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Kulp L, Sarcevic A, Zheng Y, Cheng M, Alberto E, Burd R. Checklist Design Reconsidered: Understanding Checklist Compliance and Timing of Interactions. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020. [PMID: 32685940 DOI: 10.1145/3313831.3376853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examine the association between user interactions with a checklist and task performance in a time-critical medical setting. By comparing 98 logs from a digital checklist for trauma resuscitation with activity logs generated by video review, we identified three non-compliant checklist use behaviors: failure to check items for completed tasks, falsely checking items when tasks were not performed, and inaccurately checking items for incomplete tasks. Using video review, we found that user perceptions of task completion were often misaligned with clinical practices that guided activity coding, thereby contributing to non-compliant check-offs. Our analysis of associations between different contexts and the timing of check-offs showed longer delays when (1) checklist users were absent during patient arrival, (2) patients had penetrating injuries, and (3) resuscitations were assigned to the highest acuity. We discuss opportunities for reconsidering checklist designs to reduce non-compliant checklist use.
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Affiliation(s)
- Leah Kulp
- Drexel University, Philadelphia, PA, USA
| | | | - Yinan Zheng
- Children's National Medical Center, Washington DC, USA
| | - Megan Cheng
- Children's National Medical Center, Washington DC, USA
| | - Emily Alberto
- Children's National Medical Center, Washington DC, USA
| | - Randall Burd
- Children's National Medical Center, Washington DC, USA
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Jelacic S, Bowdle A, Nair BG, Togashi K, Boorman DJ, Cain KC, Lang JD, Dellinger EP. Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by the Anesthesia Provider Improves Checklist Performance. Anesth Analg 2020; 130:382-390. [PMID: 31306243 DOI: 10.1213/ane.0000000000004328] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist. METHODS We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables. RESULTS A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed. CONCLUSIONS The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.
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Affiliation(s)
- Srdjan Jelacic
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Andrew Bowdle
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Bala G Nair
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Kei Togashi
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Daniel J Boorman
- Boeing Test and Evaluation, The Boeing Company, Seattle, Washington
| | - Kevin C Cain
- Office of Nursing Research and Department of Biostatistics
| | - John D Lang
- From the Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Aranaz Ostáriz V, Gea Velázquez de Castro MT, López Rodríguez-Arias F, Valencia Martín JL, Aibar Remón C, Requena Puche J, Díaz-Agero Pérez C, Compañ Rosique AF, Aranaz Andrés JM. Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072516. [PMID: 32272647 PMCID: PMC7177398 DOI: 10.3390/ijerph17072516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022]
Abstract
(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.
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Affiliation(s)
- Verónica Aranaz Ostáriz
- Hospital Universitario Sant Joan d’Alacant. Ctra, N-332, s/n, Sant Joan d´Alacant, 03550 Alicante, Spain; (M.T.G.V.d.C.); (A.F.C.R.)
- Correspondence: ; Tel.: +34-676707517
| | | | | | - José Lorenzo Valencia Martín
- Hospital Universitario Ramón y Cajal, IRYCIS. M-607, km 9100, 28034 Madrid, Spain; (J.L.V.M.); (C.D.-A.P.); (J.M.A.A.)
| | - Carlos Aibar Remón
- Hospital Clínico Universitario Lozano Blesa, Avda. San Juan Bosco, 15, 50009 Zaragoza, Spain;
| | - Juana Requena Puche
- Hospital General Universitario de Elda, Ctra, Sax-La Torreta, s/n, Elda, 03600 Alicante, Spain;
| | - Cristina Díaz-Agero Pérez
- Hospital Universitario Ramón y Cajal, IRYCIS. M-607, km 9100, 28034 Madrid, Spain; (J.L.V.M.); (C.D.-A.P.); (J.M.A.A.)
| | - Antonio Fernando Compañ Rosique
- Hospital Universitario Sant Joan d’Alacant. Ctra, N-332, s/n, Sant Joan d´Alacant, 03550 Alicante, Spain; (M.T.G.V.d.C.); (A.F.C.R.)
| | - Jesús María Aranaz Andrés
- Hospital Universitario Ramón y Cajal, IRYCIS. M-607, km 9100, 28034 Madrid, Spain; (J.L.V.M.); (C.D.-A.P.); (J.M.A.A.)
- Center for Biomedical Research in the Epidemiology and Public Health Network (CIBERESP), 28029 Madrid, Spain
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Elger BM, Esparaz JR, Nierstedt RT, Jennetten RC, Aprahamian CJ, Pearl RH. Engaging the patient and family in the surgical safety process utilizing. J Pediatr Surg 2020; 55:597-601. [PMID: 31262502 DOI: 10.1016/j.jpedsurg.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Owing to the vulnerable nature of children, parental/caregiver engagement in surgical safety is a crucial aspect of care. Historically, the surgical safety process has been isolated from parent involvement. The digital, tablet-based surgical safety application, SafeStart, requires parent participation and provides multiple instances of verification of patient safety information from preoperative clinic visit, to perioperative care, and into the operating room. METHOD The SafeStart application was utilized for 100 pediatric general surgery patients in an IRB approved prospective study. Parent assessments of the surgical consent and safety processes were collected in pre- and postoperative surveys with a 100% response rate. Standard consent forms were used and compared as a control. RESULTS Only 31% of parents had knowledge of the surgical safety checklist process prior to their exposure to the study. 96% of the parents reported that the SafeStart patient portal was easy to use. A majority would prefer SafeStart to the standard consent process. CONCLUSION The SafeStart program connected the surgical safety process from the preoperative clinic visit through postoperative care. Parent's preferred SafeStart to the standard surgical safety checklist and consent process, felt that they were instrumental in protecting their child's safety, and would recommend SafeStart for the surgical care of others. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Breanna M Elger
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603.
| | - Joseph R Esparaz
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603.
| | - Ryan T Nierstedt
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603.
| | - Robert C Jennetten
- Jump Trading Simulation and Education Center, 1306 Berkeley Avenue, Peoria, IL 61603, USA.
| | - Charles J Aprahamian
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603; Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603.
| | - Richard H Pearl
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603; Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603; Jump Trading Simulation and Education Center, 1306 Berkeley Avenue, Peoria, IL 61603, USA.
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Gilhooly D, Chazapis M, Moonesinghe SR. Prioritisation of quality indicators for elective perioperative care: a Delphi consensus. Perioper Med (Lond) 2020; 9:8. [PMID: 32175078 PMCID: PMC7063823 DOI: 10.1186/s13741-020-0138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 02/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A systematic review of the peer-reviewed and grey literature previously identified over 1200 perioperative structure and process quality indicators. We undertook a Delphi consensus process with the aim of creating a concise list of indicators that experts deemed most important for assessing quality in perioperative care. METHODS A basic Delphi consensus was completed using an online survey which was distributed to surgeons, anaesthetists, nurses, physicians and lay representatives. Participants were asked to prioritise the indicators in order of importance (high, medium or low) to be included for collection in a national perioperative quality improvement programme. RESULTS One hundred and thirty-seven indicators were included in the first iteration of the Delphi consensus (91 structure and 48 process indicators). Sixty-three experts agreed to participate and the consensus was completed in five rounds. Ninety-five indicators were agreed as high priority: 65 structural and 30 process indicators. CONCLUSION The Delphi consensus process was able to reduce the number of recommended indicators to only a modest extent. Further work to evaluate the practicalities of routinely collecting such a comprehensive list of quality indicators is now required.
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Affiliation(s)
- D. Gilhooly
- UCL/UCLH NIHR Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Division of Surgery and Interventional Science, Charles Bell House, University College London, London, W1W 7TS UK
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU UK
- Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG UK
| | - M. Chazapis
- UCL/UCLH NIHR Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Division of Surgery and Interventional Science, Charles Bell House, University College London, London, W1W 7TS UK
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU UK
| | - S. R. Moonesinghe
- UCL/UCLH NIHR Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Division of Surgery and Interventional Science, Charles Bell House, University College London, London, W1W 7TS UK
- Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, NW1 2BU UK
- Health Services Research Centre, National Institute for Academic Anaesthesia, Royal College of Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG UK
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Dabekaussen KFAA, Scheepers RA, Heineman E, Lombarts KMJMH. The Surgical Hazardous Attitudes Reflection Profile (SHARP) Instrument - A Prototype Study. JOURNAL OF SURGICAL EDUCATION 2020; 77:422-437. [PMID: 31548142 DOI: 10.1016/j.jsurg.2019.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/24/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE There is growing recognition that surgeons' non-technical skills are crucial in guaranteeing optimal quality and safety of patient care. However, insight in relevant attitudes underlying these behavioral skills is lacking. Hazardous attitudes potentially cause risky behavior, which can result in medical errors and adverse events. A questionnaire offering surgeons insight in their attitudinal profile is still missing and would be instrumental in risk reduction. Therefore, the aim of this study is to develop a prototype of a reliable and valid instrument to measure hazardous attitudes among surgeons. DESIGN To measure hazardous attitudes, a prototype of the Surgical Hazardous Attitudes Reflection Profile (SHARP) tool was designed using a mixed methods approach, consisting of (1) 2 focus group discussions, (2) a modified Delphi analysis, and (3) a survey followed by (4) statistical analysis of the psychometric properties. Statistical analysis included exploratory factor analysis with varimax rotation, calculation of internal consistency reliability coefficients, and interscale correlations. SETTING Fourteen hospitals across the Netherlands were recruited to guarantee demographic variety and the inclusion of academic, tertiary, and general hospitals. PARTICIPANTS Nineteen experts participated in the 2 focus groups, and 19 in the modified Delphi study. In total, 302 surgeons (54.1%) completed the SHARP. RESULTS In total, 302 surgeons (54.1%) completed the SHARP. Exploratory factor analysis resulted in 6 subscales measuring attitude towards (1) authority (α = 0.78), (2) self-performance (α = 0.69), (3) performance feedback (α = 0.61), (4) own fitness to perform (α = 0.54), (5) uncertainty (α = 0.51), and (6) planned procedures (α = 0.48). CONCLUSIONS This study resulted in a prototype instrument identifying 6 potential hazardous attitudes in surgeons. Attitudes towards "authority" and "self-performance" can now be validly and reliably measured. Further research is required to optimize the prototype version of the instrument and could usefully explore the plausible relations between hazardous attitudes and clinical outcomes.
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Affiliation(s)
| | - Renée A Scheepers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Erik Heineman
- University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kiki M J M H Lombarts
- Amsterdam Center for Professional Performance and Compassionate Care, Amsterdam UMC, University of Amsterdam, The Netherlands
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van de Graaf FW, Lange MM, Spakman JI, van Grevenstein WMU, Lips D, de Graaf EJR, Menon AG, Lange JF. Comparison of Systematic Video Documentation With Narrative Operative Report in Colorectal Cancer Surgery. JAMA Surg 2020; 154:381-389. [PMID: 30673072 DOI: 10.1001/jamasurg.2018.5246] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Despite ongoing advances in the field of colorectal surgery, the quality of surgical treatment is still variable. As an intrinsic part of surgical quality, the technical information regarding the surgical procedure is reflected only by the narrative operative report (NR), which has been found to be subjective and regularly omits important information. Objective To investigate systematic video recording (SVR) as a potential improvement in quality and safety with regard to important information in colorectal cancer surgery. Design, Setting, and Participants The Imaging for Quality Control Trial was a prospective, observational cohort study conducted between January 12, 2016, and October 30, 2017, at 3 centers in the Netherlands. The study group consisted of 113 patients 18 years or older undergoing elective laparoscopic surgery for colorectal cancer. These patients were case matched and compared with cases from a historical cohort that received only an NR. Interventions Among study cases, participating surgeons were requested to systematically capture predefined key steps of the surgical procedure intraoperatively on video in short clips. Main Outcomes and Measures The SVRs and NRs were analyzed for adequacy with respect to the availability of important information regarding the predefined key steps. Adequacy of the reported information was defined as the proportion of key steps with available and sufficient information in the report. Adequacy of the SVR and NR was compared between the study and control groups, with the SVR alone and as an adjunct to the NR in the study group vs NR alone in the control group. Results Of the 113 study patients, 69 women (61.1%) were included; mean (SD) age was 66.3 (9.8) years. In the control group, a mean (SD) of 52.5% (18.3%) of 631 steps were adequately described in the NR. In the study group, the adequacy of both the SVR (78.5% [16.5%], P < .001) and a combination of the SVR with NR (85.1% [14.6%], P < .001) was significantly superior to NR alone. The only significant difference between the study and historical control groups regarding postoperative and pathologic outcomes was a shorter postoperative mean (SD) length of stay in favor of the study group (8.0 [7.7] vs 8.6 [6.8] days; P = .03). Conclusions and Relevance Use of SVR in laparoscopic colorectal cancer surgery as an adjunct to the NR might be superior in documenting important steps of the operation compared with NR alone, adding to the overall availability of necessary intraoperative information and contributing to quality control and objectivity.
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Affiliation(s)
- Floyd W van de Graaf
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marilyne M Lange
- Department of Pathology, Free University Medical Center, Amsterdam, the Netherlands
| | - Jolanda I Spakman
- Department of Surgery, Jeroen Bosch Hospitals, Hertogenbosch, the Netherlands
| | | | - Daan Lips
- Department of Surgery, Jeroen Bosch Hospitals, Hertogenbosch, the Netherlands
| | - Eelco J R de Graaf
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands.,Department of Surgery, Havenziekenhuis, Rotterdam, the Netherlands
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108
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Wæhle HV, Haugen AS, Wiig S, Søfteland E, Sevdalis N, Harthug S. How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties. BMC Health Serv Res 2020; 20:111. [PMID: 32050960 PMCID: PMC7017532 DOI: 10.1186/s12913-020-4965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies. METHODS An ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. RESULTS We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSC's practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. CONCLUSION When the SSC is not integrated within existing risk management strategies, but perceived as an "add on", its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London, London, UK
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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109
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P Ho V, A Dicker R, Haut ER. Dissemination, implementation, and de-implementation: the trauma perspective. Trauma Surg Acute Care Open 2020; 5:e000423. [PMID: 32154382 PMCID: PMC7046940 DOI: 10.1136/tsaco-2019-000423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vanessa P Ho
- Departments of Surgery and Population and Quantitative Health Sciences, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Rochelle A Dicker
- Department of Surgery, David Geffen School of Medicine, Los Angeles, California, USA
| | - Elliott R Haut
- Departments of Surgery, Anesthesiology and Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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110
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Harris K, Søfteland E, Moi AL, Harthug S, Storesund A, Jesuthasan S, Sevdalis N, Haugen AS. Patients' and healthcare workers' recommendations for a surgical patient safety checklist - a qualitative study. BMC Health Serv Res 2020; 20:43. [PMID: 31948462 PMCID: PMC6966861 DOI: 10.1186/s12913-020-4888-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/06/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients' involvement in patient safety has increased in healthcare. Use of checklists may improve patient outcome in surgery, though few have attempted to engage patients' use of surgical checklist. To identify risk elements of complications based on patients' and healthcare workers' experiences is warranted. This study aims to identify what the patients and healthcare workers find to be the risk elements that should be included in a patient-driven surgical patient safety checklist. METHOD A qualitative study design where post-operative patients, surgeons, ward physicians, ward nurses, and secretaries from five surgical specialties took part in focus group interviews. Eleven focus groups were conducted including 25 post-operative patients and 27 healthcare workers at one tertiary teaching hospital and one community hospital in Norway. Based on their experiences, participants were asked to identify perceived risks before and after surgery. The interviews were analysed using content analysis. RESULTS Safety risk factors were categorised as pre-operative information: pre-operative preparations, post-operative information, post-operative plans and follow-up. The subcategories under pre-operative information and preparations were: contact information, medication safety, health status, optimising health, dental status, read information, preparation two weeks before surgery, inform your surgical ward, planning your own discharge, preparation on admission and just before surgery. The subcategories under post-operative information, further plans and follow-up were: prevention and complications, restriction and activity, medication safety, pain relief, stomach functions, further care and appointments. Both healthcare workers and patients express the need for a surgical patient safety checklist. CONCLUSION A broad spectre of risk elements for a patient safety checklist were identified. Developing a surgical safety checklist based on these risk elements might reduce complications and unwanted errors. TRAIL REGISTRATION The study is registered as part of a clinical trial in ClinicalTrials.gov: NCT03105713.
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Affiliation(s)
- Kristin Harris
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Kronstad, Bergen, Norway. .,Department of Anesthesia and Intensive Care, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway.
| | - Eirik Søfteland
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Kronstad, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway.,Department of Clinical Science, University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - Anette Storesund
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway.,Department of Research and Development, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway
| | - Sebastius Jesuthasan
- Department of Surgery, Førde Comunity Hospital, Postboks 1000, 6807, Førde, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College,16 De Crespigny Park, London, UK, SE5 8AF, UK
| | - Arvid Steinar Haugen
- Department of Anesthesia and Intensive Care, Haukeland University Hospital, Postboks 1400, 5021, Bergen, Norway
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111
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Koers L, van Haperen M, Meijer CGF, van Wandelen SBE, Waller E, Dongelmans D, Boermeester MA, Hermanides J, Preckel B. Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients: A Randomized Clinical Trial in a Simulation Setting. JAMA Surg 2020; 155:e194704. [PMID: 31774483 DOI: 10.1001/jamasurg.2019.4704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Failure to rescue causes significant morbidity and mortality in the surgical population. Human error is often the underlying cause of failure to rescue. Human error can be reduced by the use of cognitive aids. Objectives To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients. Design, Setting, and Participants Randomized clinical trial in a simulation setting. Surgical teams consisted of 1 surgeon and 2 nurses from a surgical ward from 4 different hospitals in Amsterdam, the Netherlands. Data were analyzed between February 2, 2017, and December 18, 2018. Interventions The teams were randomized to manage 3 simulated deteriorating patient scenarios with or without the use of cognitive aids. Main Outcomes and Measures The primary outcome of the study was failure to adhere to best practice, expressed as the percentage of omitted critical management steps. The secondary outcome of the study was the perceived usability of the cognitive aids. Results Of the total participants, 93 were women and 51 were men. Twenty-five surgical teams performed 75 patient scenarios with cognitive aids, and 25 teams performed 75 patient scenarios without cognitive aids. Using the cognitive aids resulted in a reduction of omitted critical management steps from 33% to 10%, which is a 70% (P < .001) reduction. This effect remained significant (odds ratio, 0.63; 95% CI, -0.228 to -0.061; P = .001) in a multivariate analysis. Overall usability (scale of 0-10) of the cognitive aids was scored at a median of 8.7 (interquartile range, 8-9). Conclusions and Relevance Failure to comply with best practice management of postoperative complications is associated with worse outcomes. In this simulation study, adherence to best practice in the management of postoperative complications improves significantly by the use of cognitive aids. Cognitive aids for deteriorating surgical patients therefore have the potential to reduce failure to rescue and improve patient outcome. Trial Registration ClinicalTrials.gov identifier: NCT03812861.
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Affiliation(s)
- Lena Koers
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
| | - Maartje van Haperen
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
| | - Clemens G F Meijer
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Elbert Waller
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
| | - Dave Dongelmans
- Department of Critical Care, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Jeroen Hermanides
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
| | - Benedikt Preckel
- Department of Anaesthesia, University of Amsterdam, Amsterdam, the Netherlands
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Allene MD. Clinical audit on World Health Organization surgical safety checklist completion at Debre Berhan comprehensive specialized hospital: A prospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Franco AC, Bicudo-Salomão A, Aguilar-Nascimento JE, Santos TB, Sohn RV. Uso da realimentação pós-operatória ultra precoce e seu impacto na redução de fluidos endovenosos. Rev Col Bras Cir 2020; 47:e20202356. [DOI: 10.1590/0100-6991e-20202356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
RESUMO Objetivo: investigar em uma série de casos de pacientes submetidos a operações de médio porte em cirurgia geral, o uso da conduta de realimentação pós-operatória “ultra precoce”(dieta oral líquida oferecida na recuperação pós-anestésica), avaliando-se o volume de fluidos endovenosos recebidos no pós-operatório por estes pacientes, assim como a ocorrência de complicações e o tempo de internação hospitalar. Métodos: estudo prospectivo, observacional. Avaliou-se a aderência à rotina de realimentação “ultra precoce”, abreviação do jejum pré-operatório, volume de hidratação venosa perioperatório, tempo de internação e morbidade operatória. Resultados: um total de 154 pacientes com média da idade de 46±15 anos, foram acompanhados. Realimentação “ultra precoce” foi realizada em 144 casos (93,5%). Pacientes que não receberam realimentação “ultra precoce” receberam volume significativamente maior de fluidos endovenosos no pós-operatório do que pacientes realimentados de maneira “ultra precoce” (500ml versus 200ml, p=0,018). O tempo de internação foi de 2,4±2,79 dias (realimentação convencional) versus 1,45±1,83 dias (realimentação “ultra precoce”), sem diferença estatística (p=0,133).Não houve diferença no percentual de complicações gerais (p=0,291), vômitos (p=0,696) ou infecção do sítio cirúrgico (p=0,534). Conclusão: a realimentação “ultra precoce” apresentou-se como uma conduta de elevada aderência em operações de médio porte em Cirurgia Geral nesta série de casos e, esteve relacionada a infusão de volume significativamente menor de fluidos endovenosos no pós-operatório, com índices baixos de complicações e sem impacto no tempo de internação.
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Affiliation(s)
| | - Alberto Bicudo-Salomão
- Universidade Federal do Mato Grosso, Brasil; Centro Universitário de Várzea Grande, Brasil
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Compliance With Preoperative Elements of the American Society of Colon and Rectal Surgeons Rectal Cancer Surgery Checklist Improves Pathologic and Postoperative Outcomes. Dis Colon Rectum 2020; 63:30-38. [PMID: 31804269 DOI: 10.1097/dcr.0000000000001511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2016, the American Society of Colon and Rectal Surgeons published a rectal cancer surgery checklist composed of the essential elements of preoperative, intraoperative, and postoperative care for patients undergoing rectal cancer surgery. OBJECTIVE The purpose of this study was to assess whether compliance with preoperative checklist elements was associated with improved pathologic and 30-day postoperative outcomes after rectal cancer surgery. DESIGN This was a retrospective cohort study. SETTINGS The study involved North American hospitals contributing to the American College of Surgeons National Surgical Quality Improvement Program. PATIENTS Adult patients who underwent elective rectal cancer surgery from 2016 to 2017 were included. INTERVENTION The study encompassed checklist compliance with 6 preoperative elements from the checklist. MAIN OUTCOME MEASURES Pathologic outcomes (circumferential resection margin status, distal resection margin status, and adequate lymph node harvest ≥12), 30-day surgical morbidity, and length of stay were measured. RESULTS In total, 2217 patients were included in the analysis. Individual compliance with the 6 available preoperative checklist items was variable, including 91.3% for pretreatment documentation of tumor location within the rectum, 86.8% for complete colonoscopy, 84.0% for appropriate preoperative stoma marking, 79.8% for appropriate use of neoadjuvant radiotherapy, 76.6% for locoregional staging, and 70.8% for distant staging. Only 836 patients (37.7%) had all 6 checklist elements complete, whereas 1381 (62.3%) did not. Compared with patients without checklist compliance, patients with checklist compliance were younger (60.0 vs 63.0 y; p < 0.001) but otherwise had similar demographic characteristics. On multivariate regression, checklist compliance was associated with lower odds of circumferential resection margin positivity (OR = 0.47 (95% CI, 0.31-0.71); p < 0.001), higher odds of an adequate lymph node harvest ≥12 (OR = 1.60 (95% CI, 1.29-2.00); p < 0.001), reduced surgical morbidity (OR = 0.78 (95% CI, 0.65-0.95); p = 0.01), and shorter length of stay (β = -0.87 (95% CI, -1.51 to -0.24); p = 0.007). The association between checklist compliance and reduced odds of circumferential resection margin positivity remained on sensitivity analysis (OR = 0.61 (95% CI, 0.42-0.88); p = 0.009) when adjusting for neoadjuvant radiation. LIMITATIONS This study was limited by its absence of long-term oncologic data and missing variables. CONCLUSIONS Compliance with 6 preoperative elements of the American Society of Colon and Rectal Surgeons rectal cancer surgery checklist was associated with significantly improved pathologic outcomes and reduced postoperative morbidity. See Video Abstract at http://links.lww.com/DCR/B80. EL CUMPLIMIENTO CON LOS ELEMENTOS PREOPERATORIOS DE LA LISTA DE VERIFICACIÓN DE CIRUGÍA PARA CÁNCER RECTAL DE LA SOCIEDAD AMERICANA DE CIRUJANOS DE COLON Y RECTO MEJORA LOS RESULTADOS HISTOPATOLÓGICOS Y POSTOPERATORIOS: En 2016, la Sociedad Americana de Cirujanos de Colon y Recto publicó una lista de verificación de cirugía de cáncer de recto que comprende los elementos esenciales de la atención pre, intra y postoperatoria para pacientes sometidos a cirugía de cáncer de recto.Evaluar si el cumplimiento con los elementos preoperatorios de la lista de verificación se asoció con mejores resultados histopatológicos y postoperatorios a 30 días después de la cirugía de cáncer rectal.Estudio de cohorte retrospectiva.Hospitales norteamericanos que contribuyen al Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos.Pacientes adultos que se sometieron a cirugía electiva de cáncer rectal entre 2016 y 2017.Cumplimiento de la lista de verificación con seis elementos preoperatorios de la lista de verificación.Resultados histopatológicos (estado del margen de resección circunferencial, estado del margen de resección distal, cosecha adecuada de ganglios linfáticos ≥12), morbilidad quirúrgica a 30 días y duración de la estadía.En total, 2,217 pacientes fueron incluidos en el análisis. El cumplimiento individual de los seis ítems disponibles de la lista de verificación preoperatoria fue variable: 91.3% para la documentación previa al tratamiento de la localización del tumor dentro del recto, 86.8% para colonoscopía completa, 84.0% para el marcado preoperatorio apropiado del sitio de estoma, 79.8% para el uso apropiado de radioterapia neoadyuvante, 76.6 % para estadificación locorregional y 70.8% para estadificación distante. Solo 836 (37.7%) pacientes tenían los seis elementos de la lista de verificación completos, mientras que 1,381 (62.3%) no. En comparación con los pacientes sin cumplimiento de la lista de verificación, los pacientes con cumplimiento de la lista de verificación eran más jóvenes (60.0 vs. 63.0 años, p <0.001), pero por lo demás tenían características demográficas similares. En la regresión multivariada, el cumplimiento de la lista de verificación se asoció con menores probabilidades de positividad en el margen de resección circunferencial (OR = 0.47; IC del 95%: 0.31-0.71, p <0.001), mayores probabilidades de una cosecha adecuada de ganglios linfáticos ≥12 (OR = 1.60, IC 95% 1.29-2.00, p <0.001), menor morbilidad quirúrgica (OR = 0.78, IC 95% 0.65-0.95, p = 0.01) y menor duración de estadía (β = -0.87, IC 95% -1.51 - - 0.24, p = 0.007). La asociación entre el cumplimiento de la lista de verificación y las probabilidades reducidas de positividad del margen de resección circunferencial se mantuvo en el análisis de sensibilidad (OR = 0.61; IC del 95%: 0.42-0.88, p = 0.009) al ser ajustado con radiación neoadyuvante.Ausencia de datos oncológicos a largo plazo y variables faltantes.El cumplimiento de seis elementos preoperatorios de la lista de verificación de cirugía de cáncer rectal de la Sociedad Americana de Cirujanos de Colon y Recto se asoció con resultados histopatológicos significativamente mejores y una menor morbilidad postoperatoria. Vea el resumen en video en http://links.lww.com/DCR/B80.
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Abstract
The incidence of surgical complications has remained largely unchanged over the past two decades. Inherent complexity in surgery, new technology possibilities, increasing age and comorbidity in patients may contribute to this. Surgical safety checklists may be used as some of the tools to prevent such complications. Use of checklists may reduce critical workload by eliminating issues that are already controlled for. The global introduction of the World Health Organization Surgical Safety Checklist aimed to improve safety in both anesthesia and surgery and to reduce complications and mortality by better teamwork, communication, and consistency of care. This review describes a literature synthesis on advantages and disadvantages in use of surgical safety checklists emphasizing checklist development, implementation, and possible clinical effects and using a theoretical framework for quality of provided healthcare (structure-process-outcome) to understand the checklists' possible impact on patient safety.
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116
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Olotu C. ["Emergency anesthesia" in geriatric patients]. Med Klin Intensivmed Notfmed 2019; 115:16-21. [PMID: 31832699 DOI: 10.1007/s00063-019-00635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The share of elderly patients undergoing emergency surgery is constantly increasing. Their postoperative outcome remains poor, even if surgery itself is survived in the short or medium term. OBJECTIVES Important aspects of anesthesiologic care for older emergency patients based upon recent literature and guideline recommendations are presented. METHODS Selective review of the literature, considering national and international guidelines, meta-analysis and Cochrane reviews. CONCLUSION Anesthesiologic care can significantly influence the perioperative outcome of elderly emergency surgery patients. In this context, emergency anesthesiology exceeds mere anesthesia itself and applies to the overall perioperative management.
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Affiliation(s)
- Cynthia Olotu
- Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 22051, Hamburg, Deutschland.
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Scott IA, Kallie J, Gavrilidis A. Achieving greater clinician engagement and impact in health care improvement: a neglected imperative. Med J Aust 2019; 212:5-7.e1. [DOI: 10.5694/mja2.50438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital Brisbane QLD
- University of Queensland Brisbane QLD
| | - Jennifer Kallie
- Brisbane Diamantina Health PartnersTranslational Research Institute Brisbane QLD
| | - Areti Gavrilidis
- Brisbane Diamantina Health PartnersTranslational Research Institute Brisbane QLD
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118
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Abstract
The perioperative environment is fast paced and complex. Competing responsibilities, noise and distractions, and reluctance of team members to speak up when they are aware of a potential patient safety issue are all barriers to effective communication in the perioperative setting. Communication breakdowns among health care providers can lead to medical errors and patient harm. Accurate and complete communication about the patient and the patient's care can contribute to improved efficiency, better patient outcomes, and fewer adverse events. The new AORN "Guideline for team communication" provides guidance on using standardized processes and tools to improve the quality of team communication. The key points address hand overs between phases of perioperative care; a briefing to share the surgical plan; a time out to verify the correct patient, procedure, site, and side; and a debriefing to discuss what was learned and how to improve. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
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Alidina S, Kuchukhidze S, Menon G, Citron I, Lama TN, Meara J, Barash D, Hellar A, Kapologwe NA, Maina E, Reynolds C, Staffa SJ, Troxel A, Varghese A, Zurakowski D, Ulisubisya M, Maongezi S. Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania's Lake Zone: protocol for a quasi-experimental study. BMJ Open 2019; 9:e031800. [PMID: 31594896 PMCID: PMC6797473 DOI: 10.1136/bmjopen-2019-031800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Effective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term. METHODS AND ANALYSIS Our design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania's Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance. ETHICS AND DISSEMINATION The study has received ethical approval from Harvard Medical School and Tanzania's National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania's Lake Zone region and other similar contexts.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - John Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States
| | - David Barash
- GE Foundation, Boston, Massachusetts, United States
| | | | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutritional Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Alena Troxel
- The Innovations Unit, JHPIEGO, Baltimore, Maryland, United States
| | | | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Mpoki Ulisubisya
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
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Westman M, Takala R, Rahi M, Ikonen TS. The Need for Surgical Safety Checklists in Neurosurgery Now and in the Future-A Systematic Review. World Neurosurg 2019; 134:614-628.e3. [PMID: 31589982 DOI: 10.1016/j.wneu.2019.09.140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/27/2022]
Abstract
Safety checklists have been studied among various surgical patient groups, but evidence of their benefits in neurosurgery remains sparse. Since the implementation of the World Health Organization's Surgical Safety Checklist, their use has become widespread. The aim of this review was to systematically review the state of the literature on surgical safety checklists in neurosurgery. Also, in the new era of robotics and artificial intelligence, there is a need to re-evaluate patient safety procedures in neurosurgery. A systematic review was conducted on PubMed, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, Embase, and MEDLINE for articles published between 2008 and 2016 using MeSH (medical subject heading) terms and keywords describing postoperative complications and surgical adverse events, and some additional searches were carried out until January 2019. Twenty-six original studies or reviews were eligible for this review. They were categorized into studies with patient-related outcomes, personnel-related outcomes, or previous reviews. Checklist use in neurosurgery was found to reduce hospital-acquired infectious complications and to enhance operating room safety culture. Checklists seem to improve patient safety in neurosurgery, although the amount of evidence is still limited. Despite their shortcomings, checklists are here to stay, and new research is required to update checklists to meet the requirements of the transforming working environment of the neurosurgery operating room.
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Affiliation(s)
- Marjut Westman
- Faculty of Medicine, University of Turku, Turku, Finland.
| | - Riikka Takala
- Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital, Turku, Finland
| | - Melissa Rahi
- Division of Clinical Neuroscience, Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | - Tuija S Ikonen
- Public Health, Faculty of Medicine, University of Turku, Turku, Finland
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Samuel N, Berger M. Cultural evolution: a Darwinian perspective on patient safety in neurosurgery. J Neurosurg 2019; 131:1985-1991. [PMID: 31518982 DOI: 10.3171/2019.6.jns191517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Nardin Samuel
- 1Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada; and
| | - Mitchel Berger
- 2Department of Neurological Surgery, University of California, San Francisco, California
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World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda's Referral Hospitals. Anesth Analg 2019; 127:1427-1433. [PMID: 30059396 DOI: 10.1213/ane.0000000000003672] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A pilot study on the World Health Organization (WHO) Surgical Safety Checklist (SSC) showed a reduction in both major complications and mortality of surgical patients. Compliance with this checklist varies around the world. We aimed to determine the extent of compliance with the WHO SSC and its association with surgical outcomes in 5 of Uganda's referral hospitals. METHODS A multicentre prospective cohort study was conducted in 5 referral hospitals in Uganda. Using a questionnaire based on the WHO SSC, patients undergoing surgical operations were systematically recruited into the study from April 2016 to July 2016. The patients were followed up daily for 30 days or until discharge for the purpose of documentation of complications. Logistic regression and linear regression were used to assess for association between compliance and perioperative surgical outcomes. RESULTS We recruited 859 patients into the study. Overall compliance with the WHO SSC was 41.7% (95% confidence interval [CI], 39.7-43.8) ranging from 11.9% to 89.8% across the different hospitals. Overall compliance with "sign in" was 44.7% (95% CI, 43-45.6), with "time out" was 42.0% (95% CI, 39.4-44.6), and with "sign out" was 33.3% (95% CI, 30.7-35.9). There was no association between compliance and perioperative surgical outcomes: length of hospital stay, adverse events, and mortality. CONCLUSIONS This study revealed low levels of compliance with the WHO SSC. There was a statistically significant association between this level of compliance and the incidence of pain and loss of consciousness postoperatively.
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Peden CJ, Stephens T, Martin G, Kahan BC, Thomson A, Everingham K, Kocman D, Lourtie J, Drake S, Girling A, Lilford R, Rivett K, Wells D, Mahajan R, Holt P, Yang F, Walker S, Richardson G, Kerry S, Anderson I, Murray D, Cromwell D, Phull M, Grocott MPW, Bion J, Pearse RM. A national quality improvement programme to improve survival after emergency abdominal surgery: the EPOCH stepped-wedge cluster RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients.
Objectives
The objectives were to assess whether or not the QI programme improves 90-day survival after emergency abdominal surgery; to assess effects on 180-day survival, hospital stay and hospital readmission; and to better understand these findings through an integrated process evaluation, ethnographic study and cost-effectiveness analysis.
Design
This was a stepped-wedge cluster randomised trial. Hospitals were organised into 15 geographical clusters, and commenced the QI programme in random order over 85 weeks. Analyses were performed on an intention-to-treat basis. The primary outcome was analysed using a mixed-effects parametric survival model, adjusting for time-related effects. Ethnographic and economics data were collected in six hospitals. The process evaluation included all hospitals.
Setting
The trial was set in acute surgical services of 93 NHS hospitals.
Participants
Patients aged ≥ 40 years who were undergoing emergency abdominal surgery were eligible.
Intervention
The intervention was a QI programme to implement an evidence-based care pathway.
Main outcome measures
The primary outcome measure was mortality within 90 days of surgery. Secondary outcomes were mortality within 180 days, length of hospital stay and hospital readmission within 180 days. The main economic measure was the quality-adjusted life-years.
Data sources
Data were obtained from the National Emergency Laparotomy Audit database; qualitative interviews and ethnographic observations; quality-of-life and NHS resource use data were collected via questionnaires.
Results
Of 15,873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 participants in the usual care group and 7374 in the QI group. The primary outcome occurred in 1393 participants in the usual care group (16%), compared with 1210 patients in the QI group (16%) [QI vs. usual care hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.96 to 1.28]. No differences were found in mortality at 180 days or hospital readmission; there was a small increase in hospital stay in the QI group (HR for discharge 0.90, 95% CI 0.83 to 0.97). There were only modest improvements in care processes following QI implementation. The ethnographic study revealed good QI engagement, but limited time and resources to implement change, affecting which processes teams addressed, the rate of change and eventual success. In some sites, there were challenges around prioritising the intervention in busy environments and in obtaining senior engagement. The intervention is unlikely to be cost-effective at standard cost-effectiveness thresholds, but may be cost-effective over the lifetime horizon.
Limitations
Substantial delays were encountered in securing data access to national registries. Fewer patients than expected underwent surgery and the mortality rate was lower than anticipated.
Conclusions
There was no survival benefit from a QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. The modest impact of the intervention on process measures, despite good clinician engagement, may have been limited by the time and resources needed to improve patient care.
Future work
Future QI programmes must balance intervention complexity with the practical realities of NHS services to ensure that such programmes can be delivered with the resources available.
Trial registration
Current Controlled Trials ISRCTN80682973 and The Lancet protocol 13PRT/7655.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Carol J Peden
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Stephens
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Graham Martin
- Health Sciences, University of Leicester, Leicester, UK
| | - Brennan C Kahan
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Ann Thomson
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Kirsty Everingham
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - David Kocman
- Health Sciences, University of Leicester, Leicester, UK
| | | | | | - Alan Girling
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Ravi Mahajan
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Peter Holt
- Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Fan Yang
- Centre for Health Economics, University of York, York, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | | | - Sally Kerry
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Iain Anderson
- Salford Royal Hospital NHS Foundation Trust, Manchester, UK
| | - Dave Murray
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - David Cromwell
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mandeep Phull
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Department of Anaesthesia and Intensive Care, Queen’s Hospital, Romford, UK
| | - Mike PW Grocott
- National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Anaesthesia and Critical Care Research Unit, University of Southampton, Southampton, UK
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rupert M Pearse
- William Harvey Research Institute, Queen Mary University of London, London, UK
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Banguti PR, Mvukiyehe JP, Durieux ME. The World Health Organization Surgical Safety Checklist: Happy 10th Birthday! Anesth Analg 2019; 127:1283-1284. [PMID: 30433916 DOI: 10.1213/ane.0000000000003732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paulin R Banguti
- From the Department of Anesthesiology, University of Rwanda, Kigali, Rwanda
| | | | - Marcel E Durieux
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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125
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Affiliation(s)
| | | | - Alex B Haynes
- Department of Surgery and Perioperative Care, Dell Medical School of the University of Texas at Austin, Austin, TX, USA
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126
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Bottcher B, Abu-El-Noor N, Abuowda Y, Alfaqawi M, Alaloul E, El-Hout S, Al-Najjar I, Abu-El-Noor M. Attitudes of doctors and nurses to patient safety and errors in medical practice in the Gaza-Strip: a cross-sectional study. BMJ Open 2019; 9:e026788. [PMID: 31383695 PMCID: PMC6687030 DOI: 10.1136/bmjopen-2018-026788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 06/17/2019] [Accepted: 07/10/2019] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES This study examined the attitudes of nurses and doctors to key patient safety concepts, evaluated differences and similarities between professional groups and assessed positive and negative attitudes to identify target areas for future training. SETTING Four major governmental hospitals in the Gaza-Strip. PARTICIPANTS A convenience sample of 424 nurses and 150 physicians working for at least 6 months in the study hospitals. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures were mean scores with SD as measured for individual items and nine main patient safety domains assessed by the Attitudes to Patient Safety Questionnaire. Secondary outcome measures were the proportions of doctors and nurses, that gave a positive response to each item, represented as percentage of each group. RESULTS Nurses and doctors held moderately positive attitudes towards patient safety with five out of nine domain scores >3.5 of 5. Doctors showed slightly more positive attitudes than nurses, despite a smaller proportion of doctors having received patient safety training with 37.5% compared with 41.9% of nurses. Both professions displayed their most positive patient safety attitudes in the same domains ('team functioning' and 'working hours as a cause for error'), as well as their two most negative attitudes ('importance of patient safety in the curriculum' and 'professional incompetence as a cause of error'), demonstrating significant deficits in understanding medical errors. A specific challenge will be the negative attitudes of both professions towards patient safety training for wider dissemination of this content in the postgraduate curriculum. CONCLUSION Patient safety attitudes were moderately positive in both professional groups. Target of future patient safety training should be enhancing the understanding of error in medicine. Any training has to be motivating and relevant for clinicians, demonstrating its importance in ongoing professional learning.
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Affiliation(s)
- Bettina Bottcher
- Islamic University of Gaza, Faculty of Medicine, Gaza, State of Palestine
| | | | - Yousef Abuowda
- Islamic University of Gaza, Faculty of Medicine, Gaza, State of Palestine
| | - Maha Alfaqawi
- Islamic University of Gaza, Faculty of Medicine, Gaza, State of Palestine
| | - Enas Alaloul
- Palestinian Ministry of Health, Gaza, State of Palestine
| | - Somaya El-Hout
- Palestinian Ministry of Health, Gaza, State of Palestine
| | - Ibrahem Al-Najjar
- Islamic University of Gaza, Faculty of Medicine, Gaza, State of Palestine
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127
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Non-technical skills training in the operating theatre: A meta-analysis of patient outcomes. Surgeon 2019; 17:233-243. [DOI: 10.1016/j.surge.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/10/2018] [Accepted: 07/02/2018] [Indexed: 11/17/2022]
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128
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Goldenberg MG, Elterman D. From box ticking to the black box: the evolution of operating room safety. World J Urol 2019; 38:1369-1372. [PMID: 31363833 DOI: 10.1007/s00345-019-02886-5] [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: 04/10/2019] [Accepted: 07/23/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Efforts to improve the safety of patients in the operating room have focused on mitigating harm through the standardization of system, team, and human level factors. This article highlights existing and future methods for enhancing safety in the perioperative setting, and the theory and principles that underpin them. METHODS Evidence surrounding the development and implementation of select surgical safety interventions is discussed. RESULTS Work in human factors and engineering that has inspired safety interventions such as the WHO Safety Checklist, and more recently operating room recorders, represents a movement away from traditional, retrospective or reactive methods of studying surgical safety, to prospective and proactive ones. CONCLUSIONS Future work will examine the effectiveness of these interventions for improving patient outcomes and minimizing iatrogenic harm.
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Affiliation(s)
- Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada.
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129
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Saxena S, Krombach JW, Nahrwold DA, Pirracchio R. Anaesthesia-specific checklists: A systematic review of impact. Anaesth Crit Care Pain Med 2019; 39:65-73. [PMID: 31374366 DOI: 10.1016/j.accpm.2019.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/19/2019] [Accepted: 07/16/2019] [Indexed: 11/25/2022]
Abstract
Checklists are recognised as powerful tools to prevent avoidable errors in high-reliability organisations. In healthcare, the perioperative area has been a leading field in the development of a wide range of checklists. However, clinical literature on this subject is still sparse and heterogeneous, producing results that are sometimes conflicting. This systematic review assesses the current literature on perioperative routine and crisis checklists. Literature searches did not use a date limit and included articles up to March 2019. The methodological heterogeneity precluded combining data from the individual studies into a quantitative meta-analysis. Data are presented by means of a qualitative comparison with the reference groups based on a content analysis approach. Of the 874 identified articles, 25 were included in this review. Most identified studies (23, 92%) have shown that the use of checklists in anaesthesia can decrease human error, improve patient safety and teamwork, and increase quality of care. Beyond the WHO surgical time-out, anaesthesia-specific checklists have been shown to be useful for provider handoffs, emergencies, and routine anaesthesia procedures. However, literature on anaesthesia-specific checklists is still limited and very heterogeneous. More large-scale studies are necessary to identify an ideal anaesthesia checklist and its most appropriate implementation method.
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Affiliation(s)
- Sarah Saxena
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America; Department of Anaesthesia, University Hospital of Charleroi, Charleroi, Belgium
| | - Jens W Krombach
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America
| | - Daniel A Nahrwold
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America
| | - Romain Pirracchio
- Department of Anaesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital & Trauma Centre, University of California, 1001, Potrero avenue, CA94110 San Francisco, CA, United States of America; Department of Anaesthesia and Critical Care Medicine, European Hospital Georges-Pompidou, Paris Descartes University, 75015 Paris, France; Inserm UMR 1153, ECSTRA Team, Department of Biostatistics and Medical Informatics, Saint Louis Hospital, Paris Diderot University, 75010 Paris, France.
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130
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A Multidisciplinary Discharge Timeout Checklist Improves Patient Education and Captures Discharge Process Errors. Qual Manag Health Care 2019; 27:63-68. [PMID: 29596265 DOI: 10.1097/qmh.0000000000000168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To design and implement a discharge timeout checklist, and to assess its effects on patients' understanding as well as the potential impact on preventable medical errors surrounding hospital discharges to home. METHODS Based on the structure successfully used for surgical procedures and using the Model for Improvement framework, we designed a discharge checklist to review and assess patients' understanding of discharge medications, catheters, home care plans, follow-up, symptoms, and who to call with problems after discharge. In parallel, we developed a process of integrating the checklist into the discharge process after routine discharge procedures were completed. We used the checklists to assess patients' level of understanding and need for additional education as well as changes in discharge documentation; we also noted whether good catches of significant errors in the discharge process occurred. RESULTS Over 6 months of study, 190 discharge timeouts out of 429 eligible discharges were completed. Additional education was provided in 53 of 190 discharge timeouts (27.8%), with 62% of this education being related to medications. Twenty-one (11.1%) discharge timeouts resulted in at least one change to the discharge documentation or a good catch. CONCLUSIONS A multidisciplinary discharge timeout directly involving the patient can be effective in targeting additional areas for patient education and in potentially reducing preventable adverse events.
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131
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Wang H, Zheng T, Chen D, Niu Z, Zhou X, Li S, Zhou Y, Cao S. Impacts of the surgical safety checklist on postoperative clinical outcomes in gastrointestinal tumor patients: A single-center cohort study. Medicine (Baltimore) 2019; 98:e16418. [PMID: 31305459 PMCID: PMC6641844 DOI: 10.1097/md.0000000000016418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 19-item surgical safety checklist (SSC) was published by the World Health Organization in 2008 and was proved to reduce postoperative complications. To date, however, the impacts of SSC implementation in China have not been evaluated clearly. The study was performed to evaluate the impacts of the SSC on postoperative clinical outcomes in gastrointestinal tumor patients.Between April 2007 and March 2013, 7209 patients with gastrointestinal tumor who underwent elective surgery at the Affiliated Hospital of Qingdao University were studied. Data on the clinical records and outcomes of 3238 consecutive surgeries prior to SSC implementation were retrospectively collected; data on another 3971 consecutive surgeries performed after SSC implementation were prospectively collected. The clinical outcomes (including mortality, morbidity, readmission, reoperation, unplanned intervention and postoperative hospital stay) within postoperative 30 days were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to identify independent factors for postoperative complications.The rates of morbidity and in-hospital mortality before and after SSC implementation were 16.43% vs 14.33% (P = .018), 0.46% vs 0.18% (P = .028), respectively. Median of postoperative hospital stay in post-implementation group was shorter than that in pre-implementation group (8 vs 9 days, P < .001). Multivariable analysis demonstrated that the SSC was an independent factor influencing postoperative complications (odds ratio = 0.860; 95% CI, 0.750-0.988).Implementation of the SSC could improve the clinical outcomes in gastrointestinal tumor patients undergoing elective surgery in China.
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Affiliation(s)
- Hao Wang
- Department of General Surgery, Dongying People's Hospital, Shandong, China
- Department of Gastrointestinal Surgery
| | - Taohua Zheng
- Hepatic Disease Center, Affiliated Hospital of Qingdao University
| | - Dong Chen
- Department of Gastrointestinal Surgery
| | | | - Xiaobin Zhou
- Department of Epidemiology and Health Statistics, Qingdao University Medical College, Shandong, China
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Abstract
The aim of this review is to highlight the latest movements surrounding Emergency Manual (EM) implementation nationally and abroad within perioperative medicine with a focus on studies linking EM to patient safety. This is a comprehensive literature review which includes a brief introduction to the definition and history of EM as well as an overview of a successful implementation strategy, international influence and correlations to patient safety. The recent changes in healthcare and healthcare reimbursement have directed the focus throughout healthcare to quality improvement and patient safety. The potential of EMs' application to improve patient outcomes has influential implications both on patient outcomes as well as reimbursements. This study includes relevant citations with the large majority published in the last five years. EM implementation in healthcare has grown within the US and internationally over the last decade. Prominent organizations have created EMs containing principles of evidence-based medicine and widely accepted protocols that have been endorsed by major entities in the medical field. Successful implementation strategies primarily focus on different forms of simulation training and have been found to increase adherence to protocols through EM use. An increasing amount of educational institutions and healthcare facilities worldwide are perpetuating such implementation and a growing number of successful cases are being published.
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Affiliation(s)
- Wayne R Simmons
- Anesthesiology, Hospital Corporation of America West Florida Graduate Medical Education Consortium / Oak Hill Hospital, Brooksville, USA
| | - Jeff Huang
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
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133
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Feguri GR, Lima PRLD, Franco AC, Cruz FRHDL, Borges DC, Toledo LR, Segri NJ, Aguilar-Nascimento JED. Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion During CABG: a Double-Blind Controlled Randomized Trial. Braz J Cardiovasc Surg 2019; 34:125-135. [PMID: 30916121 PMCID: PMC6436776 DOI: 10.21470/1678-9741-2018-0336] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/31/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To assess postoperative clinical data considering the association of
preoperative fasting with carbohydrate (CHO) loading and intraoperative
infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods 57 patients undergoing coronary artery bypass grafting (CABG) were randomly
assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia),
(CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5%
maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of
ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before
anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3,
n=14). The need for vasoactive drugs was analyzed, in addition to
postoperative inflammation and metabolic control. Results There were two deaths (3.5%). Patients in CHO groups presented a lower
incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94;
P=0.023), needed fewer vasoactive drugs during surgery
and ICU stay (P<0.05); and had better blood glucose
levels in the first six hours of recovery (P=0.015),
requiring less exogenous insulin (P=0.018). Incidence of
postoperative atrial fibrillation (POAF) varied significantly among groups
(P=0.009). Subjects who receive ω-3 PUFA groups
had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02;
P=0.001). Patients in the W3 group had lower
ultrasensitive-CRP levels at 36 h postoperatively
(P=0.008). Interleukin-10 levels varied among groups
(P=0.013), with the highest levels observed in the
postoperative of patients who received intraoperative infusion of ω-3
PUFA (P=0.049). Conclusion Fasting abbreviation with carbohydrate loading and intraoperative infusion of
ω-3 PUFA is safe and supports faster postoperative recovery in
patients undergoing on-pump CABG.
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Affiliation(s)
- Gibran Roder Feguri
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Paulo Ruiz Lúcio de Lima
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Anna Carolina Franco
- Department of Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | | | - Danilo Cerqueira Borges
- Department of Cardiology and Cardiovascular Surgery, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Laura Ramos Toledo
- Department of Physical Therapy, Hospital Geral Universitário, Universidade de Cuiabá (HGU-UNIC), Cuiabá, MT, Brazil
| | - Neuber José Segri
- Department of Statistics, Universidade Federal do Mato Grosso (UFMT), Cuiabá, MT, Brazil
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Yu X, Jiang J, Shang H, Wu S, Sun H, Li H, Xin S, Zhao S, Huang Y, Wu X, Zhang X, Wang Y, Xue F, Han W, Wang Z, Hu Y, Wang L, Zhao Y. Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China. BMJ Open 2019; 9:e025401. [PMID: 31182441 PMCID: PMC6561454 DOI: 10.1136/bmjopen-2018-025401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To develop a risk-stratified intervention strategy and evaluate its effect on reducing surgical complications. DESIGN A multicentre prospective study with preintervention and postintervention stages: period I (January to June 2015) to develop the intervention strategy and period II (January to June 2016) to evaluate its effectiveness. SETTING Four academic/teaching hospitals representing major Chinese administrative and economic regions. PARTICIPANTS All surgical (elective and emergent) inpatients aged ≥14 years with a minimum hospital stay of 24 hours, who underwent a surgical procedure requiring an anesthesiologist. INTERVENTIONS Targeted complications were grouped into three categories (common, specific, serious) according to their incidence pattern, severity and preventability. The corresponding expert consensus-generated interventions, which focused on both regulating medical practices and managing inherent patient-related risks, were implemented in a patient-tailored way via an electronic checklist system. PRIMARY AND SECONDARY OUTCOMES Primary outcomes were (1) in-hospital death/confirmed death within 30 days after discharge and (2) complications during hospitalisation. Secondary outcome was length of stay (LOS). RESULTS We included 51 030 patients in this analysis (eligibility rate 87.7%): 23 413 during period I, 27 617 during period II. Patients' characteristics were comparable during the two periods. After adjustment, the mean number of overall complications per 100 patients decreased from 8.84 to 7.56 (relative change 14.5%; P<0.0001). Specifically, complication rates decreased from 3.96 to 3.65 (7.8%) for common complications (P=0.0677), from 0.50 to 0.36 (28.0%) for specific complications (P=0.0153) and from 3.64 to 2.88 (20.9%) for serious complications (P<0.0001). From period I to period II, there was a decreasing trend for mortality (from 0.64 to 0.53; P=0.1031) and median LOS (by 1 day; P=0.8293), without statistical significance. CONCLUSIONS Implementing a risk-stratified intervention strategy may be a target-sensitive, convenient means to improve surgical outcomes.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingmei Jiang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Shang
- The First Hospital of China Medical University, Shenyang, China
| | - Shizheng Wu
- Qinghai Provincial People’s Hospital, Xining, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Hanzhong Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- The First Hospital of China Medical University, Shenyang, China
| | | | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinjuan Wu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Zhang
- The First Hospital of China Medical University, Shenyang, China
| | - Yaolei Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Fang Xue
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixing Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoda Hu
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yupei Zhao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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135
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Safe anesthesia for office-based plastic surgery: Proceedings from the PRS Korea 2018 meeting in Seoul, Korea. Arch Plast Surg 2019; 46:189-197. [PMID: 31113182 PMCID: PMC6536880 DOI: 10.5999/aps.2018.01473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/02/2019] [Indexed: 12/15/2022] Open
Abstract
There has been an exponential increase in plastic surgery cases over the last 20 years, surging from 2.8 million to 17.5 million cases per year. Seventy-two percent of these cases are being performed in the office-based or ambulatory setting. There are certain advantages to performing aesthetic procedures in the office, but several widely publicized fatalities and malpractice claims has put the spotlight on patient safety and the lack of uniform regulation of office-based practices. While 33 states currently have legislation for office-based surgery and anesthesia, 17 states have no mandate to report patient deaths or adverse outcomes. The literature on office-base surgery and anesthesia has demonstrated significant improvements in patient safety over the last 20 years. In the following review of the proceedings from the PRS Korea 2018 meeting, we discuss several key concepts regarding safe anesthesia for officebased cosmetic surgery. These include the safe delivery of oxygen, appropriate local anesthetic usage and the avoidance of local anesthetic toxicity, the implementation of Enhanced Recovery after Surgery protocols, multimodal analgesic techniques with less reliance on narcotic pain medications, the use of surgical safety checklists, and incorporating “the patient” into the surgical decision-making process through decision aids.
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136
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Mojdeh S, Zabihirad J, Shahriari M. Nurse’s perioperative care errors and related factors in the operating room. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/94220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ramsay G, Haynes AB, Lipsitz SR, Solsky I, Leitch J, Gawande AA, Kumar M. Reducing surgical mortality in Scotland by use of the WHO Surgical Safety Checklist. Br J Surg 2019; 106:1005-1011. [DOI: 10.1002/bjs.11151] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/29/2018] [Accepted: 02/04/2019] [Indexed: 01/07/2023]
Abstract
Abstract
Background
The WHO Surgical Safety Checklist has been implemented widely since its launch in 2008. It was introduced in Scotland as part of the Scottish Patient Safety Programme (SPSP) between 2008 and 2010, and is now integral to surgical practice. Its influence on outcomes, when analysed at a population level, remains unclear.
Methods
This was a population cohort study. All admissions to any acute hospital in Scotland between 2000 and 2014 were included. Standardized differences were used to estimate the balance of demographics over time, after which interrupted time-series (segmented regression) analyses were performed. Data were obtained from the Information Services Division, Scotland.
Results
There were 12 667 926 hospital admissions, of which 6 839 736 had a surgical procedure. Amongst the surgical cohort, the inpatient mortality rate in 2000 was 0·76 (95 per cent c.i. 0·68 to 0·84) per cent, and in 2014 it was 0·46 (0·42 to 0·50) per cent. The checklist was associated with a 36·6 (95 per cent c.i. –55·2 to –17·9) per cent relative reduction in mortality (P < 0·001). Mortality rates before implementation were decreasing by 0·003 (95 per cent c.i. –0·017 to +0·012) per cent per year; annual decreases of 0·069 (–0·092 to –0·046) per cent were seen during, and 0·019 (–0·038 to +0·001) per cent after, implementation. No such improvement trends were seen in the non-surgical cohort over this time frame.
Conclusion
Since the implementation of the checklist, as part of an overall national safety strategy, there has been a reduction in perioperative mortality.
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Affiliation(s)
- G Ramsay
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A B Haynes
- Safe Surgery Program, Ariadne Labs, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S R Lipsitz
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - I Solsky
- Safe Surgery Program, Ariadne Labs, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J Leitch
- Healthcare Quality and Strategy, The Scottish Government, Edinburgh, UK
| | - A A Gawande
- Safe Surgery Program, Ariadne Labs, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - M Kumar
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
- Scottish Mortality and Morbidity Programme, Healthcare Improvement Scotland, Edinburgh, UK
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138
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Mahmood T, Mylopoulos M, Bagli D, Damignani R, Aminmohamed Haji F. A mixed methods study of challenges in the implementation and use of the surgical safety checklist. Surgery 2019; 165:832-837. [DOI: 10.1016/j.surg.2018.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022]
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139
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Beez T, Steiger HJ, Weber B, Ahmadi SA. Pediatric neurosurgery malpractice claims in Germany. Childs Nerv Syst 2019; 35:337-342. [PMID: 30159706 DOI: 10.1007/s00381-018-3963-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is limited data regarding malpractice claims in pediatric neurosurgery. Aim of this study was to analyze the rate, subject, and outcome of malpractice claims faced by pediatric neurosurgeons. METHODS We analyzed malpractice claims in pediatric neurosurgical patients assigned to the review board of North Rhine Medical Council from 2012 to 2016. Claims were categorized as "medical error" or "adverse event, no medical error." Severity was graded from negligible (grade 1) to death (grade 6). RESULTS Of 391 pediatric malpractice claims, seven (1.8%) concerned pediatric neurosurgery. Claims were related to cranial surgery (N = 5), spinal surgery (N = 1), and a neuro-interventional procedure (N = 1). Of operative cases, three were shunt operations, two were cranioplasty procedures, and one was a spinal fusion. Complications of medical care (adverse events) had occurred in all cases. A medical error was detected in only one case. Severity of damage was grade 2 (transient minor) in three, grade 3 (transient major) in one, and grade 5 (permanent major) in three cases, respectively. CONCLUSIONS Pediatric neurosurgery accounted for 1.8% of all pediatric malpractice claims. In 14% of these claims, a medical error was confirmed. Malpractice claim rate thus appears to be lower than expected for a high-risk specialty. , adverse events were confirmed in all cases, a negligent medical error was rare. Adverse event rate appears to be a predictor for malpractice claim burden, highlighting the importance of surgical checklists, standard operating procedures and morbidity and mortality surveillance.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Beate Weber
- North Rhine Medical Council (Ärztekammer Nordrhein), Tersteegenstr. 9, 40474, Düsseldorf, Germany
| | - Sebastian Alexander Ahmadi
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
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140
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Sleiman B, Sayeed Z, Padela MT, Padela AF, Bobba V, Yassir W, Frush T, Saleh KJ. Review article: Current literature on surgical checklists and handoff tools and application for orthopaedic surgery. J Orthop 2019; 16:86-90. [PMID: 30662245 DOI: 10.1016/j.jor.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022] Open
Abstract
Despite the adaptation of checklists for specific surgeries being developed, there remains a lack of an available standard for an orthopaedic-specific checklist. Benefits of implementing checklists include cost-effectiveness as well as the ability to significantly reduce both mortality and complication rates in a variety of healthcare settings. The aim of this review is to analyze the evidence surrounding the effectiveness of checklists as well as recommend for the development of a standard checklist for specific orthopaedic surgeries such as total joint arthroplasty (TJA).
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Affiliation(s)
| | - Zain Sayeed
- Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Resident Research Partnership, Detroit, MI, USA
| | - Muhammad T Padela
- FAJR Scientific, Detroit, MI, USA.,John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA.,Chicago Medical School, Department of Orthopaedic Surgery, Rosalind Franklin University, North Chicago, IL, USA.,Resident Research Partnership, Detroit, MI, USA
| | | | - Vamsy Bobba
- Resident Research Partnership, Detroit, MI, USA
| | - Walid Yassir
- FAJR Scientific, Detroit, MI, USA.,Resident Research Partnership, Detroit, MI, USA.,DMC Children's Hospital of Michigan, Department of Orthopaedic Surgery, Detroit, MI, USA
| | - Todd Frush
- Resident Research Partnership, Detroit, MI, USA
| | - Khaled J Saleh
- FAJR Scientific, Detroit, MI, USA.,Michigan State University College of Medicine, Detroit, MI, USA.,John D. Dingell Veteran Affairs Medical Center, Detroit, MI, USA
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141
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Storesund A, Haugen AS, Wæhle HV, Mahesparan R, Boermeester MA, Nortvedt MW, Søfteland E. Validation of a Norwegian version of SURgical PAtient Safety System (SURPASS) in combination with the World Health Organizations' Surgical Safety Checklist (WHO SSC). BMJ Open Qual 2019; 8:e000488. [PMID: 30687799 PMCID: PMC6327875 DOI: 10.1136/bmjoq-2018-000488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction Surgical safety checklists may contribute to reduction of complications and mortality. The WHO’s Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway. Objective We aimed to validate a Norwegian version of the SURPASS’ preoperative and postoperative checklists for use in combination with the already established Sign In, Time Out and Sign Out parts of the WHO SSC. Methods and materials The validation of the SURPASS checklists content followed WHOs recommended guidelines. The process consisted of six steps: forward translation; testing the content; focus groups; expert panels; back translation; and approval of the final version. Qualitative content analysis was used to identify codes and categories for adaption of the SURPASS checklist items throughout Norwegian surgical care. Content validity index (CVI) was used by expert panels to score the relevance of each checklist item. The study was carried out in a neurosurgical ward in a large tertiary teaching hospital in Norway. Results Testing the preoperative and postoperative SURPASS checklists was performed in 29 neurosurgical procedures. This involved all professional groups in the entire surgical patient care pathway. Eight clinical focus groups revealed two main categories: ‘Adapt the wording to fit clinical practice’ and ‘The checklist items challenge existing workflow’. Interprofessional scoring of the content validity of the checklists reached >80% for all the SURPASS checklists. Conclusions The first version of the SURPASS checklists combined with the WHO SSC was validated for use in Norwegian surgical care with face validity confirmed and CVI >0.80%. Trial registration number NCT01872195.
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Affiliation(s)
- Anette Storesund
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Monica Wammen Nortvedt
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Accident and Emergency Department, City of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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142
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Chhabra A, Singh A, Kuka PS, Kaur H, Kuka AS, Chahal H. Role of Perioperative Surgical Safety Checklist in Reducing Morbidity and Mortality among Patients: An Observational Study. Niger J Surg 2019; 25:192-197. [PMID: 31579376 PMCID: PMC6771182 DOI: 10.4103/njs.njs_45_18] [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] [Indexed: 11/14/2022] Open
Abstract
Background: Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety. Materials and Methods: After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n = 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n = 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications. Results: We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P < 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P < 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P < 0.05). Conclusions: We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.
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Affiliation(s)
- Ashish Chhabra
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Amandeep Singh
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | | | - Haramritpal Kaur
- Department of Anaesthesia, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Amarjeet Singh Kuka
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
| | - Honey Chahal
- Department of Surgery, GGS Medical College and Hospital, Faridkot, Punjab, India
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143
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Differing perceptions of preoperative communication among surgical team members. Am J Surg 2019; 217:1-6. [DOI: 10.1016/j.amjsurg.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/19/2022]
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144
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White MC, Randall K, Ravelojaona VA, Andriamanjato HH, Andean V, Callahan J, Shrime MG, Russ S, Leather AJM, Sevdalis N. Sustainability of using the WHO surgical safety checklist: a mixed-methods longitudinal evaluation following a nationwide blended educational implementation strategy in Madagascar. BMJ Glob Health 2018; 3:e001104. [PMID: 30622746 PMCID: PMC6307586 DOI: 10.1136/bmjgh-2018-001104] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background The WHO Surgical Safety Checklist reduces postoperative complications by up to 50% with the biggest gains in low-income and middle-income countries (LMICs). However in LMICs, checklist use is sporadic and widespread implementation has hitherto been unsuccessful. In 2015/2016, we partnered with the Madagascar Ministry of Health to undertake nationwide implementation of the checklist. We report a longitudinal evaluation of checklist use at 12-18 months postimplementation. Methods Hospitals were identified from the original cohort using purposive sampling. Using a concurrent triangulation mixed-methods design, the primary outcome was self-reported checklist use. Secondary outcomes included use of basic safety processes, assessment of team behaviour, predictors of checklist use, impact on individuals and organisational culture and identification of barriers. Data were collected during 1-day hospital visits using validated questionnaires, WHO Behaviourally Adjusted Rating Scale (WHOBARS) assessment tool and focus groups and analysed using descriptive statistics, multivariate linear regression and thematic analysis. Results 175 individuals from 14 hospitals participated. 74% reported sustained checklist use after 15 months. Mean WHOBARS scores were high, indicating good team engagement. Sustained checklist use was associated with an improved overall understanding of patient safety but not with WHOBARS, hospital size or surgical volume. 87% reported improved understanding of patient safety and 83% increased job satisfaction. Thematic analysis identified improvements in hospital culture (teamwork and communication, preparation and organisation, trust and confidence) and hospital practice (pulse oximetry, timing of antibiotic prophylaxis, introduction of a surgical count). Lack of time in an emergency and obstructive leadership were the greatest implementation barriers. Conclusion 74% of participants reported sustained checklist use 12-18 months following nationwide implementation in Madagascar, with associated improvements in job satisfaction, culture and compliance with safety procedures. Further work is required to examine this implementation model in other countries.
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Affiliation(s)
- Michelle C White
- Centre for Global Health and Health Partnerships, King’s College London, London, UK
- Department of Medical Capcity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | - Kirsten Randall
- Department of Medical Capcity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | | | - Hery H Andriamanjato
- Directeur du Partenariat, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Vanessa Andean
- Department of Medical Capcity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | - James Callahan
- Department of Medical Capcity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | - Mark G Shrime
- Centre for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Stephanie Russ
- Centre for Implementation Science, King’s College London, London, UK
| | - Andrew J M Leather
- Centre for Global Health and Health Partnerships, King’s College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King’s College London, London, UK
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145
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Weller JM, Jowsey T, Skilton C, Gargiulo DA, Medvedev ON, Civil I, Hannam JA, Mitchell SJ, Torrie J, Merry AF. Improving the quality of administration of the Surgical Safety Checklist: a mixed methods study in New Zealand hospitals. BMJ Open 2018; 8:e022882. [PMID: 30559155 PMCID: PMC6303739 DOI: 10.1136/bmjopen-2018-022882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED While the WHO Surgical Safety Checklist (the Checklist) can improve patient outcomes, variable administration can erode benefits. We sought to understand and improve how operating room (OR) staff use the Checklist. Our specific aims were to: determine if OR staff can discriminate between good and poor quality of Checklist administration using a validated audit tool (WHOBARS); to determine reliability and accuracy of WHOBARS self-ratings; determine the influence of demographic variables on ratings and explore OR staff attitudes to Checklist administration. DESIGN Mixed methods study using WHOBARS ratings of surgical cases by OR staff and two independent observers, thematic analysis of staff interviews. PARTICIPANTS OR staff in three New Zealand hospitals. OUTCOME MEASURES Reliability of WHOBARS for self-audit; staff attitudes to Checklist administration. RESULTS Analysis of scores (243 participants, 2 observers, 59 cases) supported tool reliability, with 87% of WHOBARS score variance attributable to differences in Checklist administration between cases. Self-ratings were significantly higher than observer ratings, with some differences between professional groups but error variance from all raters was less than 10%. Key interview themes (33 interviewees) were: Team culture and embedding the Checklist, Information transfer and obstacles, Raising concerns and 'A tick-box exercise'. Interviewees felt the Checklist could promote teamwork and a safety culture, particularly enabling speaking up. Senior staff were of key importance in setting the appropriate tone. CONCLUSIONS The WHOBARS tool could be useful for self-audit and quality improvement as OR staff can reliably discriminate between good and poor Checklist administration. OR staff self-ratings were lenient compared with external observers suggesting the value of external audit for benchmarking. Small differences between ratings from professional groups underpin the value of including all members of the team in scoring. We identified factors explaining staff perceptions of the Checklist that should inform quality improvement interventions.
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Affiliation(s)
- Jennifer M Weller
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Carmen Skilton
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Derryn A Gargiulo
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Oleg N Medvedev
- Centre for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Ian Civil
- Division of Surgery, Auckland City Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | | | - Simon J Mitchell
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Jane Torrie
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
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146
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Sokhanvar M, Kakemam E, Goodarzi N. Implementation of the surgical safety checklist in hospitals of Iran; operating room personnel's attitude, awareness and acceptance. Int J Health Care Qual Assur 2018; 31:609-618. [PMID: 29954264 DOI: 10.1108/ijhcqa-03-2017-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The WHO Surgical Safety Checklist (SSC) has improved patient safety effectively. Despite the known benefits of applying the checklist before surgery, its implementation is less than universal in practice. The purpose of this paper is to determine the operating room personnel's attitude, their awareness and knowledge of the SSC, and to evaluate staff acceptance of the SSC (including personal beliefs). Design/methodology/approach This cross-sectional study was conducted in eight tertiary general hospitals in Tehran, Iran. Some 145 operating room personnel (surgeons, anaesthetists and nurses) were selected for the study. Data collection was carried out via a validated questionnaire in three parts which included socio-demographic, attitude, awareness and acceptance. Data were then analysed using the Kruskal-Wallis and χ2 statistical test. Findings Out of the 145 participants in the study, 92 per cent were aware of the existence of the SSC and 73.9 per cent of them were aware of the objectives of SSC. Overall, the attitude to SSC was positive. The attitude of surgeons was positive towards the impact of the SSC on safety and teamwork. Surgeons were significantly more sensitive to the barriers of SSC application compared to nurses and anaesthetists ( p=0.046). Among the three groups, nurses had the highest level of support for SSC ( p=0.001). Practical implications Despite high acceptance of the checklist among staff, there is still a gap in knowledge about when exactly the checklist should be used. Therefore, involvement of all surgical team members to complete the checklist process, support of senior managers, on-going education and training and consideration of the barriers to its implementation are all key areas that need to be taken into account. Originality/value This is the first research to examine the operating room personnel's attitude, awareness and acceptance about SSC in Iranian hospitals. The outcomes of this study provide documentation and possible justification for effective establishment of SSC in Iran and other countries.
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Affiliation(s)
- Mobin Sokhanvar
- Students' Research Committee, Tabriz University of Medical Science , Tabriz, Iran
| | - Edris Kakemam
- Iranian Centre of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Science , Tabriz, Iran.,Department of Health Management and Economics, School of Public Health, Tabriz University of Medical Science , Tabriz, Iran
| | - Narges Goodarzi
- Hospital Imam Khomeini, Social Security Organization, Arak, Iran
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147
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Helms SE, Brodell RT. Let's acknowledge our mistakes and learn from them! Br J Dermatol 2018; 179:1237-1239. [PMID: 30508236 DOI: 10.1111/bjd.17113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- S E Helms
- Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, 39216, U.S.A
| | - R T Brodell
- Department of Dermatology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi, 39216, U.S.A
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148
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Siracuse JJ, Paracha M, Farber A, Rybin D, Doros G, Tseng J, McAneny D, Sachs T. Never events after hepatopancreatobiliary operations. Am J Surg 2018; 216:1129-1134. [DOI: 10.1016/j.amjsurg.2018.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 06/01/2018] [Accepted: 06/18/2018] [Indexed: 12/15/2022]
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149
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Ariyanayagam T, Drinkwater K, Cozens N, Howlett D, Malcolm P. UK national audit of safety checks for radiology interventions. Br J Radiol 2018; 92:20180637. [PMID: 30495979 DOI: 10.1259/bjr.20180637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To reaudit the use of safety checklists in radiology departments in NHS departments throughout the UK. METHODS: This audit was performed on behalf of The Royal College of Radiologists Audit Committee in 2016 and was sent to radiology audit leads at every NHS department in the UK to determine the use of safety checks in various modalities and subspecialties. Free-form text boxes gathered data on problems with checklist implementation. RESULTS: 109/177 (62%) trusts responded. 48% of respondents used safety checklists for all radiological procedures in all modalities. 50% used checklists for some procedures. 2% did not use a checklist. Checklist use had increased since the previous audit (98% 2016, compared to 94% in 2012) but implementation for different procedures remains variable. For example, in ultrasound-guided fine needle and breast stereotactic procedures (49%), use has not increased since 2012. CONCLUSION: Reasons for not using checklists include a perception that intervention suite checklists were not appropriate for minor procedures and the limited flexibility of radiology information systems. The limitations of checklists are discussed. ADVANCES IN KNOWLEDGE: Our reaudit shows that in spite of increased implementation, use of safety checks is variable. Local ownership and radiology information system flexibility are needed to support the culture of safety processes in radiology departments.
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Affiliation(s)
- Timothy Ariyanayagam
- 1 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust , Norfolk , UK
| | | | - Neil Cozens
- 3 Department of Radiology, Derby Teaching Hospitals NHS Foundation Trust , Derby , UK
| | - David Howlett
- 2 Royal College of Radiologists , England , UK.,4 Department of Radiology, Eastbourne District General Hospital , East Sussex , UK
| | - Paul Malcolm
- 1 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust , Norfolk , UK
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150
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Chatterjee S, Shake JG, Arora RC, Engelman DT, Firstenberg MS, Geller CM, Hirose H, Lonchyna VA, Lytle FT, Milewski RKC, Moosdorf RGH, Rabin J, Sanjanwala R, Galati M, Whitman GJ. Handoffs From the Operating Room to the Intensive Care Unit After Cardiothoracic Surgery: From The Society of Thoracic Surgeons Workforce on Critical Care. Ann Thorac Surg 2018; 107:619-630. [PMID: 30500341 DOI: 10.1016/j.athoracsur.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Subhasis Chatterjee
- Division of General and Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
| | - Jay G Shake
- Department of Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Rakesh C Arora
- Department of Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | - Daniel T Engelman
- Department of Surgery, Baystate Medical Center, Springfield, Massachusetts
| | - Michael S Firstenberg
- Division of Cardiothoracic Surgery, Department of Surgery, The Medical Center of Aurora, Aurora, Colorado
| | - Charles M Geller
- Division of Cardiothoracic Surgery, Department of Surgery, Crozer-Keystone Health System, Drexel University College of Medicine, Upland, Pennsylvania
| | - Hitoshi Hirose
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vassyl A Lonchyna
- Section of Cardiac and Thoracic Surgery, Department of Surgery, University of Chicago School of Medicine, Chicago, Illinois
| | - Francis T Lytle
- Division of Critical Care Medicine, Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio
| | - Rita K C Milewski
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rainer G H Moosdorf
- Department for Cardiovascular Surgery, Phillips University Marburg, Marburg, Germany
| | - Joseph Rabin
- R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rohan Sanjanwala
- Department of Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Canada
| | | | - Glenn J Whitman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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