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Relationship Between Operating Room Teamwork, Contextual Factors, and Safety Checklist Performance. J Am Coll Surg 2016; 223:568-580.e2. [PMID: 27469627 DOI: 10.1016/j.jamcollsurg.2016.07.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies show that using surgical safety checklists (SSCs) reduces complications. Many believe SSCs accomplish this by enhancing teamwork, but evidence is limited. Our study sought to relate teamwork to checklist performance, understand how they relate, and determine conditions that affect this relationship. STUDY DESIGN Using 2 validated tools for observing and coaching operating room teams, we evaluated the association between checklist performance with surgeon buy-in and 4 domains of surgical teamwork: clinical leadership, communication, coordination, and respect. Hospital staff in 10 South Carolina hospitals observed 207 procedures between April 2011 and January 2013. We calculated levels of checklist performance, buy-in, and measures of teamwork, and evaluated their relationship, controlling for patient and case characteristics. RESULTS Few teams completed most or all SSC items. Teams more often completed items considered procedural "checks" than conversation "prompts." Surgeon buy-in, clinical leadership, communication, a summary measure of teamwork overall, and observers' teamwork ratings positively related to overall checklist completion (multivariable model estimates from 0.04, p < 0.05 for communication to 0.17, p < 0.01 for surgeon buy-in). All measures of teamwork and surgeon buy-in related positively to completing more conversation prompts; none related significantly to procedural checks (estimates from 0.10, p < 0.01 for communication to 0.27, p < 0.001 for surgeon buy-in). Patient age was significantly associated with completing the checklist and prompts (p < 0.05); only case duration was positively associated with performing more checks (p < 0.10). CONCLUSIONS Surgeon buy-in and surgical teamwork characterized by shared clinical leadership, open communication, active coordination, and mutual respect were critical in prompting case-related conversations, but not in completing procedural checks. Findings highlight the importance of surgeon engagement and high-quality, consistent teamwork for promoting checklist use and ensuring a safe surgical environment.
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252
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Bein B, Scholz J. Advances in perioperative management of high-risk patients: The A-team in charge. Best Pract Res Clin Anaesthesiol 2016; 30:127-9. [PMID: 27396801 DOI: 10.1016/j.bpa.2016.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Berthold Bein
- Department of Anaesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.
| | - Jens Scholz
- University Hospital Schleswig-Holstein, Kiel, Germany
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Symons NRA, Moorthy K, Vincent CA. Reliability in the process of care during emergency general surgical admission: A prospective cohort study. Int J Surg 2016; 32:143-9. [PMID: 27392718 DOI: 10.1016/j.ijsu.2016.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/26/2016] [Accepted: 07/04/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Emergency general surgery (EGS) is responsible for 80-90% of surgical in-hospital deaths and the early management of these unwell patients is critical to improving outcomes. Unfortunately care for EGS patients is often fragmented and important care processes are frequently omitted. METHODS This study aimed to define a group of important processes during EGS admission and assess their reliability. Literature review and semi-structured interviews were used to define a draft list of processes, which was refined and validated using the Delphi consensus methodology. A prospective cohort study of the 22 included processes was performed in 315 patients across 5 acute hospitals. RESULTS Prospective study of the 22 selected processes demonstrated omission of 1130/5668 (19.9%) processes. Only 6 (1.9%) patients had all relevant processes performed correctly. Administration of oxygen to hypoxic patients (82/129, 64%), consultant review (202/313, 65%) and administration of antibiotics within 3 h for patients with severe sepsis (41/60, 68%) were performed particularly poorly. There were significant differences in the mean number of omissions per patient between hospitals ( ANOVA F = 11.008, p < 0.001) and this was strongly correlated with hospitals' median length of stay (Spearman's rho = 0.975, p = 0.005). CONCLUSIONS Reliability of admissions processes in this study was poor, with significant variability between hospitals. It is likely that improvements in process reliability would enhance EGS patients' outcomes. This will require engagement of the entire surgical team and the implementation of multiple interventions to improve the effectiveness of the admission phase of care.
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Affiliation(s)
- Nicholas R A Symons
- Imperial Patient Safety Translational Research Centre, Department of Surgery, Imperial College London, London, UK
| | - Krishna Moorthy
- Imperial Patient Safety Translational Research Centre, Department of Surgery, Imperial College London, London, UK.
| | - Charles A Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Abstract
BACKGROUND There is excellent evidence that surgical safety checklists contribute to decreased morbidity and mortality. OBJECTIVE The purpose of this study was to develop a surgical checklist composed of the key phases of care for patients with rectal cancer. DESIGN A consensus-oriented decision-making model involving iterative input from subject matter experts under the auspices of The American Society of Colon and Rectal Surgeons was designed. SETTINGS The study was conducted through meetings and discussion to consensus. PATIENTS Patient data were extracted from an initial literature review. MAIN OUTCOME MEASURES The checklist was measured by its ability to improve care in complex rectal surgery cases by reducing the possibility of omission through the division of treatment into 3 distinct phases. RESULTS The process generated a 25-item checklist covering the spectrum of care for patients with rectal cancer who were undergoing surgery. LIMITATIONS The study was limited by its lack of prospective validation. CONCLUSIONS The American Society of Colon and Rectal Surgeons rectal cancer surgery checklist is composed of the essential elements of preoperative, intraoperative, and postoperative care that must be addressed during the surgical treatment of patients with rectal cancer.
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255
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Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach. Nat Rev Clin Oncol 2016; 13:706-712. [PMID: 27349194 DOI: 10.1038/nrclinonc.2016.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the clinical setting, the term 'unwarranted variation' refers to variations in patient outcomes that cannot be explained by the patient's underlying illness or medical needs, or the dictates of evidence-based medicine. These types of variations persist even after adjusting for patient-specific factors. Unwarranted variation depends on a complex mix of disparities, including inequalities in access to appropriate care in a wide variety of geographical and cultural settings, in the uptake and application of clinical knowledge, in the prioritization and allocation of resources, and differences in organizational and professional culture. Nevertheless, unwarranted variation has been inexorably linked with clinical practice. Thus, awareness of the antecedents of unwarranted variations in clinical practice is strategically important. In this Perspective, we discuss these antecedents in colorectal cancer clinical care pathways with an emphasis upon the multidisciplinary team (MDT), and suggest pragmatic steps that could be taken to address latent unwarranted variation.
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256
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The Introduction of Standard Operating Procedures to Improve Burn Care in the United Kingdom. J Burn Care Res 2016; 36:565-73. [PMID: 25501782 DOI: 10.1097/bcr.0000000000000210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
United Kingdom (UK) burn units face substantial new obstacles in delivering high quality care because of the advent of full-shift working patterns, cross-specialty cover arrangements, and increased trainee turnover. Junior trainees rely heavily on senior colleagues, who may not be readily accessible. The authors therefore proposed the introduction of standard operating procedures (SOPs), detailed written instructions used to achieve uniformity in performance and to improve outcomes. After undertaking a preliminary strength, weaknesses, opportunities, and threats analysis of their use locally and nationally, the authors set out to systematically develop burn-specific SOPs. The authors first mapped our existing local SOPs to the newly introduced UK national burn care pathway to specify gaps in coverage. The authors then administered a questionnaire to other UK burn units to identify SOPs already used elsewhere. Finally, the authors developed and piloted a robust pathway for the development, introduction, and auditing of new SOPs. The strength, weaknesses, opportunities, and threats analysis identified significant benefits and minimal risks. The mapping exercise identified specific deficiencies in our coverage of the national pathway. All 26 UK burn units responded to our questionnaire; only 12 had one or more SOPs (mean, 2.1). These covered initial assessment, inhalational injuries, drug prescribing, wound care, and gastric protection; none were audited. Locally, the authors have begun to develop the additional SOPs required. SOPs have not been instituted widely in the UK, despite the shift toward a standardized national care pathway and their association with improved outcomes. The authors hope that the systematic approach to their development and implementation demonstrates the feasibility of their wider use within UK regional burn centers and beyond.
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Fernando RJ, Shapiro FE, Urman RD. Survey Analysis of an Ambulatory Surgical Checklist for Patient Use. AORN J 2016; 102:290.e1-10. [PMID: 26323231 DOI: 10.1016/j.aorn.2015.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/22/2015] [Accepted: 07/24/2015] [Indexed: 01/18/2023]
Abstract
Although checklists are used as tools for providers, they have not been adequately explored as tools for patients. The purpose of this study was to survey the stakeholders on the usefulness of an ambulatory surgical checklist for patients. We performed a cross-sectional study through a survey designed to include both patients and providers. Descriptive analysis of the data was performed based on responses from 35 patients and 52 providers. Overall, 94% of patients and 83% of providers thought the checklist would be beneficial for patients. In addition, 37% of providers indicated potential barriers to checklist implementation, including fear of confusing the patient, making patients doubt the care they were receiving, taking too much time, and lack of resources. Based on survey responses, the study suggests that the ambulatory surgical checklist can potentially facilitate patient education, enable more active patient participation, increase patient satisfaction, and decrease patient anxiety.
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An intraoperative technique to reduce superficial surgical site infections in circular stapler–constructed laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2016; 12:1008-1013. [DOI: 10.1016/j.soard.2016.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/02/2016] [Accepted: 01/05/2016] [Indexed: 01/28/2023]
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The Power of Checklists. AORN J 2016; 103:549-51. [DOI: 10.1016/j.aorn.2016.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/21/2016] [Indexed: 11/18/2022]
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Abstract
BACKGROUND Hospital-acquired infections (HAIs) are a persistent concern and include surgical site infections, intravascular line-associated infections, pneumonia, catheter-associated urinary tract infections, and C. difficile infection. METHOD Review of the pertinent English-language literature. RESULTS Hospital-acquired infections result in significant increases in morbidity, mortality rates, and cost and are a focus of efforts at reduction. CONCLUSION I discuss efforts specific to each of the most common infections and a philosophical approach to prevention that strives to achieve zero potentially preventable hospital-acquired infections.
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261
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Lacassie HJ, Ferdinand C, Guzmán S, Camus L, Echevarria GC. World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile. Medicine (Baltimore) 2016; 95:e3844. [PMID: 27281092 PMCID: PMC4907670 DOI: 10.1097/md.0000000000003844] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73-0.92] before and 0.65% (95% CI, 0.57-0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61-0.89]. The median length of stay was 3 days [interquartile range (IQR), 1-5] and 2 days (IQR, 1-4) for the pre and postchecklist period, respectively (P < 0.01).This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries.
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Affiliation(s)
- Hector J. Lacassie
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Sergio Guzmán
- División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorena Camus
- Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ghislaine C. Echevarria
- División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Anesthesiology, Perioperative Care & Pain Medicine, New York University School of Medicine, New York, NY
- ∗Correspondence: Ghislaine C. Echevarria, División de Anestesiología, Hospital Clinico Universidad Católica, Marcoleta 367, Santiago 8330024, Chile (e-mail: )
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262
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Giles K, Munn Z, Aromataris E, Deakin A, Schultz T, Mandel C, Maddern G, Pearson A, Runciman W. Use of surgical safety checklists in Australian operating theatres: an observational study. ANZ J Surg 2016; 87:971-975. [PMID: 27225068 DOI: 10.1111/ans.13638] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/24/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of surgical safety checklists (SSC) is an intervention aimed at reducing mortality and morbidity. Although the effectiveness of their use in surgery has been studied extensively, little is known about their practical use in Australian hospitals. The aim of this study was to observe and document the use of SSC in Australia. METHODS This study employed direct observations of checklist use for surgical procedures by trained observers. Medical records were also audited to determine compliance with checklist use and to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). RESULTS Among the 11 participating hospitals, overall observed mean completion of the components of the checklist was 27%. Only one hospital used the original World Health Organization checklist. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were: correct patient (99%) and procedure (97%), whether the patient had any allergies (80%), and whether the instrument counts were performed correctly (56%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (86% completion) in comparison to the 27% observed. CONCLUSION This is the first study of surgical checklist use within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records.
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Affiliation(s)
- Kristy Giles
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Edoardo Aromataris
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anita Deakin
- Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy Schultz
- Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia
| | - Catherine Mandel
- Radiology Events Register, The University of Melbourne, Melbourne, Victoria, Australia
| | - Guy Maddern
- The Queen Elizabeth Hospital, SA Health, Adelaide, South Australia, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alan Pearson
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - William Runciman
- Australian Patient Safety Foundation, University of South Australia, Adelaide, South Australia, Australia
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263
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Steeples LR, Hingorani M, Flanagan D, Kelly SP. Wrong intraocular lens events-what lessons have we learned? A review of incidents reported to the National Reporting and Learning System: 2010-2014 versus 2003-2010. Eye (Lond) 2016; 30:1049-55. [PMID: 27174380 DOI: 10.1038/eye.2016.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 04/06/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo identify the causal factors in wrong intraocular lens (IOL) events from a national data set and to compare with similar historical data (2003-2010) prior to mandatory checklist use, for the purpose of developing strategies to prevent never events.MethodsData from wrong IOL patient safety incidents (PSIs) submitted to the National Reporting and Learning System (2010-2014) were reviewed by thematic analysis and compared with the data previously collected by the group using the same methodology.ResultsOne hundred and seventy eight wrong IOL PSIs were identified. The contributory factors included: transcription errors (n=26); wrong patient biometry (n=21); wrong IOL selection (n=16); changes in planned procedure (n=16); incorrect IOL brought into theatre (n=11); left/right eye selection errors (n=9); communication errors (n=9); and positive/negative IOL power errors (n=9). In 44 PSIs, no causal factor was reported, limiting the learning value of such reports. Compared with the data from previous years, biometry errors were much reduced but IOL transcription and documentation errors were greater, particularly if further checks did not refer to the original source documentation. IOL exchange surgery was reported in 45 cases.ConclusionsThe selection and implantation of the correct IOL is a complex process which is not adequately addressed by existing checking procedures. Despite the introduction of surgical checklists, wrong IOL incidents continue to occur and are probably under-reported. Human or behavioural factors are heavily implicated in these errors and need to be addressed by novel approaches, including simulation training. There is also scope to further improve the quality and detail of incident reporting and analysis to enhance patient safety.
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Affiliation(s)
- L R Steeples
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Oxford Road, Manchester, UK
| | - M Hingorani
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - D Flanagan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - S P Kelly
- Ophthalmology Department, Royal Bolton Hospital, Bolton NHS Foundation Trust, Bolton, UK
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264
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Rafiei P, Walser EM, Duncan JR, Rana H, Ross JR, Kerlan RK, Gross KA, Balter S, Bartal G, Abi-Jaoudeh N, Stecker MS, Cohen AM, Dixon RG, Thornton RH, Nikolic B. Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee. J Vasc Interv Radiol 2016; 27:695-9. [DOI: 10.1016/j.jvir.2016.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
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265
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Molina G, Jiang W, Edmondson L, Gibbons L, Huang LC, Kiang MV, Haynes AB, Gawande AA, Berry WR, Singer SJ. Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety. J Am Coll Surg 2016; 222:725-736.e5. [DOI: 10.1016/j.jamcollsurg.2015.12.052] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/29/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
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266
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Da Silva-Freitas R, Martín-Laez R, Madrazo-Leal CB, Villena-Martin M, Valduvieco-Juaristi I, Martínez-Agüeros JÁ, Vázquez Barquero A. [Establishment of a modified surgical safety checklist for the neurosurgical patient: Initial experience in 400 cases]. Neurocirugia (Astur) 2016; 23:60-9. [PMID: 22578605 DOI: 10.1016/j.neucir.2012.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 11/06/2011] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Adverse events during diagnostic and therapeutic procedures and medical errors associated with them are an important source of patient morbidity. In an attempt to reduce these, the WHO has proposed a series of measures applicable to medical and surgical patients. Within these last ones is the surgical safety checklist (SSC), a brief questionnaire that does not increase healthcare costs, is accessible to all surgical centres and can be adapted to each specific environment. OBJECTIVES To evaluate the effectiveness of establishing a modified WHO SSC on the safety and quality of care of the neurosurgical patient in a third-level university hospital. MATERIAL AND METHODS The SSC was applied to a series of 400 scheduled surgeries between May 2009 and May 2010. During the initial 6 months, 183 surgical procedures were performed (group 1). All adverse events detected in this period were studied with a root-cause analysis methodology (RCA) and, according to its results, corrective measures were introduced. After that, 217 procedures were performed (group 2). RESULTS We recorded 51 events in 44 surgeries (11%). We were able to correct 88.23% of them before surgery was initiated, avoiding any consequence in the normal management of the case. In Group 1, incidents were noted in 15.3% of the procedures. The RCA suggested that 37.8% of the events had a human cause, followed by problems related to material resources and equipment in 29.7%, and organisational reasons in 21.6%. Incidence of events was reduced in group 2 to 7.4% (P=.01). Corrective measures prevented the appearance of perioperative events in 1 out of 13 procedures. CONCLUSIONS The SSC is an effective tool for improving safety in neurosurgical patients, which can be established in surgical departments of any hospital without increasing healthcare costs or operative time.
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Affiliation(s)
- Rousinelle Da Silva-Freitas
- Servicio de Neurocirugía, Unidad de Raquis Quirúrgico, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
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A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. Anesthesiology 2016; 124:186-98. [PMID: 26513023 DOI: 10.1097/aln.0000000000000885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (eDST) would improve test performance compared with native physician behavior concerning the application of this guideline. METHODS Anesthesiology trainees and faculty at 8 institutions participated in a prospective, randomized trial in which they completed a 20-question test involving clinical scenarios related to the ASRA guidelines. The eDST group completed the test using an iOS app programmed to contain decision logic and content of the ASRA guidelines. The control group completed the test by using any resource in addition to the app. A generalized linear mixed-effects model was used to examine the effect of the intervention. RESULTS After obtaining institutional review board's approval and informed consent, 259 participants were enrolled and randomized (eDST = 122; control = 137). The mean score was 92.4 ± 6.6% in the eDST group and 68.0 ± 15.8% in the control group (P < 0.001). eDST use increased the odds of selecting correct answers (7.8; 95% CI, 5.7 to 10.7). Most control group participants (63%) used some cognitive aid during the test, and they scored higher than those who tested from memory alone (76 ± 15% vs. 57 ± 18%, P < 0.001). There was no difference in time to completion of the test (P = 0.15) and no effect of training level (P = 0.56). CONCLUSIONS eDST use improved application of the ASRA guidelines compared with the native clinician behavior in a testing environment.
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268
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Gagnier JJ, Derosier JM, Maratt JD, Hake ME, Bagian JP. Development, implementation and evaluation of a patient handoff tool to improve safety in orthopaedic surgery. Int J Qual Health Care 2016; 28:363-70. [PMID: 27090398 DOI: 10.1093/intqhc/mzw031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop, implement and test the effect of a handoff tool for orthopaedic trauma residents that reduces adverse events associated with the omission of critical information and the transfer of erroneous information. DESIGN Components of this project included a literature review, resident surveys and observations, checklist development and refinement, implementation and evaluation of impact on adverse events through a chart review of a prospective cohort compared with a historical control group. SETTING Large teaching hospital. PARTICIPANTS Findings of a literature review were presented to orthopaedic residents, epidemiologists, orthopaedic surgeons and patient safety experts in face-to-face meetings, during which we developed and refined the contents of a resident handoff tool. The tool was tested in an orthopaedic trauma service and its impact on adverse events was evaluated through a chart review. The handoff tool was developed and refined during the face-to-face meetings and a pilot implementation. Adverse event data were collected on 127 patients (n = 67 baseline period; n = 60 test period). INTERVENTION A handoff tool for use by orthopaedic residents. MAIN OUTCOME MEASUREMENTS Adverse events in patients handed off by orthopaedic trauma residents. RESULTS After controlling for age, gender and comorbidities, testing resulted in fewer events per person (25-27% reduction; P < 0.10). CONCLUSIONS Preliminary evidence suggests that our resident handoff tool may contribute to a decrease in adverse events in orthopaedic patients.
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Affiliation(s)
- Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Joseph M Derosier
- Center for Healthcare Engineering & Patient Safety, University of Michigan, Ann Arbor, MI, USA
| | - Joseph D Maratt
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E Hake
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James P Bagian
- Center for Healthcare Engineering & Patient Safety, University of Michigan, Ann Arbor, MI, USA Department of Industrial & Operations Engineering, University of Michigan, Ann Arbor, MI, USA
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Rajavi Z, Javadi MA, Daftarian N, Safi S, Nejat F, Shirvani A, Ahmadieh H, Shahraz S, Ziaei H, Moein H, Motlagh BF, Feizi S, Foroutan A, Hashemi H, Hashemian SJ, Jabbarvand M, Jafarinasab MR, Karimian F, Mohammad-Rabei H, Mohammadpour M, Nassiri N, Panahi-Bazaz M, Rohani MR, Sedaghat MR, Sheibani K. Customized Clinical Practice Guidelines for Management of Adult Cataract in Iran. J Ophthalmic Vis Res 2016; 10:445-60. [PMID: 27051491 PMCID: PMC4795396 DOI: 10.4103/2008-322x.176913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To customize clinical practice guidelines (CPGs) for cataract management in the Iranian population. Methods: First, four CPGs (American Academy of Ophthalmology 2006 and 2011, Royal College of Ophthalmologists 2010, and Canadian Ophthalmological Society 2008) were selected from a number of available CPGs in the literature for cataract management. All recommendations of these guidelines, together with their references, were studied. Each recommendation was summarized in 4 tables. The first table showed the recommendation itself in clinical question components format along with its level of evidence. The second table contained structured abstracts of supporting articles related to the clinical question with their levels of evidence. The third table included the customized recommendation of the internal group respecting its clinical advantage, cost, and complications. In the fourth table, the internal group their recommendations from 1 to 9 based on the customizing capability of the recommendation (applicability, acceptability, external validity). Finally, customized recommendations were sent one month prior to a consensus session to faculty members of all universities across the country asking for their comments on recommendations. Results: The agreed recommendations were accepted as conclusive while those with no agreement were discussed at the consensus session. Finally, all customized recommendations were codified as 80 recommendations along with their sources and levels of evidence for the Iranian population. Conclusion: Customization of CPGs for management of adult cataract for the Iranian population seems to be useful for standardization of referral, diagnosis and treatment of patients.
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Affiliation(s)
- Zhaleh Rajavi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Narsis Daftarian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sare Safi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Nejat
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Shirvani
- Office for Healthcare Standards, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran; Department of Medical Education, Faculty of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Feizi
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Foroutan
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Javad Hashemian
- Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Jabbarvand
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Jafarinasab
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Mohammad-Rabei
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mohammadpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nader Nassiri
- Department of Ophthalmology, Imam Hussein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Rohani
- Department of Ophthalmology, Al-Zahra Eye Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Kourosh Sheibani
- Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran
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270
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Dellinger EP. Teamwork and Collaboration for Prevention of Surgical Site Infections. Surg Infect (Larchmt) 2016; 17:198-202. [DOI: 10.1089/sur.2015.260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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271
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Arora KS, Shields LE, Grobman WA, D'Alton ME, Lappen JR, Mercer BM. Triggers, bundles, protocols, and checklists--what every maternal care provider needs to know. Am J Obstet Gynecol 2016; 214:444-451. [PMID: 26478105 DOI: 10.1016/j.ajog.2015.10.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 09/13/2015] [Accepted: 10/08/2015] [Indexed: 12/29/2022]
Abstract
The rise in maternal morbidity and mortality has resulted in national and international attention at optimally organizing systems and teams for pregnancy care. Given that maternal morbidity and mortality can occur unpredictably in any obstetric setting, specialists in general obstetrics and gynecology along with other primary maternal care providers should be integrally involved in efforts to improve the safety of obstetric care delivery. Quality improvement initiatives remain vital to meeting this goal. The evidence-based utilization of triggers, bundles, protocols, and checklists can aid in timely diagnosis and treatment to prevent or limit the severity of morbidity as well as facilitate interdisciplinary, patient-centered care. The purpose of this document is to summarize the pertinent elements from this forum to assist primary maternal care providers in their utilization and implementation of these safety tools.
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272
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Neis KJ, Zubke W, Römer T, Schwerdtfeger K, Schollmeyer T, Rimbach S, Holthaus B, Solomayer E, Bojahr B, Neis F, Reisenauer C, Gabriel B, Dieterich H, Runnenbaum IB, Kleine W, Strauss A, Menton M, Mylonas I, David M, Horn LC, Schmidt D, Gaß P, Teichmann AT, Brandner P, Stummvoll W, Kuhn A, Müller M, Fehr M, Tamussino K. Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015). Geburtshilfe Frauenheilkd 2016; 76:350-364. [PMID: 27667852 PMCID: PMC5031283 DOI: 10.1055/s-0042-104288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.
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Affiliation(s)
- K. J. Neis
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin der Universitätsklinik des Saarlandes
| | - W. Zubke
- Frauenklinik des Universitätsklinikum Tübingen
| | - T. Römer
- Evangelisches Krankenhaus Köln-Weyertal
| | | | - T. Schollmeyer
- Klinik für Gynäkologie und Geburtshilfe Universitätsklinikum Schleswig-Holstein
| | - S. Rimbach
- Klinik für Gynäkologie und Geburtshilfe Krankenhaus Agatharied GmbH
| | - B. Holthaus
- Klinik für Frauenheilkunde und Geburtshilfe St. Elisabeth Krankenhaus Damme
| | - E. Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin der Universitätsklinik des Saarlandes
| | - B. Bojahr
- Klinik für MIC Minimal Invasive Chirurgie am Ev. Krankenhaus Hubertus in Berlin
| | - F. Neis
- Frauenklinik des Universitätsklinikum Tübingen
| | | | - B. Gabriel
- Klinik für Gynäkologie und Geburtshilfe St. Josefs-Hospital Wiesbaden
| | | | - I. B. Runnenbaum
- Universitätsklinikum Jena Klinik für Frauenheilkunde und Geburtshilfe
| | - W. Kleine
- Universitätsklinikum Mannheim Klink für Frauenheilkunde und Geburtshilfe
| | - A. Strauss
- Klinik für Gynäkologie und Geburtshilfe Christian-Albrechts-Universität zu Kiel
| | | | - I. Mylonas
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe Klinikum der Universität München
| | - M. David
- Campus Virchow-Klinikum Charité Klinik für Gynäkologie
| | - L-C. Horn
- Institut für Pathologie Universitätsklinikum Leipzig
| | | | - P. Gaß
- Universitätsklinikum Erlangen Frauenklinik
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Cadman V. The impact of surgical safety checklists on theatre departments: a critical review of the literature. J Perioper Pract 2016; 26:62-71. [PMID: 27290755 DOI: 10.1177/175045891602600402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The World Health Organisation's Safer Surgery Checklist has become an integral part of standard practice in operating theatres in the UK and other countries. However, some doubts still exist over how much of an effect the checklist actually has, with some staff feeling some resentment towards it. This review explores the literature regarding the impact of the checklist on theatre departments and how this can inform practice. The evidence found shows that use of the checklist reduces patient morbidity and mortality, improves communication and teamwork, reduces operating time and can reduce theatre costs. The negative perceptions that surround the checklist arise from misconceptions and lack of understanding and can result in poor compliance. Further research is required across all areas but with a focus on education and implementation of strategies that address existing barriers.
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274
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Tsuburaya A, Soma T, Yoshikawa T, Cho H, Miki T, Uramatsu M, Fujisawa Y, Youngson G, Yule S. Introduction of the non-technical skills for surgeons (NOTSS) system in a Japanese cancer center. Surg Today 2016; 46:1451-1455. [DOI: 10.1007/s00595-016-1322-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
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Outcomes Associated With the Nationwide Introduction of Rapid Response Systems in The Netherlands. Crit Care Med 2016; 43:2544-51. [PMID: 26317569 DOI: 10.1097/ccm.0000000000001272] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the effect of implementation of a rapid response system on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death. DESIGN Pragmatic prospective Dutch multicenter before-after trial, Cost and Outcomes analysis of Medical Emergency Teams trial. SETTING Twelve hospitals participated, each including two surgical and two nonsurgical wards between April 2009 and November 2011. The Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments were implemented over 7 months. The rapid response team was then implemented during the following 17 months. The effects of implementing the rapid response team were measured in the last 5 months of this period. PATIENTS All patients 18 years old and older admitted to the study wards were included. MEASUREMENTS AND MAIN RESULTS In total, 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1,000 admissions was significantly reduced in the rapid response team versus the before phase (adjusted odds ratio, 0.847; 95% CI, 0.725-0.989; p = 0.036). Cardiopulmonary arrests and in-hospital mortality were also significantly reduced (odds ratio, 0.607; 95% CI, 0.393-0.937; p = 0.018 and odds ratio, 0.802; 95% CI, 0.644-1.0; p = 0.05, respectively). Unplanned ICU admissions showed a declining trend (odds ratio, 0.878; 95% CI, 0.755-1.021; p = 0.092), whereas severity of illness at the moment of ICU admission was not different between periods. CONCLUSIONS In this study, introduction of nationwide implementation of rapid response systems was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions, and mortality in patients in general hospital wards. These findings support the implementation of rapid response systems in hospitals to reduce severe adverse events.
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276
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Kansagra AP, Liu K, Yu JPJ. Disruption of Radiologist Workflow. Curr Probl Diagn Radiol 2016; 45:101-6. [DOI: 10.1067/j.cpradiol.2015.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/29/2015] [Indexed: 01/04/2023]
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Nilsson L, Risberg MB, Montgomery A, Sjödahl R, Schildmeijer K, Rutberg H. Preventable Adverse Events in Surgical Care in Sweden: A Nationwide Review of Patient Notes. Medicine (Baltimore) 2016; 95:e3047. [PMID: 26986126 PMCID: PMC4839907 DOI: 10.1097/md.0000000000003047] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Adverse events (AEs) occur in health care and may result in harm to patients especially in the field of surgery. Our objective was to analyze AEs in surgical patient care from a nationwide perspective and to analyze the frequency of AEs that may be preventable. In total 19,141 randomly selected admissions in 63 Swedish hospitals were reviewed each month during 2013 using a 2-stage record review method based on the identification of predefined triggers. The subgroup of 3301 surgical admissions was analyzed. All AEs were categorized according to site, type, level of severity, and degree of preventability. We reviewed 3301 patients' records and 507 (15.4%) were associated with AEs. A total of 62.5% of the AEs were considered probably preventable, over half contributed to prolonged hospital care or readmission, and 4.7% to permanent harm or death. Healthcare acquired infections composed of more than one third of AEs. The majority of the most serious AEs composed of healthcare acquired infections and surgical or other invasive AEs. The incidence of AEs was 13% in patients 18 to 64 years old and 17% in ≥65 years. Pressure sores and drug-related AEs were more common in patients being ≥65 years. Urinary retention and pressure sores showed the highest degree of preventability. Patients with probably preventable AEs had in median 7.1 days longer hospital stay. We conclude that AEs are common in surgical care and the majority are probably preventable.
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Affiliation(s)
- Lena Nilsson
- From the Department of Anaesthesia and Intensive Care and Department of Medical and Health Sciences (LN), Linköping University; Unit for Health Analysis (MBR), Region Östergötland; Department of Surgery (AM), Skåne University Hospital, Malmö; Department of Surgery (RS), Region Östergötland, Linköping University; Development and Patient Safety Unit (RS, HR), Region Östergötland, Linköping University, Linköping; Faculty of Health and Life Sciences (KS), School of Health and Caring Sciences, Linnaeus University, Kalmar; and Swedish Association of Local Authorities and Regions (HR), Stockholm, Sweden
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278
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Haugen AS, Bakke A, Løvøy T, Søfteland E. Preventing Complications: The Preflight Checklist. Eur Urol Focus 2016; 2:60-62. [PMID: 28723450 DOI: 10.1016/j.euf.2016.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
Compliance with the World Health Organisation Surgical Safety Checklist is associated with reduction of complications and mortality.
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Affiliation(s)
- Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry University of Bergen, Bergen, Norway.
| | - August Bakke
- Department of Clinical Science, Faculty of Medicine and Dentistry University of Bergen, Bergen, Norway; Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine and Dentistry University of Bergen, Bergen, Norway
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279
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Gaucher S, Boutron I, Marchand-Maillet F, Baron G, Douard R, Béthoux JP. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial. PLoS One 2016; 11:e0147194. [PMID: 26829478 PMCID: PMC4734771 DOI: 10.1371/journal.pone.0147194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/15/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159
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Affiliation(s)
- Sonia Gaucher
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
- * E-mail:
| | - Isabelle Boutron
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Florence Marchand-Maillet
- Unité de Chirurgie Ambulatoire, Pôle Digestif-Anesthésie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Est, Hôpital Saint-Antoine, Paris, France
| | - Gabriel Baron
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Richard Douard
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale et Digestive, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Pierre Béthoux
- Université Paris Descartes, Paris Sorbonne Cité, Paris, France
- Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Paris, France
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280
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Moonesinghe S. Innovation good … evaluation essential A plea for formal evaluation of new pathways of care and ways of working. Br J Anaesth 2016; 116:151-3. [DOI: 10.1093/bja/aev450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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van Daalen FV, Geerlings SE, Prins JM, Hulscher MEJL. A survey to identify barriers of implementing an antibiotic checklist. Eur J Clin Microbiol Infect Dis 2016; 35:545-53. [PMID: 26810059 PMCID: PMC4819538 DOI: 10.1007/s10096-015-2569-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/28/2015] [Indexed: 12/31/2022]
Abstract
A checklist is an effective implementation tool, but addressing barriers that might impact on the effectiveness of its use is crucial. In this paper, we explore barriers to the uptake of an antibiotic checklist that aims to improve antibiotic use in daily hospital care. We performed an online questionnaire survey among medical specialists and residents with various professional backgrounds from nine Dutch hospitals. The questionnaire consisted of 23 statements on anticipated barriers hindering the uptake of the checklist. Furthermore, it gave the possibility to add comments. We included 219 completed questionnaires (122 medical specialists and 97 residents) in our descriptive analysis. The top six anticipated barriers included: (1) lack of expectation of improvement of antibiotic use, (2) lack of expected patients' satisfaction by checklist use, (3) lack of feasibility of the checklist, (4) negative previous experiences with other checklists, (5) the complexity of the antibiotic checklist and (6) lack of nurses' expectation of checklist use. Remarkably, 553 comments were made, mostly (436) about the content of the checklist. These insights can be used to improve the specific content of the checklist and to develop an implementation strategy that addresses the identified barriers.
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Affiliation(s)
- F V van Daalen
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Room F4-106, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - S E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Room F4-106, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Room F4-106, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M E J L Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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283
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Merry AF, Mitchell SJ. Advancing patient safety through the use of cognitive aids. BMJ Qual Saf 2016; 25:733-5. [PMID: 26729917 DOI: 10.1136/bmjqs-2015-004984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Alan F Merry
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
| | - Simon J Mitchell
- Department of Anaesthesiology, The University of Auckland, Auckland, New Zealand
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284
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Erem HH, Aytac E. The Use of Surgical Care Improvement Projects in Prevention of Venous Thromboembolism. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 906:15-22. [PMID: 27638625 DOI: 10.1007/5584_2016_102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Venous thromboembolism (VTE) is a potentially mortal complication in patients undergoing surgery. Deep venous thrombosis and pulmonary embolism can be seen up to 40 % of patients who have no or inappropriate VTE prophylaxis during perioperative period.In addition to the preoperative and intraoperative preventive measures, the standardization of postoperative care and follow-up are essential to reduce VTE risk. Modern healthcare prioritizes patient's safety and aims to reduce postoperative morbidity by using standardized protocols. Use of quality improvement projects with well-organized surgical care has an important role to prevent VTE during hospital stay. Present surgical care improvement projects have provided us the opportunity to identify patients who are vulnerable to VTE. Description and introduction of the quality standards for VTE prevention in the educational materials, meetings and at the medical schools will increase the VTE awareness among the health care providers. You are going to find the characteristics of the major surgical quality improvement projects and their relations with VTE in the chapter.
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Affiliation(s)
- Hasan Hakan Erem
- Department of General Surgery, Gumussuyu Military Hospital, Istanbul, 34349, Turkey.
| | - Erman Aytac
- Department of General Surgery, Acibadem University, School of Medicine, Istanbul, Turkey
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285
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286
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Moppett IK, Moppett SH. Surgical caseload and the risk of surgical Never Events in England. Anaesthesia 2016; 71:17-30. [DOI: 10.1111/anae.13290] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- I. K. Moppett
- Anaesthesia and Critical Care Section; Division of Clinical Neuroscience; Queen's Medical Centre; University of Nottingham; Nottingham UK
- Department of Anaesthesia; Nottingham University Hospitals; Nottingham UK
| | - S. H. Moppett
- Clinical Support Division; Nottingham University Hospitals; Nottingham UK
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287
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Ong APC, Devcich DA, Hannam J, Lee T, Merry AF, Mitchell SJ. A ‘paperless’ wall-mounted surgical safety checklist with migrated leadership can improve compliance and team engagement. BMJ Qual Saf 2015; 25:971-976. [DOI: 10.1136/bmjqs-2015-004545] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/26/2015] [Accepted: 11/28/2015] [Indexed: 11/03/2022]
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288
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Abstract
Emergency abdominal surgery has a high mortality, with an incidence of around 15% for all patients. Mortality in elderly patients is up to 25%, and 1-year mortality for emergent colorectal resection for patients over 80 years is around 50%. Patients presenting to hospital are often given low priority. Definitive surgery is not always possible and it may be more important to control the septic focus and to revisit surgery later. The literature is poor for such a common procedure, but there is evidence that a standardized pathway focusing on rapid diagnosis; resuscitation; sepsis treatment; and, if appropriate, urgent surgery followed by admission to intensive care improves outcomes.
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Affiliation(s)
- Carol Peden
- Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
| | - Michael J Scott
- Department of Anesthesia and Perioperative Medicine, Royal Surrey County Hospital NHS Foundation Trust, Surrey, Guildford GU1 7XX, UK; Surrey Perioperative Anesthesia Critical Care Research Group (SPACeR), University of Surrey, Surrey, Guildford GU2 7XH, UK
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289
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Pires MPDO, Pedreira MLG, Peterlini MAS. Surgical Safety in Pediatrics: practical application of the Pediatric Surgical Safety Checklist. Rev Lat Am Enfermagem 2015; 23:1105-12. [PMID: 26626002 PMCID: PMC4664011 DOI: 10.1590/0104-1169.0553.2655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 06/19/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives: to assess the practical application of the Pediatric Surgical Safety Checklist on
the preoperative period and to verify family satisfaction regarding the use of the
material. Method: exploratory study that aimed to analyze the use of the checklist by children who
underwent surgical interventions. The sample was constituted by 60 children (from
preschoolers to teens) and 60 family members. The variables related to demographic
characterization, filling out the checklist, and family satisfaction, being
evaluated through inferential and descriptive statistical analysis. Results: most children (71.7%) were male, with a median age of 7.5 years. We identified
the achievement of 65.3% of the checklist items, 30.0% were not filled due to
non-performance of the team and 4.7% for children and family reasons. In the
association analysis, we found that the removal of accessories item (p = 0.008)
was the most checked by older children. Regarding satisfaction, the family members
evaluated the material as great (63.3%) and good (36.7%) and believed that there
was a reduction of the child's anxiety (83.3%). Conclusion: the use of the checklist in clinical practice can change health services
regarding safety culture and promote customer satisfaction.
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Affiliation(s)
| | - Mavilde L G Pedreira
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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290
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Quarterman C, Fletcher N, Sharma V. WHO cares? Safety checklists in echocardiography. Echo Res Pract 2015; 2:E9-E12. [PMID: 26796944 PMCID: PMC4690156 DOI: 10.1530/erp-15-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/01/2015] [Indexed: 11/14/2022] Open
Abstract
The number of potentially preventable medical errors that occur has been steadily increasing. These are a significant cause of patient morbidity, can lead to life-threatening complications and may result in a significant financial burden on health care. Effective communication and team working reduce errors and serious incidents. In particular the implementation of the World Health Organisation (WHO) Safe Surgery Checklist has been shown to reduce in-hospital mortality, postoperative complications and the incidence of surgical site infection. However an increasing number of complex medical procedures and interventions are being performed outside of the theatre environment. The lessons learnt from the surgical setting are relevant to other procedures performed in other areas. For the echocardiographer, transoesophageal echocardiography (TOE) is one such procedure in which there is the potential for medical errors that may result in patient harm. This risk is increased if patient sedation is being administered. The British Society of Echocardiography and the Association of Cardiothoracic Anaesthetists have developed a procedure specific checklist to facilitate the use of checklists into routine practice. In this article we discuss the evolution of the WHO safety checklist and explore its relevance to TOE.
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Affiliation(s)
- Clare Quarterman
- Department of Anaesthesia, Liverpool Heart and Chest Hospital NHS Foundation Trust , Liverpool , UK
| | - Nick Fletcher
- St Georges University Hospital NHS Foundation Trust , SW17 0QT, London , UK
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust , Prescot Street, Liverpool, L7 8XP , UK
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291
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Devcich DA, Weller J, Mitchell SJ, McLaughlin S, Barker L, Rudolph JW, Raemer DB, Zammert M, Singer SJ, Torrie J, Frampton CM, Merry AF. A behaviourally anchored rating scale for evaluating the use of the WHO surgical safety checklist: development and initial evaluation of the WHOBARS. BMJ Qual Saf 2015; 25:778-86. [PMID: 26590200 DOI: 10.1136/bmjqs-2015-004448] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 10/29/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Realising the full potential of the WHO Surgical Safety Checklist (SSC) to reduce perioperative harm requires the constructive engagement of all operating room (OR) team members during its administration. To facilitate research on SSC implementation, a valid and reliable instrument is needed for measuring OR team behaviours during its administration. We developed a behaviourally anchored rating scale (BARS) for this purpose. METHODS We used a modified Delphi process, involving 16 subject matter experts, to compile a BARS with behavioural domains applicable to all three phases of the SSC. We evaluated the instrument in 80 adult OR cases and 30 simulated cases using two medical student raters and seven expert raters, respectively. Intraclass correlation coefficients were calculated to assess inter-rater reliability. Internal consistency and instrument discrimination were explored. Sample size estimates for potential study designs using the instrument were calculated. RESULTS The Delphi process resulted in a BARS instrument (the WHOBARS) with five behavioural domains. Intraclass correlation coefficients calculated from the OR cases exceeded 0.80 for 80% of the instrument's domains across the SSC phases. The WHOBARS showed high internal consistency across the three phases of the SSC and ability to discriminate among surgical cases in both clinical and simulated settings. Fewer than 20 cases per group would be required to show a difference of 1 point between groups in studies of the SSC, where α=0.05 and β=0.8. CONCLUSION We have developed a generic instrument for comprehensively rating the administration of the SSC and informing initiatives to realise its full potential. We have provided data supporting its capacity for discrimination, internal consistency and inter-rater reliability. Further psychometric evaluation is warranted.
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Affiliation(s)
- Daniel A Devcich
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Jennifer Weller
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Simon J Mitchell
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Scott McLaughlin
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Lauren Barker
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Jenny W Rudolph
- Harvard Medical School, Center for Medical Simulation, Boston, Massachusetts, United States
| | - Daniel B Raemer
- Harvard Medical School, Center for Medical Simulation, Boston, Massachusetts, United States
| | - Martin Zammert
- Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Sara J Singer
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Jane Torrie
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Chris Ma Frampton
- Department of Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
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292
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Wetmore D, Goldberg A, Gandhi N, Spivack J, McCormick P, DeMaria S. An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting. BMJ Qual Saf 2015; 25:739-46. [DOI: 10.1136/bmjqs-2015-004707] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022]
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293
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Cohen DL, Stewart KO. The Stories Clinicians Tell: Achieving High Reliability and Improving Patient Safety. Perm J 2015; 20:85-90. [PMID: 26580146 DOI: 10.7812/tpp/15-039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The patient safety movement has been deeply affected by the stories patients have shared that have identified numerous opportunities for improvements in safety. These stories have identified system and/or human inefficiencies or dysfunctions, possibly even failures, often resulting in patient harm. Although patients' stories tell us much, less commonly heard are the stories of clinicians and how their personal observations regarding the environments they work in and the circumstances and pressures under which they work may degrade patient safety and lead to harm.If the health care industry is to function like a high-reliability industry, to improve its processes and achieve the outcomes that patients rightly deserve, then leaders and managers must seek and value input from those on the front lines-both clinicians and patients. Stories from clinicians provided in this article address themes that include incident identification, disclosure and transparency, just culture, the impact of clinical workload pressures, human factors liabilities, clinicians as secondary victims, the impact of disruptive and punitive behaviors, factors affecting professional morale, and personal failings.
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Affiliation(s)
- Daniel L Cohen
- Former Chief Medical Officer of the US Department of Defense TRICARE Health Plan; is currently the Chief Medical Officer for Datix, Ltd (UK)/Datix, Inc (US); and presents on topics related to patient safety.
| | - Kevin O Stewart
- Clinical Director of the Clinical Effectiveness and Evaluation Unit for the Royal College of Physicians and an Internal Medicine Consultant Physician for the English National Health Service in London, United Kingdom.
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294
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Minami CA, Sheils CR, Bilimoria KY, Johnson JK, Berger ER, Berian JR, Englesbe MJ, Guillamondegui OD, Hines LH, Cofer JB, Flum DR, Thirlby RC, Kazaure HS, Wren SM, O'Leary KJ, Thurk JL, Kennedy GD, Tevis SE, Yang AD. Process improvement in surgery. Curr Probl Surg 2015; 53:62-96. [PMID: 26806271 DOI: 10.1067/j.cpsurg.2015.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/10/2015] [Indexed: 11/22/2022]
Affiliation(s)
- Christina A Minami
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Catherine R Sheils
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Rochester School of Medicine, University of Rochester, Rochester, NY
| | - Karl Y Bilimoria
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Julie K Johnson
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Elizabeth R Berger
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Loyola University Medical Center, Maywood, IL
| | - Julia R Berian
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL
| | - Michael J Englesbe
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI
| | | | - Leonard H Hines
- Department of Surgery, University of Tennessee College of Medicine, Knoxville, TN
| | - Joseph B Cofer
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, TN
| | - David R Flum
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | | | - Hadiza S Kazaure
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jessica L Thurk
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sarah E Tevis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Anthony D Yang
- Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies in the Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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295
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Borgmann H, Helbig S, Reiter MA, Hüsch T, Schilling D, Tsaur I, Haferkamp A. Utilization of surgical safety checklists by urological surgeons in Germany: a nationwide prospective survey. Patient Saf Surg 2015; 9:37. [PMID: 26561502 PMCID: PMC4641404 DOI: 10.1186/s13037-015-0082-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to investigate the contemporary usage rate and habits of the WHO Surgical Safety Checklist (SSC) in German urological departments. Methods We designed a 26-item questionnaire that was sent to all urological departments in Germany. The primary aim of this study was to evaluate the usage rate of the SSC. Secondary aims were to compare perioperative characteristics of users vs. non-users of the SSC and to assess circumstances of the SSC application. Results A total of 213 of 234 (91 %) urological departments were users of the SSC, and 21 (9 %) were non-users. SSC users had more often a standard protocol, took less time and had fewer people involved for checking perioperative patient data compared to non-users. Financial budgeting for the SSC existed in 55 (24 %) departments and for patient safety in 73 (32 %) departments. Conclusions The usage rate of the SSC in urological departments in Germany is high despite restricted financial budgeting. Users of the SSC profit by saving time and manpower for checking perioperative patient data. Electronic supplementary material The online version of this article (doi:10.1186/s13037-015-0082-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik Borgmann
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Sarah Helbig
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Michael A Reiter
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - David Schilling
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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296
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White AD, Skelton M, Mushtaq F, Pike TW, Mon-Williams M, Lodge JPA, Wilkie RM. Inconsistent reporting of minimally invasive surgery errors. Ann R Coll Surg Engl 2015; 97:608-12. [PMID: 26492908 PMCID: PMC5096613 DOI: 10.1308/rcsann.2015.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery (MIS) is a complex task requiring dexterity and high level cognitive function. Unlike surgical 'never events', potentially important (and frequent) manual or cognitive slips ('technical errors') are underresearched. Little is known about the occurrence of routine errors in MIS, their relationship to patient outcome, and whether they are reported accurately and/or consistently. METHODS An electronic survey was sent to all members of the Association of Surgeons of Great Britain and Ireland, gathering demographic information, experience and reporting of MIS errors, and a rating of factors affecting error prevalence. RESULTS Of 249 responses, 203 completed more than 80% of the questions regarding the surgery they had performed in the preceding 12 months. Of these, 47% reported a significant error in their own performance and 75% were aware of a colleague experiencing error. Technical skill, knowledge, situational awareness and decision making were all identified as particularly important for avoiding errors in MIS. Reporting of errors was variable: 15% did not necessarily report an intraoperative error to a patient while 50% did not consistently report at an institutional level. Critically, 12% of surgeons were unaware of the procedure for reporting a technical error and 59% felt guidance is needed. Overall, 40% believed a confidential reporting system would increase their likelihood of reporting an error. CONCLUSION These data indicate inconsistent reporting of operative errors, and highlight the need to better understand how and why technical errors occur in MIS. A confidential 'no blame' reporting system might help improve patient outcomes and avoid a closed culture that can undermine public confidence.
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Affiliation(s)
- A D White
- Leeds Teaching Hospitals NHS Trust , UK
- University of Leeds , UK
| | | | | | - T W Pike
- Leeds Teaching Hospitals NHS Trust , UK
- University of Leeds , UK
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297
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Haerkens MHTM, Kox M, Lemson J, Houterman S, Hoeven JG, Pickkers P. Crew Resource Management in the Intensive Care Unit: a prospective 3-year cohort study. Acta Anaesthesiol Scand 2015; 59:1319-29. [PMID: 26079640 PMCID: PMC5033035 DOI: 10.1111/aas.12573] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/19/2015] [Accepted: 05/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human factors account for the majority of adverse events in both aviation and medicine. Human factors awareness training entitled "Crew Resource Management (CRM)" is associated with improved aviation safety. We determined whether implementation of CRM impacts outcome in critically ill patients. METHODS We performed a prospective 3-year cohort study in a 32-bed ICU, admitting 2500-3000 patients yearly. At the end of the baseline year, all personnel received CRM training, followed by 1 year of implementation. The third year was defined as the clinical effect year. All 7271 patients admitted to the ICU in the study period were included. The primary outcome measure was ICU complication rate. Secondary outcome measures were ICU and hospital length of stay, and standardized mortality ratio. RESULTS Occurrence of serious complications was 67.1/1000 patients and 66.4/1000 patients during the baseline and implementation year respectively, decreasing to 50.9/1000 patients in the post-implementation year (P = 0.03). Adjusted odds ratios for occurrence of complications were 0.92 (95% CI 0.71-1.19, P = 0.52) and 0.66 (95% CI 0.51-0.87, P = 0.003) in the implementation and post-implementation year. The incidence of cardiac arrests was 9.2/1000 patients and 8.3/1000 patients during the baseline and implementation year, decreasing to 3.5/1000 patients (P = 0.04) in the post-implementation year, while cardiopulmonary resuscitation success rate increased from 19% to 55% and 67% (P = 0.02). Standardized mortality ratio decreased from 0.72 (95% CI 0.63-0.81) in the baseline year to 0.60 (95% CI 0.53-0.67) in the post-implementation year (P = 0.04). CONCLUSION Our data indicate an association between CRM implementation and reduction in serious complications and lower mortality in critically ill patients.
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Affiliation(s)
- M. H. T. M. Haerkens
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
| | - M. Kox
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
- Department of Anesthesiology Radboud University Medical Center Nijmegen The Netherlands
| | - J. Lemson
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
| | - S. Houterman
- Department of Education and Research Catharina Hospital Eindhoven The Netherlands
| | - J. G. Hoeven
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
| | - P. Pickkers
- Department of Intensive Care Medicine Radboud University Medical Center Nijmegen The Netherlands
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298
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Laws ER, Wong JM, Smith TR, de Los Reyes K, Aglio LS, Thorne AJ, Cote DJ, Esposito F, Cappabianca P, Gawande A. A checklist for endonasal transsphenoidal anterior skull base surgery. J Neurosurg 2015; 124:1634-9. [PMID: 26517770 DOI: 10.3171/2015.4.jns142184] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECT Approximately 250 million surgical procedures are performed annually worldwide, and data suggest that major complications occur in 3%-17% of them. Many of these complications can be classified as avoidable, and previous studies have demonstrated that preoperative checklists improve operating room teamwork and decrease complication rates. Although the authors' institution has instituted a general preoperative "time-out" designed to streamline communication, flatten vertical authority gradients, and decrease procedural errors, there is no specific checklist for transnasal transsphenoidal anterior skull base surgery, with or without endoscopy. Such minimally invasive cranial surgery uses a completely different conceptual approach, set-up, instrumentation, and operative procedure. Therefore, it can be associated with different types of complications as compared with open cranial surgery. The authors hypothesized that a detailed, procedure-specific, preoperative checklist would be useful to reduce errors, improve outcomes, decrease delays, and maximize both teambuilding and operational efficiency. Thus, the object of this study was to develop such a checklist for endonasal transsphenoidal anterior skull base surgery. METHODS An expert panel was convened that consisted of all members of the typical surgical team for transsphenoidal endoscopic cases: neurosurgeons, anesthesiologists, circulating nurses, scrub technicians, surgical operations managers, and technical assistants. Beginning with a general checklist, procedure-specific items were added and categorized into 4 pauses: Anesthesia Pause, Surgical Pause, Equipment Pause, and Closure Pause. RESULTS The final endonasal transsphenoidal anterior skull base surgery checklist is composed of the following 4 pauses. The Anesthesia Pause consists of patient identification, diagnosis, pertinent laboratory studies, medications, surgical preparation, patient positioning, intravenous/arterial access, fluid management, monitoring, and other special considerations (e.g., Valsalva, jugular compression, lumbar drain, and so on). The Surgical Pause is composed of personnel introductions, planned procedural elements, estimation of duration of surgery, anticipated blood loss and fluid management, imaging, specimen collection, and questions of a surgical nature. The Equipment Pause assures proper function and availability of the microscope, endoscope, cameras and recorders, guidance systems, special instruments, ultrasonic microdoppler, microdebrider, drills, and other adjunctive supplies (e.g., Avitene, cotton balls, nasal packs, and so on). The Closure Pause is dedicated to issues of immediate postoperative patient disposition, orders, and management. CONCLUSIONS Surgical complications are a considerable cause of death and disability worldwide. Checklists have been shown to be an effective tool for reducing preventable errors surrounding surgery and decreasing associated complications. Although general checklists are already in place in most institutions, a specific checklist for endonasal transsphenoidal anterior skull base surgery was developed to help safeguard patients, improve outcomes, and enhance teambuilding.
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Affiliation(s)
| | - Judith M Wong
- Department of Neurosurgery, University of Southern California, Los Angeles
| | | | | | - Linda S Aglio
- Anesthesiology, Perioperative and Pain Medicine, and
| | | | | | - Felice Esposito
- Department of Neurosurgery, University of Messina, Italy; and
| | - Paolo Cappabianca
- Department of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Atul Gawande
- Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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299
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Goldhaber-Fiebert SN, Lei V, Nandagopal K, Bereknyei S. Emergency manual implementation: can brief simulation-based or staff trainings increase familiarity and planned clinical use? Jt Comm J Qual Patient Saf 2015; 41:212-20. [PMID: 25977248 DOI: 10.1016/s1553-7250(15)41028-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Emergency manuals (EMs)-context-relevant sets of cognitive aids such as crisis checklists-are useful tools to enhance perioperative patient care. Studies in high-hazard industries demonstrate that humans, regardless of expertise, do not optimally retrieve or deploy key knowledge under stress. EM use has been shown in both health care simulation studies and other industries to help expert teams effectively manage critical events. However, clinical adoption and use are still nascent in health care. Recognizing that training with, access to, and cultural acceptance of EMs can be vital elements for successful implementation, this study assessed the impact of a brief in situ operating room (OR) staff training program on familiarity with EMs and intention to use them during critical events. METHODS Nine 50-minute training sessions were held with OR staff as part of a broader perioperative EM implementation. Participants primarily included OR nurses and surgical technologists. The simulation-based in situ trainings included why and how to use EMs, familiarization with format, simulated scenarios of critical events, and debriefings. A retrospective pre-post survey was conducted to determine participants' levels of EM familiarity and intentions to use EMs clinically. RESULTS The 126 trained OR staff self-reported increases in awareness of the EM (p < .01), familiarity with EM (p < .01), willingness to use for educational review (p < .01), and intention to use during critical events (p < .01). Participants rated the sessions highly and expressed interest in more opportunities to practice using EMs. CONCLUSIONS Implementing institutions should not only provide EMs in accessible places in ORs but also incorporate training mechanisms to increase clinicians' familiarity, cultural acceptance, and planned clinical use.
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Affiliation(s)
- Sara N Goldhaber-Fiebert
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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300
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Gillespie BM, Marshall A. Implementation of safety checklists in surgery: a realist synthesis of evidence. Implement Sci 2015; 10:137. [PMID: 26415946 PMCID: PMC4587654 DOI: 10.1186/s13012-015-0319-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/24/2015] [Indexed: 11/10/2022] Open
Abstract
AIM The aim of this review is to present a realist synthesis of the evidence of implementation interventions to improve adherence to the use of safety checklists in surgery. BACKGROUND Surgical safety checklists have been shown to improve teamwork and patient safety in the operating room. Yet, despite the benefits associated with their use, universal implementation of and compliance with these checklists has been inconsistent. DATA SOURCES An overview of the literature from 2008 is examined in relation to checklist implementation, compliance, and sustainability. REVIEW METHODS Pawson's and Rycroft-Malone's realist synthesis methodology was used to explain the interaction between context, mechanism, and outcome. This approach incorporated the following: defining the scope of the review, searching and appraising the evidence, extracting and synthesising the findings, and disseminating, implementing, and evaluating the evidence. We identified two theories a priori that explained contextual nuances associated with implementation and evaluation of checklists in surgery: the Normalisation Process Theory and Responsive Regulation Theory. RESULTS We identified four a priori propositions: (1) Checklist protocols that are prospectively tailored to the context are more likely to be used and sustained in practice, (2) Fidelity and sustainability is increased when checklist protocols can be seamlessly integrated into daily professional practice, (3) Routine embedding of checklist protocols in practice is influenced by factors that promote or inhibit clinicians' participation, and (4) Regulation reinforcement mechanisms that are more contextually responsive should lead to greater compliance in using checklist protocols. The final explanatory model suggests that the sustained use of surgical checklists is discipline-specific and is more likely to occur when medical staff are actively engaged and leading the process of implementation. Involving clinicians in tailoring the checklist to better fit their context of practice and giving them the opportunity to reflect and evaluate the implementation intervention enables greater participation and ownership of the process. CONCLUSIONS A major limitation in the surgical checklist literature is the lack of robust descriptions of intervention methods and implementation strategies. Despite this, two consequential findings have emerged through this realist synthesis: First, the sustained use of surgical checklists is discipline-specific and is more successful when physicians are actively engaged and leading implementation. Second, involving clinicians in tailoring the checklist to their context and encouraging them to reflect on and evaluate the implementation process enables greater participation and ownership.
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Affiliation(s)
- Brigid M Gillespie
- NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
| | - Andrea Marshall
- NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia. .,School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia. .,Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, QLD, 4215, Australia.
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