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Abstract
OBJECTIVE Human factors account for the majority of adverse events. Human factors awareness training entitled Crew Resource Management (CRM) is associated with improved safety and reduced complications and mortality in critically ill patients. We determined the effects of CRM implementation in the trauma room of an Emergency Department (ED). PATIENTS AND METHODS A prospective 3-year cohort study was carried out in a level 1 ED, admitting more than 12 000 patients annually (>1500 trauma related). At the end of the baseline year, CRM training was performed, followed by an implementation year. The third year was defined as the clinical effect year. The primary outcomes were safety climate, measured using the Safety Attitudes Questionnaire, and ED length of stay. The secondary outcome measures were hospital length of stay and 48-h crude mortality of trauma patients. RESULTS All 5070 trauma patients admitted to the ED during the study period were included. Following CRM implementation, safety climate improved significantly in three out of six Safety Attitudes Questionnaire domains, both at the end of the implementation and clinical effect years: teamwork climate, safety climate, and stress recognition. ED length of stay of these patients increased from 141 (102-192) in the baseline year to 161 (116-211) and 170 (128-223) min in the implementation and clinical effect years, respectively (P<0.05 vs. baseline). Hospital length of stay was prolonged by 1 day in the implementation and clinical effect years (P<0.05 vs. baseline), whereas mortality was unaltered. CONCLUSION Although CRM implementation in the ED was associated with an improved safety climate, the time spent by trauma patients in the ED increased.
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Carayon P, Wooldridge A, Hose BZ, Salwei M, Benneyan J. Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering. Health Aff (Millwood) 2018; 37:1862-1869. [PMID: 30395503 PMCID: PMC6509351 DOI: 10.1377/hlthaff.2018.0723] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite progress on patient safety since the publication of the Institute of Medicine's 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. However, broad awareness of HF/SE and its adoption into safety improvement work have been frustratingly slow. We provide an overview of HF/SE, its demonstrated value to a wide range of patient safety problems (in particular, medication safety), and challenges to its broader implementation across health care. We make a variety of recommendations to maximize the spread of HF/SE, including formal and informal education programs, greater adoption of HF/SE by health care organizations, expanded funding to foster more clinician-engineer partnerships, and coordinated national efforts to design and operationalize a system for spreading HF/SE into health care nationally.
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Affiliation(s)
- Pascale Carayon
- Pascale Carayon ( ) is a professor in the Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Abigail Wooldridge
- Abigail Wooldridge is an assistant professor in the Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign
| | - Bat-Zion Hose
- Bat-Zion Hose is a PhD student in the Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Megan Salwei
- Megan Salwei is a PhD student in the Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - James Benneyan
- James Benneyan is a professor in the Department of Mechanical and Industrial Engineering, Northeastern University, in Boston, Massachusetts
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153
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Hoste P, Ferdinande P, Vogelaers D, Vanhaecht K, Hoste E, Rogiers X, Eeckloo K, Vandewoude K. Adherence to guidelines for the management of donors after brain death. J Crit Care 2018; 49:56-63. [PMID: 30388489 DOI: 10.1016/j.jcrc.2018.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/02/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance-performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD. MATERIALS AND METHODS This observational, cross-sectional multicenter study was performed in 21 Belgian ICUs. A retrospective review of patient records of adult utilized DBDs between 2013 and 2016 used 67 KIs to describe adherence to guidelines. RESULTS A total of 296 patients were included. Thirty-five of 67 KIs had a high level of adherence congruent to a high expert panel rating of importance. Nineteen of 67 KIs had a low level of adherence in spite of a high level of importance according to expert consensus. However, inadequate documentation proved an important issue, hampering true guideline adherence assessment. Adherence ranged between 3 and 100% for single KI items and on average, patients received 72% of the integrated expert panel recommended care set. CONCLUSIONS Guideline adherence to an expert panel predefined care set in DBD donor management proved moderate leaving substantial room for improvement. An importance-performance analysis can be used to improve implementation and documentation of guidelines.
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Affiliation(s)
- Pieter Hoste
- Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Intensive Care, General Hospital Sint-Lucas Ghent, Groenebriel 1, 9000 Ghent, Belgium.
| | - Patrick Ferdinande
- Surgical and Transplantation ICU, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; European Pathway Association, Kapucijnenvoer 35, 3000 Leuven, Belgium.
| | - Eric Hoste
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Intensive Care Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Research Foundation - Flanders (FWO), Egmontstraat 5, 1000 Brussels, Belgium.
| | - Xavier Rogiers
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Transplant Surgery, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium.
| | - Koenraad Vandewoude
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 3K3, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Dellinger EP, Bowdle A, Jelacic S. Modifying the Checklist - It Needs to be Done, but Carefully. J Surg Res 2018; 246:623-625. [PMID: 30322682 DOI: 10.1016/j.jss.2018.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
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155
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Epiu I, Byamugisha J, Kwikiriza A, Autry MA. Health and sustainable development; strengthening peri-operative care in low income countries to improve maternal and neonatal outcomes. Reprod Health 2018; 15:168. [PMID: 30290812 PMCID: PMC6173895 DOI: 10.1186/s12978-018-0604-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Uganda is far from meeting the sustainable development goals on maternal and neonatal mortality with a maternal mortality ratio of 383/100,000 live births, and 33% of the women gave birth by 18 years. The neonatal mortality ratio was 29/1000 live births and 96 stillbirths occur every day due to placental abruption, and/or eclampsia - preeclampsia and other unkown causes. These deaths could be reduced with access to timely safe surgery and safe anaesthesia if the Comprehensive Emergency Obstetric and Newborn Care services (CEmONC), and appropriate intensive care post operatively were implemented. A 2013 multi-national survey by Epiu et al. showed that, the Safe Surgical Checklist was not available for use at main referral hospitals in East Africa. We, therefore, set out to further assess 64 government and private hospitals in Uganda for the availability and usage of the WHO Checklists, and investigate the post-operative care of paturients; to advocate for CEmONC implementation in similarly burdened low income countries. METHODS The cross-sectional survey was conducted at 64 government and private hospitals in Uganda using preset questionnaires. RESULTS We surveyed 41% of all hospitals in Uganda: 100% of the government regional referral hospitals, 16% of government district hospitals and 33% of all private hospitals. Only 22/64 (34.38%: 95% CI = 23.56-47.09) used the WHO Safe Surgical Checklist. Additionally, only 6% of the government hospitals and 14% not-for profit hospitals had access to Intensive Care Unit (ICU) services for postoperative care compared to 57% of the private hospitals. CONCLUSIONS There is urgent need to make WHO checklists available and operationalized. Strengthening peri-operative care in obstetrics would decrease maternal and neonatal morbidity and move closer to the goal of safe motherhood working towards Universal Health Care.
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Affiliation(s)
- Isabella Epiu
- NIH Fogarty Global Health Fellow, University of California Global Health Institute, San Francisco, CA USA
- Health Solutions International, P.O.Box 2336, Kampala, Uganda
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Amaya-Arias AC, Zuluaga O, Idárraga D, Eslava-Schmalbach JH. Adaptation and validation for Colombia of the WHO safe childbirth checklist. COLOMBIA MEDICA (CALI, COLOMBIA) 2018; 49:201-212. [PMID: 30410194 PMCID: PMC6220487 DOI: 10.25100/cm.v49i2.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Most maternal that deaths occur in developing countries are considered unfair and can be avoided. In 2008, The WHO proposed a checklist for delivery care, in order to assess whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. Aim To translate, adapt and validate the content of the WHO Safe Childbirth Checklist (SCC) for its use in Colombia. Methods The translation of the list was carried out, adaptation was made to our context and validation of content through a panel of experts composed of 17 health workers with experience in maternal and neonatal care and safety. The reliability among the judges was calculated (Rwg) and according to the results, items were modified or added to each section of the list. Results Modifications were made to the wording of 28 items, none was eliminated, and 19 new items were added. The most important modifications were made to the management guidelines that accompany each item and the items included refer to risks inherent to our environment. Conclusion The Colombian version of the SCC will be a useful tool to improve maternal and neonatal care and thereby will contribute to reducing maternal and neonatal morbidity and mortality in our country.
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Affiliation(s)
- Ana Carolina Amaya-Arias
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Oscar Zuluaga
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Douglas Idárraga
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Javier H Eslava-Schmalbach
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia.,Hospital Universitario Nacional de Colombia, Facultad de Medicina- Universidad Nacional de Colombia. Bogota, Colombia
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Storesund A, Haugen AS, Hjortås M, Nortvedt MW, Flaatten H, Eide GE, Boermeester MA, Sevdalis N, Søfteland E. Accuracy of surgical complication rate estimation using ICD-10 codes. Br J Surg 2018; 106:236-244. [PMID: 30229870 PMCID: PMC6519147 DOI: 10.1002/bjs.10985] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/16/2018] [Accepted: 07/26/2018] [Indexed: 11/08/2022]
Abstract
Background The ICD‐10 codes are used globally for comparison of diagnoses and complications, and are an important tool for the development of patient safety, healthcare policies and the health economy. The aim of this study was to investigate the accuracy of verified complication rates in surgical admissions identified by ICD‐10 codes and to validate these estimates against complications identified using the established Global Trigger Tool (GTT) methodology. Methods This was a prospective observational study of a sample of surgical admissions in two Norwegian hospitals. Complications were identified and classified by two expert GTT teams who reviewed patients' medical records. Three trained reviewers verified ICD‐10 codes indicating a complication present on admission or emerging in hospital. Results A total of 700 admissions were drawn randomly from 12 966 procedures. Some 519 possible complications were identified in 332 of 700 admissions (47·4 per cent) from ICD‐10 codes. Verification of the ICD‐10 codes against information from patients' medical records confirmed 298 as in‐hospital complications in 141 of 700 admissions (20·1 per cent). Using GTT methodology, 331 complications were found in 212 of 700 admissions (30·3 per cent). Agreement between the two methods reached 83·3 per cent after verification of ICD‐10 codes. The odds ratio for identifying complications using the GTT increased from 5·85 (95 per cent c.i. 4·06 to 8·44) to 25·38 (15·41 to 41·79) when ICD‐10 complication codes were verified against patients' medical records. Conclusion Verified ICD‐10 codes strengthen the accuracy of complication rates. Use of non‐verified complication codes from administrative systems significantly overestimates in‐hospital surgical complication rates. Code correctly
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Affiliation(s)
- A Storesund
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A S Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - M Hjortås
- Department of Surgery, Førde Central Hospital, Førde, Norway
| | - M W Nortvedt
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Public Health and Services, City of Bergen, Bergen, Norway
| | - H Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - G E Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - E Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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159
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Evaluating Adherence to Guideline-Based Quality Indicators for Postpartum Hemorrhage Care in the Netherlands Using Video Analysis. Obstet Gynecol 2018; 132:656-667. [DOI: 10.1097/aog.0000000000002781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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160
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McLellan EJ, Hade AD, Pelecanos A, Okano S. Introduction of a Mandatory Pre-Block Safety Checklist into a Regional Anaesthesia Block Room Service: A Quality Improvement Project. Anaesth Intensive Care 2018; 46:504-509. [DOI: 10.1177/0310057x1804600512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Wrong-side block is an uncommon yet potentially preventable complication of regional anaesthesia. One strategy for reducing the incidence of wrong-side block is to introduce an additional check into the pre-block workflow in the form of a block ‘time out’ or ‘stop before you block’. In the aftermath of a wrong-side block incident at our institution, the mandatory use of a pre-block safety checklist was successfully introduced into the workflow of the block room. Compliance with the checklist rose from 31% in the six-month pre-intervention phase to over 90% in the six-month post-intervention phase. This was achieved without any negative effect on block efficacy, theatre efficiency, complication rates or patient satisfaction. The high rate of checklist utilisation was associated with an increased rate of ultrasound video documentation. This suggests that there may be collateral benefit to using a pre-block safety checklist in addition to merely reducing the risk of wrong-side block.
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Affiliation(s)
- E. J. McLellan
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - A. D. Hade
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland
| | - A. Pelecanos
- Biostatistician, Statistics Unit, Queensland Institute of Medical Research Berghofer, Brisbane, Queensland
| | - S. Okano
- Biostatistician, Statistics Unit, Queensland Institute of Medical Research Berghofer, Brisbane, Queensland
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161
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Using an animated patient avatar to improve perception of vital sign information by anaesthesia professionals. Br J Anaesth 2018; 121:662-671. [DOI: 10.1016/j.bja.2018.04.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/22/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
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Improved Compliance and Comprehension of a Surgical Safety Checklist With Customized Versus Standard Training: A Randomized Trial. J Patient Saf 2018; 14:138-142. [DOI: 10.1097/pts.0000000000000183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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163
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Procedural Timeout Compliance Is Improved With Real-Time Clinical Decision Support. J Patient Saf 2018; 14:148-152. [DOI: 10.1097/pts.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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164
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Abstract
BACKGROUND Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. RESULTS Nearly half of surveys (n = 91, 48.1%) were returned at a median of 4.7 months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). CONCLUSIONS Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.
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165
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Fatima I, Humayun A, Anwar MI, Shafiq M. Evaluating quality standards' adherence in surgical care: a case study from Pakistan. Int J Qual Health Care 2018; 30:138-144. [PMID: 29300889 DOI: 10.1093/intqhc/mzx179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 12/12/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the extent of adherence to surgical quality standards and areas of improvement. Design Multi-method case study was done. Assessment of observed/actual and self-reported adherence to quality standards in surgical care was done on WHO's safe-surgery checklist. Client satisfaction through exit interviews assessed of all operated during 1 month. Semi-structured interviews of key informants were conducted to identify areas of improvements in surgical care in this hospital. Setting Conducted in a tertiary care teaching hospital in Lahore, Pakistan. Participants Out of all 154 patients during 1 month were admitted with indications for surgery and 35.71% patients gave consent and participated in the study. Outcome measure Actual and reported adherence data were categorized in excellent, good, satisfactory and poor adherence to standards. For in-depth interviews, themes were identified from textual data. Results Overall activities in surgical department were performed well, patients were satisfied and hospital surgical mortality rate was zero but infection control measures needs attention and these practices were found poor with high re-operation and re-admissionrate (P-value < 0.001). Adherence to standards of surgical quality was inadequate in pre-operative, operative and post-op steps as assessed on the checklist but actual adherence was different from reported adherence by surgical care providers. Conclusion This case study shows a complete picture of surgical care quality in a hospital of Pakistan. Discrepancy between perceived/reported adherence and actual practice was found. Patients' satisfaction is not a reliable outcome measure of surgical care quality.
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Affiliation(s)
- Iram Fatima
- Institute of Quality and Technology Management, University of the Punjab at Khayaban-e-Jamia Punjab, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Public Health and Community Medicine, Federal Postgraduate Medical Institute & Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Khayaban-e-Jamia Punjab, Lahore, Pakistan
| | - Muhammad Imran Anwar
- Department of Surgery, Federal Postgraduate Medical Institute & Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Khayaban-e-Jamia Punjab, Lahore, Pakistan
| | - Muhammad Shafiq
- Institute of Quality and Technology Management, University of the Punjab at Khayaban-e-Jamia Punjab, Lahore, Pakistan
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Kandler L, Tscholl DW, Kolbe M, Seifert B, Spahn DR, Noethiger CB. Using educational video to enhance protocol adherence for medical procedures. Br J Anaesth 2018; 116:662-9. [PMID: 27106970 DOI: 10.1093/bja/aew030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Better education of clinicians is expected to enhance patient safety. An important component of education is adherence to standard protocols, which are mainly available in written form. Believing in the potential power of videos, we hypothesized that the introduction of an educational video, based on an institutional standard protocol, would foster adherence to the protocol. METHODS We conducted a prospective intervention study of 425 anaesthesia procedures and teams (202 pre-video and 223 post-video) involving 1091 team members (516 pre-video and 575 post-video) in seven individual operating areas (with a total of 30 operating rooms) in a university hospital. Failure of adherence to safety-critical tasks during rapid sequence anaesthesia inductions was assessed during systematic on-site observations pre- and post-introduction of an educational video demonstrating evidence-based and best practice guidelines. RESULTS The odds for failure of adherence to safety-critical tasks between the pre- and post-intervention period were reduced, odds ratio 0.34 (95% confidence interval 0.27-0.42, P<0.001). The risk for failure of adherence was reduced significantly for eight of the 14 safety-critical tasks (all P<0.001). CONCLUSIONS This study provides empirical evidence for the effectiveness of an educational video to enhance adherence to a standard protocol during complex medical procedures. The introduction of a video can reduce failure of adherence to safety-critical tasks and contribute to patient safety. We recommend the introduction of videos to improve protocol adherence.
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Affiliation(s)
- Lukas Kandler
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Michaela Kolbe
- Organization, Work and Technology Group, ETH Zurich, Weinbergstrasse 56/58, 8092 Zurich, Switzerland Quality Management and Patient Safety, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Burkhardt Seifert
- Biostatistics, Epidemiology, and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Donat R Spahn
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Christoph B Noethiger
- Institute of Anaesthesiology, University and University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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Heideveld-Chevalking AJ, Calsbeek H, Griffioen I, Damen J, Meijerink WJHJ, Wolff AP. Development and validation of a Self-assessment Instrument for Perioperative Patient Safety (SIPPS). BJS Open 2018; 2:381-391. [PMID: 30511039 PMCID: PMC6254004 DOI: 10.1002/bjs5.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background Patient safety is a fundamental value of healthcare to avoid patient harm. Non‐compliance with patient safety standards may result in patient harm and is therefore a global concern. A Self‐assessment Instrument for Perioperative Patient Safety (SIPPS) monitoring and benchmarking compliance to safety standards was validated in a multicentre pilot study. Methods A preliminary questionnaire, based on the Dutch perioperative patient safety guidelines and covering international patient safety goals, was evaluated in a first digital RAND Delphi round. The results were used to optimize the questionnaire and design the SIPPS. For measurement and benchmarking purposes, SIPPS was categorized into seven main patient safety domains concerning all care episode phases of the perioperative trajectory. After consensus was reached in a face‐to‐face Delphi round, SIPPS was pilot‐tested in five hospitals for five characteristics: measurability, applicability, improvement potential, discriminatory capacity and feasibility. Results The results of the first Delphi round showed moderate feasibility for the preliminary questionnaire (81·6 per cent). The pilot test showed good measurability for SIPPS: 99·8 per cent of requested information was assessable. Some 99·9 per cent of SIPPS questions were applicable to the selected respondents. With SIPPS, room for improvement in perioperative patient safety compliance was demonstrated for all hospitals, concerning all safety domains and all care episode phases of the perioperative trajectory (compliance 76·1 per cent). SIPPS showed mixed results for discriminatory capacity. SIPPS showed good feasibility for all items (range 91·9–95·7 per cent). Conclusion A self‐assessment instrument for measuring perioperative patient safety (SIPPS) compliance meeting international standards was validated. With SIPPS, improvement areas for perioperative patient safety and best practices across hospitals could be identified.
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Affiliation(s)
| | - H Calsbeek
- Scientific Institute for Quality of Healthcare Radboud University Medical Centre Nijmegen the Netherlands
| | - I Griffioen
- Faculty of Industrial Design Engineering Technical University of Delft Delft the Netherlands
| | - J Damen
- Department of Anaesthesiology Radboud University Medical Centre Nijmegen the Netherlands
| | - W J H J Meijerink
- Department of Operating Theatres Radboud University Medical Centre Nijmegen the Netherlands
| | - A P Wolff
- Department of Anaesthesiology University Medical Centre Groningen Groningen the Netherlands
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Georgiou Ε, Mashini M, Panayiotou I, Efstathiou G, Efstathiou CI, Charalambous M, Irakleous I. Barriers and facilitators for implementing the WHO's safety surgical checklist: A focus group study among nurses. J Perioper Pract 2018; 28:339-346. [PMID: 29911920 DOI: 10.1177/1750458918780120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The World Health's Organization's safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list's implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.
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Affiliation(s)
- Εvanthia Georgiou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Maria Mashini
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Irene Panayiotou
- 1 Chief Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | - Georgios Efstathiou
- 3 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
| | | | - Melanie Charalambous
- 5 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus,
| | - Iraklis Irakleous
- 2 Senior Nursing Officer, Educational Sector, Nursing Services, Ministry of Health, Cyprus
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169
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Alidina S, Hur HC, Berry WR, Molina G, Guenthner G, Modest AM, Singer SJ. Narrative feedback from OR personnel about the safety of their surgical practice before and after a surgical safety checklist intervention. Int J Qual Health Care 2018; 29:461-469. [PMID: 28482011 DOI: 10.1093/intqhc/mzx050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 04/17/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To examine narrative feedback to understand surgical team perceptions about surgical safety checklists (SSCs) and their impact on the safety of surgical practice. Design We reviewed free-text comments from surveys administered before and after SSC implementation between 2011 and 2013. We categorized feedback thematically and as positive, negative or neutral. Setting South Carolina hospitals participating in a statewide collaborative on checklist implementation. Participants Surgical teams from 11 hospitals offering free-text comments in both pre-and post-implementation surveys. Intervention Implementation of the World Health Organization SSC. Main Outcome Measure Differences in comments made before and after implementation and by provider role; types of complications averted through checklist use. Results Before SSC implementation, the proportion of positive comments among provider roles differed significantly (P = 0.04), with more clinicians offering negative comments (87.9%, (29/33)) compared to other surgical team members (58.3% (7/12) to 60.9% (14/23)), after SSC implementation, these proportions did not significantly differ (clinicians 77.8% (14/18)), other surgical team members (50% (2/4) to 76.9% (20/26)) (P = 0.52). Distribution of negative comments differed significantly before and after implementation (P = 0.01); for example, there were more negative comments made about checklist buy-in after implementation (51.3 % (20/39)) compared to before implementation (24.5% (13/53)). Surgical team members most frequently reported that checklist use averted complications involving antibiotic administration, equipment and side/site of surgery. Conclusions Narrative feedback suggested that SSC implementation can facilitate patient safety by averting complications; however, buy-in is a persistent challenge. Presenting information on the impact of the SSC on lives saved, teamwork and complications averted, adapting the SSC to fit the local context, demonstrating leadership support and engaging champions to promote checklist use and address concerns could improve checklist adoption and efficacy.
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Affiliation(s)
- Shehnaz Alidina
- Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Hye-Chun Hur
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - William R Berry
- Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - George Molina
- Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Guy Guenthner
- Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Sara J Singer
- Ariadne Labs at Brigham and Women's Hospital and The Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, USA.,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA, USA
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170
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Reporting of Inferior Vena Cava Filter Complications on CT: Impact of Standardized Macros. AJR Am J Roentgenol 2018; 211:439-444. [PMID: 29873505 DOI: 10.2214/ajr.17.19148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to report the effect of implementing standardized inferior vena cava filter (IVCF) macros on the reporting of IVCFs and filter-related complications in abdominal CT reports. MATERIALS AND METHODS Retrospective analysis was performed of all abdominal CT reports performed between October 2014 and January 2015 before implementation of IVCF macros (n = 5143). Duplicated examinations and studies requested specifically to evaluate known IVCFs were excluded. In March 2016, normal and abnormal standardized IVCF macros were implemented. Two radiologists reviewed all CT abdominal reports using IVCF macros between March 2016 to July 2016 to assess for missed IVCF complications. RESULTS Before the implementation of the IVCF macros, 146 of 5143 (2.8%) abdominal CT studies (89 men and 57 women; mean age, 59 years) showed an IVCF. After implementation of IVCF macros, 105 abdominal CT studies using the IVCF macros were analyzed (48 men and 57 women; mean age, 58 years), including 73 normal macros and 32 abnormal macros). The rate of reported caval penetration and filter element-organ interaction improved from 12% (9/73) to 57% (28/49) (p < 0.001) and from 0% (0/53) to 36% (9/25) (p < 0.001) before and after macro implementation, respectively. However, one filter fracture and two filter-associated thrombi were missed when using the IVCF macros. CONCLUSION Implementation of standardized IVCF macros improves reporting of IVCFs and IVCF-associated complications in abdominal CT reports.
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171
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Acil Servise Başvuran Hastalarda Post Operatif Komplikasyonların Epidemiyolojik İncelenmesi. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.412029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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172
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Abstract
Not just a tick box exercise
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Affiliation(s)
- T G Weiser
- Department of Clinical Surgery, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, UK.,Department of Surgery, Stanford University, Stanford, California, USA
| | - A B Haynes
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Safe Surgery Program, Ariadne Labs, Harvard TH Chan School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
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173
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Crolla RMPH, Mulder PG, van der Schelling GP. Does robotic rectal cancer surgery improve the results of experienced laparoscopic surgeons? An observational single institution study comparing 168 robotic assisted with 184 laparoscopic rectal resections. Surg Endosc 2018; 32:4562-4570. [DOI: 10.1007/s00464-018-6209-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/09/2018] [Indexed: 12/24/2022]
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174
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Westman M, Marttila H, Rahi M, Rintala E, Löyttyniemi E, Ikonen T. Analysis of hospital infection register indicates that the implementation of WHO surgical safety checklist has an impact on early postoperative neurosurgical infections. J Clin Neurosci 2018; 53:188-192. [PMID: 29753621 DOI: 10.1016/j.jocn.2018.04.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/27/2018] [Accepted: 04/30/2018] [Indexed: 11/16/2022]
Abstract
WHO surgical safety checklist has been proven to reduce postoperative infections in several studies. The aim of our study was to focus on surgical site infections (SSIs) after neurosurgical operations, and to determine whether the checklist implementation would have an impact on the reported SSIs. We used hospital-acquired infection (HAI) register to evaluate the effects of WHO surgical safety checklist in neurosurgery. The HAI register was searched for superficial and deep SSIs, deep organ SSIs, infections following orthopaedic implantation, and other surgical infections of 4678 neurosurgical patients operated on between 2007 and 2011. The data analysis consisted of 95 and 104 neurosurgical postoperative infections before and after the checklist implementation. Time from operation to infection was shorter before than after checklist implementation (p = 0.039), indicating a positive effect of the checklist use in the onset of early HAIs. The overall incidence of SSIs of all neurosurgical patients did not differ (4.1% and 4.5%, respectively) and no differences were noticed in the incidences of the subgroups of superficial SSIs, deep SSIs, and deep organ SSIs. The reduction in early postoperative infection rate along with checklist implementation, but not in the long run indicates the complexity of preventing HAIs in neurosurgical patients and need for a multistep infection control approach.
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Affiliation(s)
| | - Harri Marttila
- Department of Hospital Hygiene and Infection Control, Turku University Hospital, Finland
| | - Melissa Rahi
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital, Finland.
| | - Esa Rintala
- Department of Hospital Hygiene and Infection Control, Turku University Hospital, Finland
| | | | - Tuija Ikonen
- Administrative Centre, Hospital District of Southwest Finland, Turku, Finland
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175
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Mehta N, Amaranathan A, Jayapal L, Kundra P, Nelamangala Ramakrishnaiah VP. Effect of Comprehensive Surgical Safety System on Patients' Outcome: A Prospective Clinical Study. Cureus 2018; 10:e2601. [PMID: 30013865 PMCID: PMC6039221 DOI: 10.7759/cureus.2601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Patient safety has become an integral part of hospital management to prevent catastrophic events which adversely affects the patients, care providers and the hospital. Surgical Checklists are an easy and simple way to prevent surgical errors and complications. Objective This prospective study is to evaluate the effect of SURPASS (Surgical Patient Safety System) checklist on the outcome of the patients who underwent surgery in our hospital. Methods All the patients who underwent surgery in the sixth unit of Department of Surgery from April 2014 to May 2015 were included in the study excluding those aged above 13 years and day care surgery cases. For the control group (initial six months) no checklist was implemented whereas for the study group (next six months) SURPASS checklist was implemented. Data collected on age, sex, diagnosis, surgical procedure, type of anaesthesia, number and type of postoperative complications, need of second surgery because of complications, length of hospital stay and outcome (discharge, disability or death). Mann–Whitney U test and Fisher’s exact test were used for analysis. Results Of the total 372 patients operated, 200 were before and 172 were after implementation of SURPASS checklist. Before implementation of the checklist, complications were noticed in 66.66% of elective and 77.23% of emergency cases. Whereas after implementation of checklist the complications in elective cases were found to be 51.09% (p-value = 0.008) and 67.50% (p-value = 0.024) in emergency cases. Conclusion Implementation of SURPASS checklist is effective in reducing the rate of postoperative complications in both elective and emergency surgeries.
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Affiliation(s)
- Nishkarsh Mehta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Loganathan Jayapal
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Pankaj Kundra
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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176
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Alingh CW, van Wijngaarden JDH, Huijsman R, Paauwe J. The influence of environmental conditions on safety management in hospitals: a qualitative study. BMC Health Serv Res 2018; 18:313. [PMID: 29720265 PMCID: PMC5930828 DOI: 10.1186/s12913-018-3116-8] [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: 03/15/2017] [Accepted: 04/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hospitals are confronted with increasing safety demands from a diverse set of stakeholders, including governmental organisations, professional associations, health insurance companies, patient associations and the media. However, little is known about the effects of these institutional and competitive pressures on hospital safety management. Previous research has shown that organisations generally shape their safety management approach along the lines of control- or commitment-based management. Using a heuristic framework, based on the contextually-based human resource theory, we analysed how environmental pressures affect the safety management approach used by hospitals. Methods A qualitative study was conducted into hospital care in the Netherlands. Five hospitals were selected for participation, based on organisational characteristics as well as variation in their reputation for patient safety. We interviewed hospital managers and staff with a central role in safety management. A total of 43 semi-structured interviews were conducted with 48 respondents. The heuristic framework was used as an initial model for analysing the data, though new codes emerged from the data as well. Results In order to ensure safe care delivery, institutional and competitive stakeholders often impose detailed safety requirements, strong forces for compliance and growing demands for accountability. As a consequence, hospitals experience a decrease in the room to manoeuvre. Hence, organisations increasingly choose a control-based management approach to make sure that safety demands are met. In contrast, in case of more abstract safety demands and an organisational culture which favours patient safety, hospitals generally experience more leeway. This often results in a stronger focus on commitment-based management. Conclusions Institutional and competitive conditions as well as strategic choices that hospitals make have resulted in various combinations of control- and commitment-based safety management. A balanced approach is required. A strong focus on control-based management generates extrinsic motivation in employees but may, at the same time, undermine or even diminish intrinsic motivation to work on patient safety. Emphasising commitment-based management may, in contrast, strengthen intrinsic motivation but increases the risk of priorities being set elsewhere. Currently, external pressures frequently lead to the adoption of control-based management. A balanced approach requires a shift towards more trust-based safety demands.
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Affiliation(s)
- Carien W Alingh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands. .,Department of Human Resource Studies, Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands.
| | - Jeroen D H van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Jaap Paauwe
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.,Department of Human Resource Studies, Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands
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177
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Collares FB, Sonde M, Harper K, Armitage M, Neuhardt DL, Fronek HS. Patient safety in phlebology: The ACP Phlebology Safety Checklist. Phlebology 2018; 33:273-277. [DOI: 10.1177/0268355517694725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To assess the current use of safety checklists among the American College of Phlebology (ACP) members and their interest in implementing a checklist supported by the ACP on their clinical practices; and to develop a phlebology safety checklist. Method Online surveys were sent to ACP members, and a phlebology safety checklist was developed by a multispecialty team through the ACP Leadership Academy. Results Forty-seven percent of respondents are using a safety checklist in their practices; 23% think that a phlebology safety checklist would interfere or disrupt workflow; 79% answered that a phlebology safety checklist could improve procedure outcomes or prevent complications; and 85% would be interested in implementing a phlebology safety checklist approved by the ACP. Conclusion A phlebology safety checklist was developed with the intent to increase awareness on patient safety and improve outcome in phlebology practice.
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Affiliation(s)
- Felipe Birchal Collares
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mehru Sonde
- Vein Clinics of America, Chevy Chase, MD, USA
| | | | | | | | - Helane S Fronek
- Department of Medicine, UC-San Diego School of Medicine, La Jolla, CA, USA
- Western University of Health Sciences, Pomona, CA, USA
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178
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Nazari T, Vlieger EJ, Dankbaar MEW, van Merriënboer JJG, Lange JF, Wiggers T. Creation of a universal language for surgical procedures using the step-by-step framework. BJS Open 2018; 2:151-157. [PMID: 29951639 PMCID: PMC5989977 DOI: 10.1002/bjs5.47] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background Learning of surgical procedures is traditionally based on a master–apprentice model. Segmenting procedures into steps is commonly used to achieve an efficient manner of learning. Existing methods of segmenting procedures into steps, however, are procedure‐specific and not standardized, hampering their application across different specialties and thus worldwide uptake. The aim of this study was to establish consensus on the step‐by‐step framework for standardizing the segmentation of surgical procedures into steps. Methods An international expert panel consisting of general, gastrointestinal and oncological surgeons was approached to establish consensus on the preciseness, novelty, usefulness and applicability of the proposed step‐by‐step framework through a Delphi technique. All statements were rated on a five‐point Likert scale. A statement was accepted when the lower confidence limit was 3·00 or more. Qualitative comments were requested when a score of 3 or less was given. Results In round one, 20 of 49 experts participated. Eighteen of 19 statements were accepted; the ‘novelty’ statement needed further exploration (mean 3·05, 95 per cent c.i. 2·45 to 3·65). Based on the qualitative comments of round one, five clarifying statements were formulated for more specific statements in round two. Twenty‐two experts participated and accepted all statements. Conclusion The international expert panel consisting of general, gastrointestinal and oncological surgeons supported the preciseness, usefulness and applicability of the step‐by‐step framework. This framework creates a universal language by standardizing the segmentation of surgical procedures into step‐by‐step descriptions based on anatomical structures, and may facilitate education, communication and assessment.
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Affiliation(s)
- T Nazari
- Incision Academy Amsterdam The Netherlands.,Department of Surgery Erasmus University Medical Centre Rotterdam The Netherlands
| | | | - M E W Dankbaar
- Institute of Medical Education Research Rotterdam and Department of Education Erasmus University Medical Centre Rotterdam The Netherlands
| | - J J G van Merriënboer
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
| | - J F Lange
- Department of Surgery Erasmus University Medical Centre Rotterdam The Netherlands
| | - T Wiggers
- Incision Academy Amsterdam The Netherlands
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179
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Heideveld-Chevalking AJ, Calsbeek H, Emond YJ, Damen J, Meijerink WJHJ, Hofland J, Wolff AP. Development of the Surgical Patient safety Observation Tool (SPOT). BJS Open 2018; 2:119-127. [PMID: 29951635 PMCID: PMC5989983 DOI: 10.1002/bjs5.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background A Surgical Patient safety Observation Tool (SPOT) was developed and tested in a multicentre observational pilot study. The tool enables monitoring and benchmarking perioperative safety performance across departments and hospitals, covering international patient safety goals. Methods Nineteen perioperative patient safety observation topics were selected from Dutch perioperative patient safety guidelines, which also cover international patient safety goals. All items that measured these selected topics were then extracted from available local observation checklists of the participating hospitals. Experts individually prioritized the best measurement items per topic in an initial written Delphi round. The second (face to face) Delphi round resulted in consensus on the content of SPOT, after which the measurable elements (MEs) per topic were defined. Finally, the tool was piloted in eight hospitals for measurability, applicability, improvement potential, discriminatory capacity and feasibility. Results The pilot test showed good measurability for all 19 patient safety topics (range of 8-291 MEs among topics), with good applicability (median 97 (range 11·8-100) per cent). The overall improvement potential appeared to be good (median 89 (range 72·5-100) per cent), and at topic level the tool showed good discriminatory capacity (variation 27·5 per cent, range in compliance 72·5-100 per cent). Overall scores showed relatively little variation between the participating hospitals (variation 13 per cent, range in compliance 83-96 per cent). All eight auditors considered SPOT a straightforward and easy-to-use tracer tool. Conclusion A comprehensive tool to measure safety of care was developed and validated using a systematic, stepwise method, enabling hospitals to monitor, benchmark and improve perioperative safety performance.
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Affiliation(s)
| | - H Calsbeek
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences Radboud University Medical Centre Nijmegen The Netherlands
| | - Y J Emond
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences Radboud University Medical Centre Nijmegen The Netherlands
| | - J Damen
- Department of Anaesthesiology Radboud University Medical Centre Nijmegen The Netherlands
| | - W J H J Meijerink
- Department of Operating Theatres Radboud University Medical Centre Nijmegen The Netherlands
| | - J Hofland
- Department of Operating Theatres Radboud University Medical Centre Nijmegen The Netherlands.,Department of Anaesthesiology Radboud University Medical Centre Nijmegen The Netherlands
| | - A P Wolff
- Department of Anaesthesiology University Medical Centre Groningen, University of Groningen Groningen The Netherlands
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180
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Willassen ET, Jacobsen ILS, Tveiten S. Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility-Coequal Demands? A Focus Group Study. Glob Qual Nurs Res 2018; 5:2333393618764070. [PMID: 29623287 PMCID: PMC5881961 DOI: 10.1177/2333393618764070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022] Open
Abstract
The use of World Health Organization’s (WHO’s) Safe Surgery checklist is an established practice worldwide and contributes toward ensuring patient safety and collaborative teamwork. The aim of this study was to elucidate operating room nurses’ and operating room nursing students’ experiences and opinions about execution of and compliance with checklists. We chose a qualitative design with semistructured focus group discussions. Qualitative content analysis was conducted. Two main themes were identified; the Safe Surgery checklists have varied influence on teamwork and patient safety, and taking responsibility for executing the checks on the Safe Surgery checklist entails practical and ethical challenges. The experiences and opinions of operating room nurses and their students revealed differences of practices and attitudes toward checklist compliance and the intentions of checklist procedures. These differences are related to cultural and professional distances between team members and their understanding of the Safe Surgery checklists as a tool for patient safety.
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Affiliation(s)
| | | | - Sidsel Tveiten
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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181
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Measuring and improving comprehensive pediatric cardiac care: Learning from continuous quality improvement methods and tools. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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182
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Singh SS, Mehra N, Hopkins L. No. 286-Surgical Safety Checklist in Obstetrics and Gynaecology. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018. [DOI: 10.1016/j.jogc.2018.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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183
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Safety culture among pediatric surgeons: A national survey of attitudes and perceptions of patient safety. J Pediatr Surg 2018; 53:381-395. [PMID: 29111082 DOI: 10.1016/j.jpedsurg.2017.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Improving the culture of safety within health care is an essential component of preventing errors and improving overall health care quality. The purpose of this study was to characterize the attitudes and perceptions of patient safety among pediatric surgeons. METHODS We conducted a cross-sectional online survey of American Pediatric Surgery Association members. Survey items assessed surgeons' knowledge, attitudes, and perceptions of patient safety. We performed descriptive statistics and evaluated associations between respondent characteristics and survey responses. RESULTS Response rate was 38% (353/928). Surgeons in academic practice (96% vs 83% private, P=0.01) and in leadership positions (98% vs 92%, P=0.03) were more likely to feel actively engaged in patient safety initiatives. Surgeons in private practice were less likely to feel safe having their own children undergo surgery at their institution (80% vs 96% academic, P<0.005). CONCLUSION Pediatric surgeons have disparate attitudes and perceptions of patient safety within their hospitals. Significant variation exists based on surgeon characteristics. These findings underscore the need to identify barriers to surgeon engagement and develop educational initiatives to empower surgeons as leaders in improving patient safety culture. LEVEL OF EVIDENCE V.
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184
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N° 286-Liste de contrôle de la sécurité chirurgicale en obstétrique-gynécologie. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018. [DOI: 10.1016/j.jogc.2018.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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185
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Sommer DD, Arbab-Tafti S, Farrokhyar F, Tewfik M, Vescan A, Witterick IJ, Rotenberg B, Chandra R, Weitzel EK, Wright E, Ramakrishna J. A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues. Int Forum Allergy Rhinol 2018; 8:831-836. [PMID: 29485750 DOI: 10.1002/alr.22106] [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] [Received: 11/17/2017] [Revised: 01/29/2018] [Accepted: 02/01/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery. METHODS This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method. RESULTS Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%). CONCLUSION The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating room setting.
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Affiliation(s)
- Doron D Sommer
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Sadaf Arbab-Tafti
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster University Medical Centre, Hamilton, ON, Canada.,Department of and Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Marc Tewfik
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montréal, QC, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian Rotenberg
- Department of Otolaryngology-Head and Neck Surgery, London, ON, Canada
| | - Rakesh Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, TN
| | - Erik K Weitzel
- Department of Otolaryngology, San Antonio Military Medical Center, Joint Base San Antonio, TX
| | - Erin Wright
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jayant Ramakrishna
- Otolaryngology-Head and Neck Surgery Division, Department of Surgery-Otolaryngology, McMaster University Medical Centre, Hamilton, ON, Canada
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186
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Lean LL, Hong RYS, Ti LK. How the personalities of medical students at the National University of Singapore differ from those of the local non-medical undergraduate population: a cross-sectional study. Singapore Med J 2018; 59:656-659. [PMID: 29430574 DOI: 10.11622/smedj.2018018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Integrity and willingness to contribute to society are desired traits of medical students beyond academic excellence. We investigated the personality traits of medical students at the National University of Singapore (NUS), who were about to become doctors. Personality traits were compared with a peer population of local university students. METHODS This study was conducted between October 2013 and December 2014. Year 4 medical students were administered the Revised NEO (Neuroticism-Extraversion-Openness) Personality Inventory (NEO PI-R), a 240-item Likert scale personality test. Test data was analysed by an institutional psychologist and compared to a separate sample of 377 non-medical students who were peers at the same university taking psychology as a module. Data was collated and analysed. RESULTS 65 Year 4 medical students completed the NEO PI-R personality test. The personalities of Year 4 medical students at NUS differed from their peers in all domains except for openness. NUS medical students generally had less neuroticism, and were more extroverted, agreeable and conscientious than their peers. CONCLUSION Personality testing of NUS Year 4 medical students showed many of the desired traits of a doctor when compared to their peers at the same university.
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Affiliation(s)
- Lyn Li Lean
- Department of Anaesthesia, National University Hospital, Singapore
| | | | - Lian Kah Ti
- Department of Anaesthesia, National University Hospital, Singapore
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187
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de Visser SM, Woiski MD, Grol RP, Vandenbussche FPHA, Hulscher MEJL, Scheepers HCJ, Hermens RPMG. Development of a tailored strategy to improve postpartum hemorrhage guideline adherence. BMC Pregnancy Childbirth 2018; 18:49. [PMID: 29422014 PMCID: PMC5806456 DOI: 10.1186/s12884-018-1676-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the introduction of evidence based guidelines and practical courses, the incidence of postpartum hemorrhage shows an increasing trend in developed countries. Substandard care is often found, which implies an inadequate implementation in high resource countries. We aimed to reduce the gap between evidence-based guidelines and clinical application, by developing a strategy, tailored to current barriers for implementation. METHODS The development of the implementation strategy consisted of three phases, supervised by a multidisciplinary expert panel. In the first phase a framework of the strategy was created, based on barriers to optimal adherence identified among professionals and patients together with evidence on effectiveness of strategies found in literature. In the second phase, the tools within the framework were developed, leading to a first draft. In the third phase the strategy was evaluated among professionals and patients. The professionals were asked to give written feedback on tool contents, clinical usability and inconsistencies with current evidence care. Patients evaluated the tools on content and usability. Based on the feedback of both professionals and patients the tools were adjusted. RESULTS We developed a tailored strategy to improve guideline adherence, covering the trajectory of the third trimester of pregnancy till the end of the delivery. The strategy, directed at professionals, comprehending three stop moments includes a risk assessment checklist, care bundle and time-out procedure. As patient empowerment tools, a patient passport and a website with patient information was developed. The evaluation among the expert panel showed all professionals to be satisfied with the content and usability and no discrepancies or inconsistencies with current evidence was found. Patients' evaluation revealed that the information they received through the tools was incomplete. The tools were adjusted accordingly to the missing information. CONCLUSION A usable, tailored strategy to implement PPH guidelines and practical courses was developed. The next step is the evaluation of the strategy in a feasibility trial. TRIAL REGISTRATION Clinical trial registration: The Fluxim study, registration number: NCT00928863 .
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Affiliation(s)
- Suzan M de Visser
- Department of Obstetrics and Gynecology, Radboud Institute for Health Science, Radboud University Medical Center, Geert Grootplein 10, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - Mallory D Woiski
- Department of Obstetrics and Gynecology, Radboud Institute for Health Science, Radboud University Medical Center, Geert Grootplein 10, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Richard P Grol
- Department of IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank P H A Vandenbussche
- Department of Obstetrics and Gynecology, Radboud Institute for Health Science, Radboud University Medical Center, Geert Grootplein 10, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands
| | - Marlies E J L Hulscher
- Department of IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hubertina C J Scheepers
- Department of Obstetrics and Gynecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rosella P M G Hermens
- Department of IQ Healthcare, Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, Netherlands
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188
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White MC, Baxter LS, Close KL, Ravelojaona VA, Rakotoarison HN, Bruno E, Herbert A, Andean V, Callahan J, Andriamanjato HH, Shrime MG. Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar. PLoS One 2018; 13:e0191849. [PMID: 29401465 PMCID: PMC5798831 DOI: 10.1371/journal.pone.0191849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/08/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 2009 World Health Organisation (WHO) surgical safety checklist significantly reduces surgical mortality and morbidity (up to 47%). Yet in 2016, only 25% of East African anesthetists regularly use the checklist. Nationwide implementation of the checklist is reported in high-income countries, but in low- and middle-income countries (LMICs) reports of successful implementations are sparse, limited to single institutions and require intensive support. Since checklist use leads to the biggest improvements in outcomes in LMICs, methods of wide-scale implementation are needed. We hypothesized that, using a three-day course, successful wide-scale implementation of the checklist could be achieved, as measured by at least 50% compliance with six basic safety processes at three to four months. We also aimed to determine predictors for checklist utilization. MATERIALS AND METHODS Using a blended educational implementation strategy based on prior pilot studies we designed a three-day dynamic educational course to facilitate widespread implementation of the WHO checklist. The course utilized lectures, film, small group breakouts, participant feedback and simulation to teach the knowledge, skills and behavior changes needed to implement the checklist. In collaboration with the Ministry of Health and local hospital leadership, the course was delivered to 427 multi-disciplinary staff at 21 hospitals located in 19 of 22 regions of Madagascar between September 2015 and March 2016. We evaluated implementation at three to four months using questionnaires (with a 5-point Likert scale) and focus groups. Multivariate linear regression was used to test predictors of checklist utilization. RESULTS At three to four months, 65% of respondents reported always using the checklist, with another 13% using it in part. Participant's years in practice, hospital size, or surgical volume did not predict checklist use. Checklist use was associated with counting instruments (p< 0.05), but not with verifying: patient identity, difficult intubation risk, risk of blood loss, prophylactic antibiotic administration, or counting needles and sponges. CONCLUSION Use of a multi-disciplinary three-day course for checklist implementation resulted in 78% of participants using the checklist, at three months; and an increase in counting surgical instruments. Successful checklist implementation was not predicted by participant length of medical service, hospital size or surgical volume. If reproducible in other countries, widespread implementation in LMICs becomes a realistic possibility.
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Affiliation(s)
- Michelle C. White
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
- Department of Medical Capacity Building, Mercy Ships, Africa Bureau, Cotonou, Benin
- * E-mail:
| | - Linden S. Baxter
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
| | - Kristin L. Close
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
- Department of Medical Capacity Building, Mercy Ships, Africa Bureau, Cotonou, Benin
| | | | | | - Emily Bruno
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, United States of America
| | - Alison Herbert
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
| | - Vanessa Andean
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
- The Austin Hospital, Melbourne, Australia
| | - James Callahan
- Department of Medical Capacity Building, Mercy Ships, Port of Toamasina, Madagascar
| | | | - Mark G. Shrime
- Department of Medical Capacity Building, Mercy Ships, Africa Bureau, Cotonou, Benin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, United States of America
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States of America
- Office of Global Surgery and Health, Massachusetts Eye and Ear Infirmary, Boston, MA, United States of America
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189
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Blikkendaal MD, Driessen SRC, Rodrigues SP, Rhemrev JPT, Smeets MJGH, Dankelman J, van den Dobbelsteen JJ, Jansen FW. Measuring surgical safety during minimally invasive surgical procedures: a validation study. Surg Endosc 2018; 32:3087-3095. [PMID: 29352453 PMCID: PMC5988766 DOI: 10.1007/s00464-018-6021-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND During the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safety, especially with regard to the introduction of new interventions. METHODS A Surgical Safety Questionnaire was developed that had to be filled out directly postoperative by three surgical team members. A potential safety concern was defined as at least one answer between (strongly) disagree and indifferent. The validity of the questionnaire was assessed by comparison with the results from video analysis. Two different observers annotated the presence and effect of surgical flow disturbances during 40 laparoscopic hysterectomies performed between November 2010 and April 2012. RESULTS The surgeon reported a potential safety concern in 16% (85/520 questions). With respect to the scrub nurse and anesthesiologist, this was both 9% (46/520). With respect to the preparation, functioning, and ease of use of the devices in 37.5-47.5% (15-19/40 procedures) a potential safety concern was reported by one or more team members. During procedures after which a potential safety concern was reported, surgical flow disturbances lasted a higher percentage of the procedure duration [9.3 ± 6.2 vs. 2.9 ± 3.7% (mean ± SD), p < .001]. After procedures during which a new instrument or device was used, more potential safety concerns were reported (51.2 vs. 23.1%, p < .001). CONCLUSIONS Potential safety concerns were especially reported during procedures in which a relatively high percentage of the duration consisted of surgical flow disturbances and during procedures in which a new instrument or device was used. The Surgical Safety Questionnaire can act as a validated tool to evaluate and maintain surgical safety during minimally invasive procedures, especially during the introduction of a new intervention.
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Affiliation(s)
- Mathijs D Blikkendaal
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sharon P Rodrigues
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Johann P T Rhemrev
- Department of Gynecology, Haaglanden Medical Center, P.O. Box 96900, 2509 JH, The Hague, The Netherlands
| | - Maddy J G H Smeets
- Department of Gynecology, Haaglanden Medical Center, P.O. Box 96900, 2509 JH, The Hague, The Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - John J van den Dobbelsteen
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Arriaga AF, Hepner DL, Bader AM. "However Beautiful the Strategy, You Should Occasionally Look at the Results": Sir Winston Churchill and Medical Checklists. Anesth Analg 2018; 126:16-18. [PMID: 29252477 DOI: 10.1213/ane.0000000000002492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alexander F Arriaga
- From the Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Ariadne Labs, Boston, Massachusetts
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts
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191
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van Delft EAK, Schepers T, Bonjer HJ, Kerkhoffs GMMJ, Goslings JC, Schep NWL. Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics. Arch Orthop Trauma Surg 2018; 138:459-462. [PMID: 29270821 PMCID: PMC5854724 DOI: 10.1007/s00402-017-2862-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary objective was to determine the incidence of adverse events related to technical equipment and logistics. The secondary objective was to evaluate the consequences of these adverse events. METHODS We completed a cross-sectional observational study to assess the incidence, consequences and preventability of adverse events related to technical equipment and logistics during orthopedic trauma surgery. During a 10 week period, all orthopedic trauma operations were evaluated by an observer. Six types of procedures were differentiated: osteosynthesis; arthroscopy; removal of hardware; joint replacement; bone grafting and other. Adverse events were divided in six categories: staff dependent factors; patient dependent factors; anaesthesia; imaging equipment; operation room equipment and instruments and implants. Adverse events were defined as any factor affecting the surgical procedure in a negative way. RESULTS Hundred-fifty operative procedures were included. In 54% of the procedures, at least one adverse event occurred. In total, 147 adverse events occurred, with a range of 1-5 per procedure. Most adverse events occurred during joint replacement procedures. Thirty-seven percent of the incidents concerned defect, incorrect connected or absent instruments. In 36% of the procedures adverse events resulted in a prolonged operation time with a median prolongation of 10.0 min. CONCLUSION In more than half of orthopedic trauma surgical procedures adverse events related to technical equipment and logistics occurred, most of them could easily be prevented. These adverse events could endanger the safety of the patient and staff and should therefore be reduced. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E. A. K. van Delft
- Department of Surgery, VU Medical Center, 7057, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
| | - T. Schepers
- Department of Trauma surgery, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - H. J. Bonjer
- Department of Surgery, VU Medical Center, 7057, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands
| | - G. M. M. J. Kerkhoffs
- Department of Orthopedic surgery, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J. C. Goslings
- Department of Trauma surgery, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - N. W. L. Schep
- Department of Trauma surgery, Maasstad Hospital, Rotterdam, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
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192
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Levin PE, Moon D, Payne DE. Overlapping and Concurrent Surgery: A Professional and Ethical Analysis. J Bone Joint Surg Am 2017; 99:2045-2050. [PMID: 29206796 DOI: 10.2106/jbjs.17.00109] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Overlapping and concurrent surgeries form a continuum of simultaneous surgical practice in which a single surgeon has 2 or more patients in operating rooms at the same time. Undeniably, in an acute life-or-limb-threatening presentation, it may be essential for a surgeon to care for 2 individual patients simultaneously. These situations are different from scheduled elective surgery. Concurrent surgery is defined as the attending surgeon not being present for "critical and key" portions of a procedure. Billing for concurrent surgical procedures is a violation of the U.S. Centers for Medicare & Medicaid Services guidelines. The American College of Surgeons Statement of Principles (April 2016), adopted by the American Academy of Orthopaedic Surgeons, judges the practice of concurrent surgery to be "inappropriate." Overlapping surgery, although permissible under regulatory guidelines in the United States, presents substantial professional, bioethical, and legal concerns, and threatens our obligation as orthopaedic surgeons to respect the primacy of patient welfare and an individual's autonomy.
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Affiliation(s)
- Paul E Levin
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Daniel Moon
- University of Colorado School of Medicine, Aurora Colorado
| | - Diane E Payne
- Emory University School of Medicine, Atlanta, Georgia
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193
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Watters DA. The World Health Organization Surgical Safety Checklist. ANZ J Surg 2017; 87:961-962. [PMID: 29205826 DOI: 10.1111/ans.14210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023]
Affiliation(s)
- David A Watters
- Department of Surgery, University Hospital Geelong and Deakin University, Geelong, Victoria, Australia
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Street M, Phillips NM, Mohebbi M, Kent B. Effect of a newly designed observation, response and discharge chart in the Post Anaesthesia Care Unit on patient outcomes: a quasi-expermental study in Australia. BMJ Open 2017; 7:e015149. [PMID: 29203501 PMCID: PMC5778298 DOI: 10.1136/bmjopen-2016-015149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. METHODS A prospective non-randomised pre-post intervention study was conducted in three hospitals in Australia. Participants were adults undergoing elective surgery before (n=723) and after (n=694) implementation of the Post-Anaesthetic Care Tool (PACT). RESULTS Nursing response to patients at-risk of deterioration was higher using PACT, with more medical consultations initiated by PACU nurses (19% vs 30%, P<0.001) and more patients with Medical Emergency Team activation criteria modified by an anaesthetist while in PACU (6.5% vs 13.8%, P<0.001). There were higher rates of analgesia administration (37.3% vs 54.2%, P=0.001), nursing assessment of pain and documentation of ongoing analgesia prior to discharge (55% vs 85%, P<0.001). More adverse events were recorded in PACU after introduction of the PACT (8.3% vs 16.7%, P<0.001). The rate of adverse events after discharge from PACU remained constant (16.5%), but the rate of cardiac events (5.1% vs 2.6%, P=0.021) and clinical deterioration (8.7% vs 4.3%, P=0.001) following PACU discharge significantly decreased, using the PACT. Despite the increased number of patients with adverse events in phase 2, healthcare costs did not increase significantly. Length of stay in PACU and length of hospital admission for those patients who had an adverse event in PACU were significantly reduced after implementation of the PACT. CONCLUSION This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.
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Affiliation(s)
- Maryann Street
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Eastern Health-Deakin University Nursing and Midwifery Research Centre, Box Hill, Australia
- Quality and Patient Safety Research Centre, Deakin University, Burwood, Australia
| | - Nicole M Phillips
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Quality and Patient Safety Research Centre, Deakin University, Burwood, Australia
| | | | - Bridie Kent
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
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196
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Abstract
OBJECTIVE To determine whether completion of a voluntary, checklist-based surgical quality improvement program is associated with reduced 30-day postoperative mortality. BACKGROUND Despite evidence of efficacy of team-based surgical safety checklists in improving perioperative outcomes in research trials, effective methods of population-based implementation have been lacking. The Safe Surgery 2015 South Carolina program was designed to foster state-wide engagement of hospitals in a voluntary, collaborative implementation of a checklist program. METHODS We compared postoperative mortality rates after inpatient surgery in South Carolina utilizing state-wide all-payer discharge claims from 2008 to 2013, linked with state vital statistics, stratifying hospitals on the basis of completion of the checklist program. Changes in risk-adjusted 30-day mortality were compared between hospitals, using propensity score-adjusted difference-in-differences analysis. RESULTS Fourteen hospitals completed the program by December 2013. Before program launch, there was no difference in mortality trends between the completion cohort and all others (P = 0.33), but postoperative mortality diverged thereafter (P = 0.021). Risk-adjusted 30-day mortality among completers was 3.38% in 2010 and 2.84% in 2013 (P < 0.00001), whereas mortality among other hospitals (n = 44) was 3.50% in 2010 and 3.71% in 2013 (P = 0.3281), reflecting a 22% difference between the groups on difference-in-differences analysis (P = 0.0021). CONCLUSIONS Despite similar pre-existing rates and trends of postoperative mortality, hospitals in South Carolina completing a voluntary checklist-based surgical quality improvement program had a reduction in deaths after inpatient surgery over the first 3 years of the collaborative compared with other hospitals in the state. This may indicate that effective large-scale implementation of a team-based surgical safety checklist is feasible.
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197
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Aghdassi SJS, Gastmeier P. Novel approaches to surgical site infections: what recommendations can be made? Expert Rev Anti Infect Ther 2017; 15:1113-1121. [PMID: 29125385 DOI: 10.1080/14787210.2017.1404451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Surgical site infections (SSI) are one of the most frequent healthcare-associated infections worldwide, representing a substantial burden on the healthcare system and the individual patient. Various risk factors for SSI have been identified, which can be separated into patient-related, procedure-related and other risk factors. Areas covered: Other risk factors relevant for SSI are the season in which surgery is performed, the volume of surgeries in a department, the working atmosphere in the operating room and the indications for surgery. Overall, the risk of SSI is higher during summertime. Higher-volume departments appear to be protective against SSI as does a calm working atmosphere. The frequency of certain types of surgery differs greatly among European countries. The decision to perform surgery appears to be dependent on the patient's condition as well as the healthcare system and financial incentives. Expert commentary: When possible, elective surgery should not be executed during summertime but during cooler times of year. Departments with a high volume of surgical procedures should be given preference. The establishment of a calm working atmosphere is beneficial to a surgeon's performance and can reduce SSI rates. The indications for performing surgery should be carefully reevaluated whenever possible.
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Affiliation(s)
- Seven Johannes Sam Aghdassi
- a Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin , Berlin , Germany.,b German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) , Berlin , Germany
| | - Petra Gastmeier
- a Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin , Berlin , Germany.,b German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) , Berlin , Germany
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Richter J, Mazurenko O, Kazley AS, Ford EW. How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care. J Patient Saf 2017; 16:289-293. [PMID: 29112031 DOI: 10.1097/pts.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. METHODS Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. RESULTS We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. CONCLUSIONS Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.
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Affiliation(s)
- Jason Richter
- From the Army-Baylor University, Fort Sam Houston, San Antonio, Texas
| | - Olena Mazurenko
- Department of Health Policy and Management, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Abby Swanson Kazley
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, South Carolina
| | - Eric W Ford
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Lashoher A, Schneider EB, Juillard C, Stevens K, Colantuoni E, Berry WR, Bloem C, Chadbunchachai W, Dharap S, Dy SM, Dziekan G, Gruen RL, Henry JA, Huwer C, Joshipura M, Kelley E, Krug E, Kumar V, Kyamanywa P, Mefire AC, Musafir M, Nathens AB, Ngendahayo E, Nguyen TS, Roy N, Pronovost PJ, Khan IQ, Razzak JA, Rubiano AM, Turner JA, Varghese M, Zakirova R, Mock C. Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures. World J Surg 2017; 41:954-962. [PMID: 27800590 DOI: 10.1007/s00268-016-3759-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries. METHODS From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability. RESULTS Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses. CONCLUSIONS Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.
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Affiliation(s)
| | - Eric B Schneider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA.
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Catherine Juillard
- Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Ave, 3A, San Francisco, CA, 94110, USA
| | - Kent Stevens
- The Johns Hopkins School of Medicine, 1800 Orleans Street, Suite 6107E, Baltimore, MD, 21287, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, 21205, USA
| | - William R Berry
- Department of Health Policy and Management, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA
| | - Christina Bloem
- Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, 11203, USA
| | - Witaya Chadbunchachai
- WHO Collaborating Center for Injury Prevention and Safety Promotion, Khon Kaen Hospital, Khon Kaen, 40000, Thailand
| | - Satish Dharap
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India
| | - Sydney M Dy
- Johns Hopkins Bloomberg School of Public Health, Rm 609, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Gerald Dziekan
- World Self-Medication Industry, Rue de Cossonay 5, Case Postale 124, 1023, Crissier, Switzerland
| | - Russell L Gruen
- Lee Kong Chian School of Medicine, Nanyang Technological University, Research Techno Plaza, #02-07, 50 Nanyang Drive, Singapore, 637553, Singapore
| | - Jaymie A Henry
- Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Christina Huwer
- Clinic for Trauma Surgery and Orthopedics, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany
| | - Manjul Joshipura
- Academy of Traumatology, 504, Sangita Complex, Parimal Garden, Ahmadabad, 380015, India
| | - Edward Kelley
- Service Delivery and Safety Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Etienne Krug
- Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, College Building, First Floor, Sion, Mumbai, 400022, India
| | - Patrick Kyamanywa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, P.O. Box. 3286, Kigali, Rwanda
| | - Alain Chichom Mefire
- Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon
| | - Marcos Musafir
- Federal University of Rio de Janeiro, Rua Voluntarios da Patria, 445 SL 201, Botafogo, Rio de Janeiro, CEP: 22270-005, Brazil
| | - Avery B Nathens
- Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D5 74, Toronto, Ontario, M4N 3M5, Canada
| | | | - Thai Son Nguyen
- Duc Giang General Hospital, 54 Truong Lam, Long Bien, Hanoi, Vietnam
| | - Nobhojit Roy
- Department of Surgery, BARC hospital (Govt of India), HBNI University, Anushaktinagar, Mumbai, 400094, India
| | - Peter J Pronovost
- Johns Hopkins Medicine, 600 N Wolfe Street, CMSC 131, Baltimore, MD, 21287, USA
| | - Irum Qumar Khan
- Department of Emergency Medicine, Aga Khan University, 1st floor, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Junaid Abdul Razzak
- Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste 220, Baltimore, MD, 21219, USA
- Aga Khan University, Karachi, Pakistan
| | - Andrés M Rubiano
- MEDITECH Foundation, Neiva University Hospital, Calle 5#11-19, Huila, Neiva, Colombia
| | - James A Turner
- Department of Paedeatric Orthopedics, Sick Kids Hospital, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Mathew Varghese
- Department of Orthopaedics, St Stephen's Hospital, Tis Hazari, Delhi, 110054, India
| | - Rimma Zakirova
- St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Charles Mock
- Department of Surgery, Harborview Medical Center, HIPRC, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA
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200
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Lagoo J, Lopushinsky SR, Haynes AB, Bain P, Flageole H, Skarsgard ED, Brindle ME. Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis. BMJ Open 2017; 7:e016298. [PMID: 29042377 PMCID: PMC5652514 DOI: 10.1136/bmjopen-2017-016298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. SUMMARY BACKGROUND DATA Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. METHODS A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing. RESULTS 1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety. CONCLUSIONS A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs' role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.
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Affiliation(s)
- Janaka Lagoo
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Alex B Haynes
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Helene Flageole
- Section of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E Brindle
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada
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