global Trigger Tool in Sweden - implications on preventable prolonged hospitalizations. Patient Saf Surg 2016; 10:23. [PMID: 27800019 PMCID: PMC5080833 DOI: 10.1186/s13037-016-0112-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 10/13/2016] [Indexed: 11/11/2022] Open
Abstract
Background The national incidence of adverse events (AEs) in Swedish orthopedic care has never been described. A new national database has made it possible to describe incidence, nature, preventability and consequences of AEs in Swedish orthopedic care. Methods We used national data from a structured two-stage record review with a Swedish modification of the Global Trigger Tool. The sample was 4,994 randomly selected orthopedic admissions in 56 hospitals during 2013 and 2014. The AEs were classified according to the Swedish Patient Safety Act into preventable or non-preventable. Results At least one AE occurred in 733 (15 %, 95 % CI 13.7–15.7) admissions. Of 950 identified AEs, 697 (73 %) were judged preventable. More than half of the AEs (54 %) were of temporary nature. The most common types of AE were healthcare-associated infections and distended urinary bladder. Patients ≥65 years had more AEs (p < 0.001), and were more often affected by pressure ulcer (p < 0.001) and urinary tract infections (p < 0.01). Distended urinary bladder was seen more frequently in patients aged 18–64 years (p = 0.01). Length of stay was twice as long for patients with AEs (p < 0.001). We estimate 232,000 extra hospital days due to AEs during these 2 years. The pattern of AEs in orthopedic care was different compared to other hospital specialties. Conclusions Using a national database, we found AEs in 15 % of orthopedic admissions. The majority of the AEs was of temporary nature and judged preventable. Our results can be used to guide focused patient safety work.
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Affiliation(s)
- Hans Rutberg
- Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden ; Swedish Association of Local Authorities and Regions, Stockholm, Sweden
| | | | - Pelle Gustafson
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Skane University Hospital, Lund, Sweden ; Department of Orthopedics, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Maria Unbeck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden ; Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden
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Life-threatening complications after postoperative intermediate care unit discharge: A retrospective, observational study. Eur J Anaesthesiol 2016. [PMID: 26225496 DOI: 10.1097/eja.0000000000000321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative patients who require intensive monitoring, intervention with an arterial line, vasoactive drugs and prolonged ventilator weaning are admitted to the postoperative intermediate care unit (IMCU). OBJECTIVES The aim of this study was to estimate the prevalence of life-threatening complications within 7 days after IMCU discharge. Furthermore, we searched for associations between perioperative risk factors and these life-threatening complications. DESIGN A retrospective observational study. SETTING The postoperative IMCU of a university hospital in Tokyo, Japan, between 2010 and 2012. PATIENTS All adult patients who stayed in the postoperative IMCU and who were discharged to general wards without being transferred to the ICU were included. MAIN OUTCOME MEASURES A composite outcome of life-threatening complications needing unplanned ICU admission within 7 days after IMCU stay, or death within 7 days after IMCU stay. RESULTS Forty out of 3093 patients (1.3%) presented a life-threatening complication; all had an unplanned ICU admission, and none died. Patients with life-threatening complications had a longer length of hospital stay [median 38.0 (interquartile range, IQR 21.3 to 56.8) days vs. 12.0 (IQR 8.0 to 23.0), P < 0.001] and a higher in-hospital mortality (12.5 vs. 0.7%, P < 0.001). Independent risk factors were an emergency operation before IMCU admission [vs. elective; odds ratio (OR) 20.5; 95% confidence interval (95% CI) 12.2 to 36.0, P < 0.001], higher cumulative perioperative fluid load during the surgical operation and IMCU stay (3000 to 4999 vs. <1000 ml; OR 5.7; 95% CI 1.6 to 23.7, P = 0.009; ≥5000 vs. <1000 ml; OR 7.2; 95% CI 1.3 to 39.6, P = 0.021), mechanical ventilation during IMCU stay less than 6 h (vs. no use; OR 3.6; 95% CI 1.4 to 9.2, P = 0.007). CONCLUSION More than 1% of patients had a life-threatening complication within 7 days after IMCU discharge, but with no deaths. Risk factors were an emergency operation before IMCU admission, higher cumulative perioperative fluid load and a short period of mechanical ventilation during the IMCU stay.
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Jayasuriya-Illesinghe V, Guruge S, Gamage B, Espin S. Interprofessional work in operating rooms: a qualitative study from Sri Lanka. BMC Surg 2016; 16:61. [PMID: 27596281 PMCID: PMC5011874 DOI: 10.1186/s12893-016-0177-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
Background A growing body of research shows links between poor teamwork and preventable surgical errors. Similar work has received little attention in the Global South, and in South Asia, in particular. This paper describes surgeons’ perception of teamwork, team members’ roles, and the team processes in a teaching hospital in Sri Lanka to highlight the nature of interprofessional teamwork and the factors that influence teamwork in this setting. Methods Data gathered from interviews with 15 surgeons were analyzed using a conceptual framework for interprofessional teamwork. Results Interprofessional teamwork was characterized by low levels of interdependency and integration of work. The demarcation of roles and responsibilities for surgeons, nurses, and anesthetists appeared to be a strong element of interprofessional teamwork in this setting. Various relational factors, such as, professional power, hierarchy, and socialization, as well as contextual factors, such as, patriarchy and gender norms influenced interprofessional collaboration, and created barriers to communication between surgeons and nurses. Junior surgeons derived their understanding of appropriate practices mainly from observing senior surgeons, and there was a lack of formal training opportunities and motivation to develop non-technical skills that could improve interprofessional teamwork in operating rooms. Conclusions A more nuanced view of interprofessional teamwork can highlight the different elements of such work suited for each specific setting. Understanding the relational and contextual factors related to and influencing interprofessional socialization and status hierarchies can help improve quality of teamwork, and the training and mentoring of junior members.
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Affiliation(s)
| | - Sepali Guruge
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
| | - Bawantha Gamage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada
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Abstract
The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing information on dosage, pharmacological interactions, side effects and contraindications of medications.The major challenges for quality and risk management, for the heads of departments and the executive board is the implementation and support of the described actions and a sustained guidance of the staff involved in the modification management process. The global trigger tool is suitable for improving transparency and objectifying the frequency of medical errors.
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132
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Dutta S, Jaffer AK. Reporting Quality Improvement Interventions: A Call to Action. Jt Comm J Qual Patient Saf 2016; 42:195. [PMID: 27066921 DOI: 10.1016/s1553-7250(16)42024-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Suparna Dutta
- Department of Internal Medicine and Division of Hospital Medicine, Rush Medical College, Chicago, USA
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Jones EL, Lees N, Martin G, Dixon-Woods M. How Well Is Quality Improvement Described in the Perioperative Care Literature? A Systematic Review. Jt Comm J Qual Patient Saf 2016; 42:196-206. [PMID: 27066922 PMCID: PMC4964906 DOI: 10.1016/s1553-7250(16)42025-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Quality improvement (QI) approaches are widely used across health care, but how well they are reported in the academic literature is not clear. A systematic review was conducted to assess the completeness of reporting of QI interventions and techniques in the field of perioperative care. METHODS Searches were conducted using Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organization of Care database, and PubMed. Two independent reviewers used the Template for Intervention Description and Replication (TIDieR) check list, which identifies 12 features of interventions that studies should describe (for example, How: the interventions were delivered [e. g., face to face, internet]), When and how much: duration, dose, intensity), to assign scores for each included article. Articles were also scored against a small number of additional criteria relevant to QI. RESULTS The search identified 16,103 abstracts from databases and 19 from other sources. Following review, full-text was obtained for 223 articles, 100 of which met the criteria for inclusion. Completeness of reporting of QI in the perioperative care literature was variable. Only one article was judged fully complete against the 11 TIDieR items used. The mean TIDieR score across the 100 included articles was 6.31 (of a maximum 11). More than a third (35%) of the articles scored 5 or lower. Particularly problematic was reporting of fidelity (absent in 74% of articles) and whether any modifications were made to the intervention (absent in 73% of articles). CONCLUSIONS The standard of reporting of quality interventions and QI techniques in surgery is often suboptimal, making it difficult to determine whether an intervention can be replicated and used to deliver a positive effect in another setting. This suggests a need to explore how reporting practices could be improved.
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Affiliation(s)
- Emma L Jones
- University of Leicester, University Hospitals of Leicester NHS Trust, Leicester, USA
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Gagnier JJ, Derosier JM, Maratt JD, Hake ME, Bagian JP. Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery. Int J Qual Health Care 2016; 28:363-70. [PMID: 27090398 DOI: 10.1093/intqhc/mzw031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. DESIGN Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. SETTING Large teaching hospital. PARTICIPANTS Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). INTERVENTION A handoff tool for use by orthopaedic residents. MAIN OUTCOME MEASUREMENTS Adverse events in patients handed off by orthopaedic trauma residents. RESULTS After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). CONCLUSIONS Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Joseph M Derosier
- Center for Healthcare Engineering & Patient Safety, University of Michigan, Ann Arbor, MI, USA
| | - Joseph D Maratt
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E Hake
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James P Bagian
- Center for Healthcare Engineering & Patient Safety, University of Michigan, Ann Arbor, MI, USA Department of Industrial & Operations Engineering, University of Michigan, Ann Arbor, MI, USA
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Nilsson L, Risberg MB, Montgomery A, Sjödahl R, Schildmeijer K, Rutberg H. Preventable Adverse Events in Surgical Care in Sweden: A Nationwide Review of Patient Notes. Medicine (Baltimore) 2016; 95:e3047. [PMID: 26986126 PMCID: PMC4839907 DOI: 10.1097/md.0000000000003047] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Adverse events (AEs) occur in health care and may result in harm to patients especially in the field of surgery. Our objective was to analyze AEs in surgical patient care from a nationwide perspective and to analyze the frequency of AEs that may be preventable. In total 19,141 randomly selected admissions in 63 Swedish hospitals were reviewed each month during 2013 using a 2-stage record review method based on the identification of predefined triggers. The subgroup of 3301 surgical admissions was analyzed. All AEs were categorized according to site, type, level of severity, and degree of preventability. We reviewed 3301 patients' records and 507 (15.4%) were associated with AEs. A total of 62.5% of the AEs were considered probably preventable, over half contributed to prolonged hospital care or readmission, and 4.7% to permanent harm or death. Healthcare acquired infections composed of more than one third of AEs. The majority of the most serious AEs composed of healthcare acquired infections and surgical or other invasive AEs. The incidence of AEs was 13% in patients 18 to 64 years old and 17% in ≥65 years. Pressure sores and drug-related AEs were more common in patients being ≥65 years. Urinary retention and pressure sores showed the highest degree of preventability. Patients with probably preventable AEs had in median 7.1 days longer hospital stay. We conclude that AEs are common in surgical care and the majority are probably preventable.
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Affiliation(s)
- Lena Nilsson
- From the Department of Anaesthesia and Intensive Care and Department of Medical and Health Sciences (LN), Linköping University; Unit for Health Analysis (MBR), Region Östergötland; Department of Surgery (AM), Skåne University Hospital, Malmö; Department of Surgery (RS), Region Östergötland, Linköping University; Development and Patient Safety Unit (RS, HR), Region Östergötland, Linköping University, Linköping; Faculty of Health and Life Sciences (KS), School of Health and Caring Sciences, Linnaeus University, Kalmar; and Swedish Association of Local Authorities and Regions (HR), Stockholm, Sweden
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Mascherek AC, Bezzola P, Gehring K, Schwappach DL. Effect of a two-year national quality improvement program on surgical checklist implementation. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2016; 114:39-47. [DOI: 10.1016/j.zefq.2016.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/01/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022]
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Borgmann H, Helbig S, Reiter MA, Hüsch T, Schilling D, Tsaur I, Haferkamp A. Utilization of surgical safety checklists by urological surgeons in Germany: a nationwide prospective survey. Patient Saf Surg 2015; 9:37. [PMID: 26561502 PMCID: PMC4641404 DOI: 10.1186/s13037-015-0082-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to investigate the contemporary usage rate and habits of the WHO Surgical Safety Checklist (SSC) in German urological departments. Methods We designed a 26-item questionnaire that was sent to all urological departments in Germany. The primary aim of this study was to evaluate the usage rate of the SSC. Secondary aims were to compare perioperative characteristics of users vs. non-users of the SSC and to assess circumstances of the SSC application. Results A total of 213 of 234 (91 %) urological departments were users of the SSC, and 21 (9 %) were non-users. SSC users had more often a standard protocol, took less time and had fewer people involved for checking perioperative patient data compared to non-users. Financial budgeting for the SSC existed in 55 (24 %) departments and for patient safety in 73 (32 %) departments. Conclusions The usage rate of the SSC in urological departments in Germany is high despite restricted financial budgeting. Users of the SSC profit by saving time and manpower for checking perioperative patient data. Electronic supplementary material The online version of this article (doi:10.1186/s13037-015-0082-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik Borgmann
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Sarah Helbig
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Michael A Reiter
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - David Schilling
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Yule S, Parker SH, Wilkinson J, McKinley A, MacDonald J, Neill A, McAdam T. Coaching Non-technical Skills Improves Surgical Residents' Performance in a Simulated Operating Room. JOURNAL OF SURGICAL EDUCATION 2015; 72:1124-30. [PMID: 26610355 DOI: 10.1016/j.jsurg.2015.06.012] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To investigate the effect of coaching on non-technical skills and performance during laparoscopic cholecystectomy in a simulated operating room (OR). BACKGROUND Non-technical skills (situation awareness, decision making, teamwork, and leadership) underpin technical ability and are critical to the success of operations and the safety of patients in the OR. The rate of developing assessment tools in this area has outpaced development of workable interventions to improve non-technical skills in surgical training and beyond. METHOD A randomized trial was conducted with senior surgical residents (n = 16). Participants were randomized to receive either non-technical skills coaching (intervention) or to self-reflect (control) after each of 5 simulated operations. Coaching was based on the Non-Technical Skills For Surgeons (NOTSS) behavior observation system. Surgeon-coaches trained in this method coached participants in the intervention group for 10 minutes after each simulation. Primary outcome measure was non-technical skills, assessed from video by a surgeon using the NOTSS system. Secondary outcomes were time to call for help during bleeding, operative time, and path length of laparoscopic instruments. RESULTS Non-technical skills improved in the intervention group from scenario 1 to scenario 5 compared with those in the control group (p = 0.04). The intervention group was faster to call for help when faced with unstoppable bleeding in the final scenario (no. 5; p = 0.03). CONCLUSIONS Coaching improved residents' non-technical skills in the simulated OR compared with those in the control group. Important next steps are to implement non-technical skills coaching in the real OR and assess effect on clinically important process measures and patient outcomes.
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Affiliation(s)
- Steven Yule
- STRATUS Center for Medical Simulation, Brigham & Women's Hospital, Boston, Massachusetts; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Aberdeen, Aberdeen, Scotland.
| | - Sarah Henrickson Parker
- Department of Psychology, University of Aberdeen, Aberdeen, Scotland; National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia
| | - Jill Wilkinson
- Department of Psychology, University of Aberdeen, Aberdeen, Scotland
| | - Aileen McKinley
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Jamie MacDonald
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Adrian Neill
- Department of Surgery, Southern Trust, Northern Ireland
| | - Tim McAdam
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland; Department of Surgery, Belfast City Hospital, Belfast, Northern Ireland
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[Patient safety: a topic of the future, the future of the topic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:4-9. [PMID: 25487852 DOI: 10.1007/s00103-014-2082-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Almost 10 years ago, the German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit) was founded as a cooperation covering most institutions of the German health care system. As in other countries facing the issue of patient safety, methods for the analysis of "never events" have been developed, instruments for the identification of the "unknown unknowns" have been established (e.g., CIRS), and the paradigm of individual blame has been replaced by organizational, team and management factors. After these first steps, further developments can only be achieved in so far as patient safety is understood as a system property, which leads to specific implications for the further evolution of the healthccare system. The "patient safety movement" has to participate in this discussion in order to avoid misuse of the patient safety concept as a defensive means, merely confined to overcome the adverse events of payment and structural incentives (e.g., diagnosis related groups in the inpatient sector). Because the dominant requirements for the future healthcare system consist of care for an elderly population with chronic and multiple diseases, the focus has to be shifted away from acute and surgical procedures and diseases, as given in the present quality assurance programs in Germany, to prevention and coordination of chronic care. Efforts to improve drug and medication safety of elderly people can be regarded as perfect examples, but other efforts are still missing. Second, the structural problems as the sector-associated optimization of care should be addressed, because typical safety issues are not limited to single sectors but represent problems of missing integration and suboptimal population care (e.g., MRSA). In the third line, the perspectives of society and institutions on safety (and quality of care) must urgently be enlarged to the perspectives of patients on the one hand and the benefit of treatments (e.g., overuse) on the other hand. All these issues are only to be implemented as far as the general societal attitude supportings further improvement of patient safety and is ready to regard it as a major aim for future developments. Cost arguments alone - costs of suboptimal safety can be estimated to around <euro> 1 billion in Germany per year - are considered as insufficient to guarantee further improvements because other issues in the healthcare system show similar magnitudes. As a consequence, ethical implications remain as major arguments for ongoing professional and public discussions.
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Rodrigo-Rincon I, Martin-Vizcaino MP, Tirapu-Leon B, Zabalza-Lopez P, Abad-Vicente FJ, Merino-Peralta A. Validity of the clinical and administrative databases in detecting post-operative adverse events. Int J Qual Health Care 2015; 27:267-75. [DOI: 10.1093/intqhc/mzv039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/15/2022] Open
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Emond YEJJM, Calsbeek H, Teerenstra S, Bloo GJA, Westert GP, Damen J, Wolff AP, Wollersheim HC. Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial. Implement Sci 2015; 10:3. [PMID: 25567584 PMCID: PMC4296536 DOI: 10.1186/s13012-014-0198-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/18/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study is initiated to evaluate the effects, costs, and feasibility at the hospital and patient level of an evidence-based strategy to improve the use of Dutch perioperative safety guidelines. Based on current knowledge, expert opinions and expertise of the project team, a multifaceted implementation strategy has been developed. METHODS/DESIGN This is a stepped wedge cluster randomized trial including nine representative hospitals across The Netherlands. Hospitals are stratified into three groups according to hospital type and geographical location and randomized in terms of the period for receipt of the intervention. All adult surgical patients meeting the inclusion criteria are assessed for patient outcomes. The implementation strategy includes education, audit and feedback, organizational interventions (e.g., local embedding of the guidelines), team-directed interventions (e.g., multi-professional team training), reminders, as well as patient-mediated interventions (e.g., patient safety cards). To tailor the implementation activities, we developed a questionnaire to identify barriers for effective guideline adherence, based on (a) a theoretical framework for classifying barriers and facilitators, (b) an instrument for measuring determinants of innovations, and (c) 19 semi-structured interviews with perioperative key professionals. Primary outcome is guideline adherence measured at the hospital (i.e., cluster) and patient levels by a set of perioperative Patient Safety Indicators (PSIs), which was developed parallel to the perioperative guidelines. Secondary outcomes at the patient level are in-hospital complications, postoperative wound infections and mortality, length of hospital stay, and unscheduled transfer to the intensive care unit, non-elective readmission to the hospital and unplanned reoperation, all within 30 days after the initial surgery. Also, patient safety culture and team climate will be studied as potential determinants. Finally, a process evaluation is conducted to identify the compliance with the implementation strategy, as well as an economic evaluation to assess the costs. Data sources are registered clinical data and surveys. There is no form of blinding. DISCUSSION The perioperative setting is an unexplored area with respect to implementation issues. This study is expected to yield important new evidence about the effects of a multifaceted approach on guideline adherence in the perioperative care setting. TRIAL REGISTRATION Dutch trial registry: NTR3568.
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Affiliation(s)
- Yvette E J J M Emond
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
| | - Hiske Calsbeek
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands.
| | - Steven Teerenstra
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Dapartment for Health Evidence, section Biostatics, Nijmegen, The Netherlands.
| | - Gerrit J A Bloo
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands. .,Radboud university medical center, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
| | - Gert P Westert
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands.
| | - Johan Damen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
| | - André P Wolff
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands.
| | - Hub C Wollersheim
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 114 IQ healthcare, 6500, HB, Nijmegen, The Netherlands.
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Heideveld-Chevalking AJ, Calsbeek H, Damen J, Gooszen H, Wolff AP. The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 'near-misses' and adverse events. Patient Saf Surg 2014; 8:46. [PMID: 25632301 PMCID: PMC4308849 DOI: 10.1186/s13037-014-0046-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 11/27/2014] [Indexed: 12/01/2022] Open
Abstract
Background The reduction of perioperative harm is a major priority of in-hospital health care and the reporting of incidents and their causes is an important source of information to improve perioperative patient safety. We explored the number, nature and causes of voluntarily reported perioperative incidents in order to highlight the areas where further efforts are required to improve patient safety. Methods Data from the Hospital Incident Management System (HIMS), entered in the period from July 2009 to July 2012, were analyzed in a Dutch university hospital. Employees in the perioperatve field filled out a semi-structured digital form of the reporting system. The risk classification of the reported adverse events and ‘near misses’ was based on the estimated patient consequences and the risk of recurrence, according to national guidelines. Predefined reported incident causes were categorized as human, organizational, technical and patient related. Results In total, 2,563 incidents (1,300 adverse events and 1,263 ‘near-miss’ events) were reported during 67,360 operations. Reporters were anesthesia, operating room and recovery nurses (37%), ward nurses (31%), physicians (17%), administrative personnel (5%), others (6%) and unmentioned (3%). A total of 414 (16%) adverse events had patient consequences (which affected 0,6% of all surgery patients), estimated as catastrophic in 2, very serious in 34, serious in 105, and marginally serious in 273 cases. Shortcomings in communication was the most frequent reported type of incidents. Non-compliance with Standard Operating Procedures (SOPs: instructions, regulations, protocols and guidelines) was reported with 877 (34%) of incident reports. In total, 1,194 (27%) voluntarily reported causes were SOP-related, mainly human-based (79%) and partially organization-based (21%). SOP-related incidents were not associated with more patient consequences than other voluntarily reported incidents. Furthermore ‘mistake or forgotten’ (15%) and ‘communication problems’ (11%) were frequently reported causes of incidents. Conclusions The analysis of voluntarily reported perioperative incidents identified an association between perioperative patient safety problems and human failure, such as SOP non-compliance, mistakes, forgetting, and shortcomings in communication. The data suggest that professionals themselves indicate that SOP compliance in combination with other human failures provide room for improvement.
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Affiliation(s)
- Anita J Heideveld-Chevalking
- Department of Operating Theatres, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Internal postal code 738, 6525 GA Nijmegen, The Netherlands
| | - Hiske Calsbeek
- Department of IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johan Damen
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein Gooszen
- Department of Operating Theatres, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Internal postal code 738, 6525 GA Nijmegen, The Netherlands
| | - André P Wolff
- Department of Operating Theatres, Radboud University Medical Center, Geert Grooteplein-Zuid 10, Internal postal code 738, 6525 GA Nijmegen, The Netherlands ; Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
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143
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Incidence and impact of adverse effects of medical care on complications in patients who underwent excision of cervical lymph nodes. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:271-7. [DOI: 10.1016/j.oooo.2014.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/07/2014] [Accepted: 04/27/2014] [Indexed: 11/23/2022]
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Power M, Fogarty M, Madsen J, Fenton K, Stewart K, Brotherton A, Cheema K, Harrison A, Provost L. Learning from the design and development of the NHS Safety Thermometer. Int J Qual Health Care 2014; 26:287-97. [PMID: 24787136 PMCID: PMC4041095 DOI: 10.1093/intqhc/mzu043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Quality issue Research indicates that 10% of patients are harmed by healthcare but data that can be used in real time to improve safety are not routinely available. Initial assessment We identified the need for a prospective safety measurement system that healthcare professionals can use to improve safety locally, regionally and nationally. Choice of solution We designed, developed and implemented a national tool, named the NHS Safety Thermometer (NHS ST) with the goal of measuring the prevalence of harm from pressure ulcers, falls, urinary tract infection in patients with catheters and venous thromboembolism on one day each month for all NHS patients. Implementation The NHS ST survey instrument was developed in a learning collaborative involving 161 organizations (e.g. hospitals and other delivery organizations) using a Plan, Do, Study, Act method. Evaluation Testing of operational definitions, technical capability and use were conducted and feedback systems were established by site coordinators in each participating organization. During the 17-month pilot, site coordinators reported a total of 73 651 patient entries. Lessons learned It is feasible to obtain national data through standardized reporting by site coordinators at the point of care. Some caution is required in interpreting data and work is required locally to ensure data collection systems are robust and data collectors were trained. Sampling is an important strategy to optimize efficiency and reduce the burden of measurement.
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Affiliation(s)
- Maxine Power
- Haelo, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Matthew Fogarty
- Patient Safety Policy and Strategy, NHS Commissioning Board, 4-8 Maple Street, London W1 T 5HD, UK
| | - John Madsen
- Health and Social Care Information Centre, 1 Trevelyan Square, Boar Lane, Leeds LS1 6EB, UK
| | - Katherine Fenton
- University College London Hospitals, 235 Euston Road, London NW1 2BU, UK
| | - Kevin Stewart
- Clinical Effectiveness & Evaluation Unit, Royal College of Physicians, 11 St Andrews Place, Regent's Park, London NW1 4LE, UK
| | - Ailsa Brotherton
- Haelo, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - Katherine Cheema
- The Quality Observatory, York House, 18-20 Massetts Road, Horley, Surrey RH6 7DE, UK
| | - Abigail Harrison
- Haelo, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
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145
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Research and Patient Safety. Patient Saf Surg 2014. [DOI: 10.1007/978-1-4471-4369-7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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146
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Helling TS, Martin LC, Martin M, Mitchell ME. Failure events in transition of care for surgical patients. J Am Coll Surg 2013; 218:723-31. [PMID: 24508426 DOI: 10.1016/j.jamcollsurg.2013.12.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Unexpected clinical deterioration (failure events) in surgical patients on standard nursing units (WARDs) could have a significant impact on eventual survival. We sought to investigate failure events requiring intensive care (surgical ICU [SICU]) transfer of surgical patients on WARDs in a single-center academic setting. STUDY DESIGN Surgical patients admitted to WARDs over a 12-month period, who developed failure events, were retrospectively reviewed. Time to deterioration since WARD arrival, clinical factors, notification chain, and outcomes were identified. A physician review panel determined the preventability of failure events. RESULTS Ninety-eight patients experienced 111 failure events requiring SICU transfer. Most patients (85%) were emergency admissions. Of 111 events, 90% had been previously discharged from an SICU or a postanesthesia care unit (PACU). Recognition of failure was by nursing (54%) and on routine physician rounds (34%). Rapid response or code blue alone was less common (12%). A second physician notification was needed in 29%, with delays due to failure to identify severity of illness. Most commonly, respiratory events prompted notification (77 of 111, 69%). Overall mortality was 26 of 98 (27%). Median time to failure was 2 days and was associated with early transfer from the SICU or PACU. Rapid response or code blue activation was associated with higher mortality than physician notification. CONCLUSIONS Patients most at risk for WARD failures were those with acute surgical emergencies or recently discharged from the SICU or PACU. Respiratory complications were the most common cause of WARD failure events. Many early failures may have been due to premature transfer from the SICU or PACU. Failure events on WARDs can have lethal consequences. Awareness, monitoring, and communication are important components of preventative measures.
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Affiliation(s)
- Thomas S Helling
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS.
| | - Larry C Martin
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Magdeline Martin
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Marc E Mitchell
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
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Mascherek AC, Schwappach DL, Bezzola P. Frequency of use and knowledge of the WHO-surgical checklist in Swiss hospitals: a cross-sectional online survey. Patient Saf Surg 2013; 7:36. [PMID: 24304634 PMCID: PMC4176192 DOI: 10.1186/1754-9493-7-36] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/02/2013] [Indexed: 12/31/2022] Open
Abstract
Background The WHO-surgical checklist is strongly recommended as a highly effective yet economically simple intervention to improve patient safety. Its use and potentially influential factors were investigated as little data exist on the current situation in Switzerland. Methods A cross-sectional online survey with members (N = 1378) of three Swiss professional associations of invasive health care professionals was conducted in German, French, and Italian. The survey assessed use of, knowledge of and satisfaction with the WHO-surgical checklist. T-Tests and ANOVA were conducted to test for differences between professional groups. Bivariate correlations were computed to test for associations between measures of knowledge and satisfaction. Results 1090 (79.1%) reported the use of a surgical checklist. 346 (25.1%) use the WHO-checklist, 532 (38.6%) use the Swiss Patient Safety Foundation recommendations to avoid Wrong Site Surgery, and 212 (15.7%) reported the use of other checklists. Satisfaction with checklist use was generally high (doctors: 71.9% satisfied, nurses: 60.8% satisfied) and knowledge was moderate depending on the use of the WHO-checklist. No association between measures of subjective and objective knowledge was found. Conclusions Implementation of a surgical checklist remains an important task for health care institutions in Switzerland. Although checklist use is present in Switzerland on a regular basis, a substantial group of health care personnel still do not use a checklist as a routine. Influential factors and the associations among themselves need to be addressed in future studies in more detail.
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Affiliation(s)
- Anna C Mascherek
- Patient Safety Switzerland, Asylstrasse 77, 8032 Zurich, Switzerland.
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Kawano T, Taniwaki M, Ogata K, Sakamoto M, Yokoyama M. Improvement of teamwork and safety climate following implementation of the WHO surgical safety checklist at a university hospital in Japan. J Anesth 2013; 28:467-70. [PMID: 24170220 DOI: 10.1007/s00540-013-1737-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/15/2013] [Indexed: 01/10/2023]
Abstract
With the aim to optimize surgical safety, the World Health Organization (WHO) introduced the Surgical Safety Checklist (SSCL) in 2008. The SSCL has been piloted in many countries worldwide and shown to improve both safety attitudes within surgical teams and patient outcomes. In the study reported here we investigated whether implementation of the SSCL improved the teamwork and safety climate at a single university hospital in Japan. All surgical teams at the hospital implemented the SSCL in all surgical procedures with strict adherence to the SSCL implementation manual developed by WHO. Changes in safety attitudes were evaluated using the modified operating-room version of the Safety Attitudes Questionnaire (SAQ). A before and after design was used, with the questionnaire administered before and 3 months after SSCL implementation. Our analysis revealed that the mean scores on the SAQ had significantly improved 3 months after implementation of the SSCL compared to those before implementation. This finding implies that effective implementation of the SSCL could improve patient outcomes in Japan, similar to the findings of the WHO pilot study.
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Affiliation(s)
- Takashi Kawano
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan,
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Aveling EL, McCulloch P, Dixon-Woods M. A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries. BMJ Open 2013; 3:e003039. [PMID: 23950205 PMCID: PMC3752057 DOI: 10.1136/bmjopen-2013-003039] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/05/2013] [Accepted: 07/15/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Bold claims have been made for the ability of the WHO surgical checklist to reduce surgical morbidity and mortality and improve patient safety regardless of the setting. Little is known about how far the challenges faced by low-income countries are the same as those in high-income countries or different. We aimed to identify and compare the influences on checklist implementation and compliance in the UK and Africa. DESIGN Ethnographic study involving observations, interviews and collection of documents. Thematic analysis of the data. SETTING Operating theatres in one African university hospital and two UK university hospitals. PARTICIPANTS 112 h of observations were undertaken. Interviews with 39 theatre and administrative staff were conducted. RESULTS Many staff saw value in the checklist in the UK and African hospitals. Some resentment was present in all settings, linked to conflicts between the philosophy behind the checklist and the realities of local cultural, social and economic contexts. Compliance-involving use, completeness and fidelity-was considerably higher, though not perfect, in the UK settings. In these hospitals, compliance was supported by established structures and systems, and was not significantly undermined by major resource constraints; the same was not true of the low-income context. Hierarchical relationships were a major barrier to implementation in all settings, but were more marked in the low-income setting. Introducing a checklist in a professional environment characterised by a lack of accountability and transparency could make the staff feel jeopardised legally, professionally, and personally, and it encouraged them to make misleading records of what had actually been done. CONCLUSIONS Surgical checklist implementation is likely to be optimised, regardless of the setting, when used as a tool in multifaceted cultural and organisational programmes to strengthen patient safety. It cannot be assumed that the introduction of a checklist will automatically lead to improved communication and clinical processes.
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Affiliation(s)
| | - Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Mary Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK
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