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Turley N, Kogut K, Burian B, Moyal-Smith R, Etheridge J, Sonnay Y, Berry W, Merry A, Hannenberg A, Haynes AB, Dias RD, Hagen K, Molina G, Spruce L, Williams C, Brindle ME. Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol. ANNALS OF SURGERY OPEN 2024; 5:e436. [PMID: 38911631 PMCID: PMC11191993 DOI: 10.1097/as9.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 04/19/2024] [Indexed: 06/25/2024] Open
Abstract
Objectives The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. Background The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. Methods A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Data analysis Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. Setting The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. Anticipated impact We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.
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Affiliation(s)
- Nathan Turley
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Karolina Kogut
- From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Barbara Burian
- NASA, Ames Research Center, Moffett Field, California, USA
| | - Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - James Etheridge
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - William Berry
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alan Merry
- Department of Anaesthesiology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Alexander Hannenberg
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Alex B. Haynes
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas Austin, Austin, TX
| | - Roger D. Dias
- STRATUS Center for Medical Simulation, Department of Emergency Medicine, Harvard Medical School, Boston, MA
| | - Kathryn Hagen
- Department of Anaesthesia and Peri-operative Medicine, Te Toka Tumai|Auckland City Hospital, Te Whātua Ora|Health New Zealand, New Zealand
| | - George Molina
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa Spruce
- Sr. Director, Evidence-based Perioperative Practice at AORN, Denver, CO
| | | | - Mary E. Brindle
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, MA
- Professor of Surgery and Community Health Sciences, Cumming School of Medicine University of Calgary, Pediatric General Surgeon, Alberta Children’s Hospital, Calgary, AB
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Podda M, Di Martino M, Pata F, Nigri G, Pisanu A, Di Saverio S, Pellino G, Ielpo B. Global disparities in surgeons' workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study. Updates Surg 2024:10.1007/s13304-024-01859-7. [PMID: 38684574 DOI: 10.1007/s13304-024-01859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI.
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Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy.
| | - Marcello Di Martino
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Giuseppe Nigri
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Adolfo Pisanu
- Department of Surgical Science, Emergency Surgery Unit, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Benedetto Ielpo
- Hepatobiliary Surgery Unit, Hospital del Mar, University Pompeu Fabra, Barcelona, Spain
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Kirengo TO, Dossajee H, Onyango EM, Rachakonda RH, Schneider B, Sela DP, Hosseinzadeh Z, Nadeem Z, Obonyo NG. Catalysing global surgery: a meta-research study on factors affecting surgical research collaborations with Africa. Syst Rev 2024; 13:89. [PMID: 38500200 PMCID: PMC10946148 DOI: 10.1186/s13643-024-02474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/28/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION In December 2019, the COVID-19 pandemic highlighted the urgent need for rapid collaboration, research, and interventions. International research collaborations foster more significant responses to rapid global changes by enabling international, multicentre research, decreasing biases, and increasing study validity while reducing overall research time and costs. However, there has been low uptake of collaborative research by African institutions and individuals. AIM To systematically review facilitating factors and challenges to collaborative surgical research studies conducted in Africa. METHODOLOGY A meta-research review using PubMed®/MEDLINE and Embase on surgical collaboration in Africa from 1st of January 2011 to 31st of September 2021 in accordance to PRISMA guidelines. Surgical studies by collaborative groups involving African authors and sites were included (55 papers). Data on the study period, geographical regions, and research scope, facilitating factors, and challenges were extracted from the studies retrieved from the search. RESULTS Most of the collaborations in Africa occurred with European institutions (76%). Of the 54 African countries, 63% (34/54) participated in surgical collaborations. The highest collaboration frequency occurred in South Africa (11%) and Nigeria (8%). However, most publications originated from Eastern Africa (43%). Leveraging synergies between high- and low- to middle-income countries (LMICs), well-defined structures, and secure data platforms facilitated collaboration. However, the underrepresentation of collaborators from LMICs was a significant challenge. CONCLUSION Available literature provides critical insights into the facilitating factors and challenges of research collaboration with Africa. However, there is a need for a detailed prospective study to explore the themes highlighted further. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2022 CRD42022352115 .
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Affiliation(s)
- Thomas O Kirengo
- Imara Hospital, Embu, Kenya.
- Kenya Medical Association, Nairobi, Kenya.
| | - Hussein Dossajee
- MP Shah Hospital, Nairobi, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Evans M Onyango
- Ministry of Health, Kajiado County, Kenya
- Kenya Medical Association, Nairobi, Kenya
| | - Reema H Rachakonda
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Bailey Schneider
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Declan P Sela
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zahra Hosseinzadeh
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Zohaib Nadeem
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
| | - Nchafatso G Obonyo
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Critical Care Research Group, Brisbane, Australia
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Kenya Medical Association, Nairobi, Kenya
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Rangasamy K, Jeyaraman M, Selvaraj P, Gopinathan NR, Arumugam D, Dhillon MS. Does the WHO Surgical Safety Checklist Need Modification for Orthopaedic Surgery Practices? A Cross-Sectional Survey Among Indian Orthopaedic Surgeons. Indian J Orthop 2024; 58:278-288. [PMID: 38425830 PMCID: PMC10899545 DOI: 10.1007/s43465-024-01096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024]
Abstract
Background It is well known that the implementation of the WHO surgical safety checklist (SSC) leads to improved operating room team coordination and reduced perioperative complication and mortality rates. Although it is proven to be beneficial worldwide, its awareness and usage need to be evaluated in a diverse country like India. As orthopaedic surgeries involve implants and tourniquet usage, it is important to evaluate the applicability of WHO SSC specifically to orthopaedic surgeries, and whether any modifications are needed. Materials and Methods A web-based cross-sectional survey was conducted among Indian Orthopaedic Surgeons with a pre-defined questionnaire regarding awareness, usage and suggestions to modify the existing WHO SSC (2009) for orthopaedic surgeries. Results 513 responses were included for final analysis. 90.3% of surgeons were aware of the surgical safety checklist; however, only 55.8% used it routinely in their practice. The awareness of SSC availability was 1.85 times more among younger surgeons (< 20 years of experience) than among those with > 20 years of experience. 17% of surgeons thought the usage of SSC was time-consuming and 52.4% of participants felt a need to modify the existing WHO SSC (2009) for orthopaedic surgeries. 34.5% recommended the inclusion of the patient blood group in the "Sign-in" section, 62.77% proposed the inclusion of details about the tourniquet, whereas only 6.63% suggested adding about surgical implant readiness in the "Time-out" section and 72.7% suggested including a check to make sure the tourniquet was deflated, removed and also recording of the total usage time during the "Sign-out" section. Conclusion Despite high (90%) awareness among Indian Orthopaedic surgeons, they have limited usage of the WHO SSC in their practice. Identifying barriers and considering modifications for orthopaedic surgeries, like details about tourniquet usage during the "Time-out" section and a check to ensure it was removed during the "Sign-out" section, will improve patient safety and outcomes. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s43465-024-01096-5.
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Affiliation(s)
- Karthick Rangasamy
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
| | - Preethi Selvaraj
- Department of Community Medicine, Faculty of Medicine-Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
| | - Nirmal Raj Gopinathan
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Mandeep Singh Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Riley MS, Etheridge J, Palter V, Zeh H, Grantcharov T, Kaelberer Z, Sonnay Y, Smink DS, Brindle ME, Molina G. Remote Assessment of Real-World Surgical Safety Checklist Performance Using the OR Black Box: A Multi-Institutional Evaluation. J Am Coll Surg 2024; 238:206-215. [PMID: 37846086 DOI: 10.1097/xcs.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Large-scale evaluation of surgical safety checklist performance has been limited by the need for direct observation. The operating room (OR) Black Box is a multichannel surgical data capture platform that may allow for the holistic evaluation of checklist performance at scale. STUDY DESIGN In this retrospective cohort study, data from 7 North American academic medical centers using the OR Black Box were collected between August 2020 and January 2022. All cases captured during this period were analyzed. Measures of checklist compliance, team engagement, and quality of checklist content review were investigated. RESULTS Data from 7,243 surgical procedures were evaluated. A time-out was performed during most surgical procedures (98.4%, n = 7,127), whereas a debrief was performed during 62.3% (n = 4,510) of procedures. The mean percentage of OR staff who paused and participated during the time-out and debrief was 75.5% (SD 25.1%) and 54.6% (SD 36.4%), respectively. A team introduction (performed 42.6% of the time) was associated with more prompts completed (31.3% vs 18.7%, p < 0.001), a higher engagement score (0.90 vs 0.86, p < 0.001), and a higher percentage of team members who ceased other activities (80.3% vs 72%, p < 0.001) during the time-out. CONCLUSIONS Remote assessment using OR Black Box data provides useful insight into surgical safety checklist performance. Many items included in the time-out and debrief were not routinely discussed. Completion of a team introduction was associated with improved time-out performance. There is potential to use OR Black Box metrics to improve intraoperative process measures.
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Affiliation(s)
- Max S Riley
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
| | - James Etheridge
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
| | - Vanessa Palter
- International Centre for Surgical Safety, St Michael's Hospital, University of Toronto, Toronto, ON, Canada (Palter)
| | - Herbert Zeh
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX (Zeh)
| | - Teodor Grantcharov
- Department of Surgery, Clinical Excellence Research Centre, Stanford University, Stanford, CA (Grantcharov)
| | - Zoey Kaelberer
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
| | - Yves Sonnay
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
| | - Douglas S Smink
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
| | - Mary E Brindle
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
| | - George Molina
- From the Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA (Riley, Etheridge, Kaelberer, Sonnay, Smink, Brindle, Molina)
- Department of Surgery, Brigham and Women's Hospital, Boston, MA (Riley, Etheridge, Kaelberer, Smink, Brindle, Molina)
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Etheridge JC, Moyal-Smith R, Yong TT, Lim SR, Sonnay Y, Lim C, Tan HK, Brindle ME, Havens JM. Transforming Team Performance Through Reimplementation of the Surgical Safety Checklist. JAMA Surg 2024; 159:78-86. [PMID: 37966829 PMCID: PMC10652215 DOI: 10.1001/jamasurg.2023.5400] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/25/2023] [Indexed: 11/16/2023]
Abstract
Importance Patient safety interventions, like the World Health Organization Surgical Safety Checklist, require effective implementation strategies to achieve meaningful results. Institutions with underperforming checklists require evidence-based guidance for reimplementing these practices to maximize their impact on patient safety. Objective To assess the ability of a comprehensive system of safety checklist reimplementation to change behavior, enhance safety culture, and improve outcomes for surgical patients. Design, Setting, and Participants This prospective type 2 hybrid implementation-effectiveness study took place at 2 large academic referral centers in Singapore. All operations performed at either hospital were eligible for observation. Surveys were distributed to all operating room staff. Intervention The study team developed a comprehensive surgical safety checklist reimplementation package based on the Exploration, Preparation, Implementation, Sustainment framework. Best practices from implementation science and human factors engineering were combined to redesign the checklist. The revised instrument was reimplemented in November 2021. Main Outcomes and Measures Implementation outcomes included penetration and fidelity. The primary effectiveness outcome was team performance, assessed by trained observers using the Oxford Non-Technical Skills (NOTECH) system before and after reimplementation. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to assess safety culture and observers tracked device-related interruptions (DRIs). Patient safety events, near-miss events, 30-day mortality, and serious complications were tracked for exploratory analyses. Results Observers captured 252 cases (161 baseline and 91 end point). Penetration of the checklist was excellent at both time points, but there were significant improvements in all measures of fidelity after reimplementation. Mean NOTECHS scores increased from 37.1 to 42.4 points (4.3 point adjusted increase; 95% CI, 2.9-5.7; P < .001). DRIs decreased by 86.5% (95% CI, -22.1% to -97.8%; P = .03). Significant improvements were noted in 9 of 12 composite areas on culture of safety surveys. Exploratory analyses suggested reductions in patient safety events, mortality, and serious complications. Conclusions and Relevance Comprehensive reimplementation of an established checklist intervention can meaningfully improve team behavior, safety culture, patient safety, and patient outcomes. Future efforts will expand the reach of this system by testing a structured guidebook coupled with light-touch implementation guidance in a variety of settings.
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Affiliation(s)
- James C. Etheridge
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tze Tein Yong
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Shu Rong Lim
- Health Services Research Unit, Singapore General Hospital, Singapore
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christine Lim
- International Safety and Policy, Johnson and Johnson Medical Devices, New Brunswick, New Jersey
| | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
| | - Mary E. Brindle
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joaquim M. Havens
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Ranganathan P, Dare A, Harrison EM, Kingham TP, Mutebi M, Parham G, Sullivan R, Pramesh CS. Inequities in global cancer surgery: Challenges and solutions. J Surg Oncol 2024; 129:150-158. [PMID: 38073139 PMCID: PMC11186466 DOI: 10.1002/jso.27551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
The disparity in access to and quality of surgical cancer care between high and low resource settings impacts immediate and long-term oncological outcomes. With cancer incidence and mortality set to increase rapidly in the next few decades, we examine the factors leading to inequities in global cancer surgery, and look at potential solutions to overcome these challenges.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anna Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Groesbeck Parham
- Department of Obstetrics and Gynecology, Charles Drew University of Science and Medicine, Los Angeles, California, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Richard Sullivan
- School of Cancer Sciences, Centre for Cancer Society and Public Health, Institute of Cancer Policy, King’s College London, London, UK
| | - C. S. Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Rohatgi N. JMIR Perioperative Medicine: A Global Journal for Publishing Interdisciplinary Innovations, Research, and Perspectives. JMIR Perioper Med 2023; 6:e54344. [PMID: 37988142 DOI: 10.2196/54344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
JMIR Perioperative Medicine supports the dissemination of technological and data science-driven innovative research conducted by interdisciplinary teams in perioperative medicine. We invite contributions on a broad range of topics from clinicians, scientists, and allied health professionals from across the globe.
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Affiliation(s)
- Nidhi Rohatgi
- Stanford University School of Medicine, Stanford, CA, United States
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Bete DY, Sibhatu MK, Godebo MG, Abdulahi IJ, Liyew TW, Minas SM, Bryce E, Ashengo TA, Varallo J. Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project. BMJ Open Qual 2023; 12:e002406. [PMID: 37940334 PMCID: PMC10632882 DOI: 10.1136/bmjoq-2023-002406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND In 2009, the WHO introduced the surgical safety checklist (SSC) as one of the interventions for improving patient safety. The systematic use of structured checklists during surgery has been shown to reduce perioperative morbidity and mortality. However, SSC utilisation has been challenging in low-income and middle-income countries, including Ethiopia. Jhpiego Ethiopia implemented a quality improvement project (QIP) aimed to increase SSC utilisation. METHODOLOGY A model for improvement was used to design and implement a collaborative QIP to improve SSC utilisation at 23 public health facilities (13 primary health care facilities, 4 general hospitals and 6 tertiary hospitals) in Ethiopia from October 2020 to September 2021. SSC utilisation was defined as when a patient chart had SSC attached and each part of the checklist was completed. Training of surgical staff on safe surgery packages, monthly clinical mentorship and cluster-based learning platforms were implemented during the study period. We analysed bimonthly chart audit reports from each facility to assess the proportion of surgeries where the SSC was used. Shewhart charts were used to conduct a time-series analysis. Additionally, the Z-test for two sample proportions was used to determine if there is a statistically significant change from the baseline measure with a p<0.05. RESULT In the postintervention period, the overall SSC utilisation improved by 39.9 absolute percentage points to 90.3% (p<0.0001) compared with the baseline value of 50.4% early in 2020. A time-series analysis using Shewhart charts showed a shift in the mean performance and signals of special cause variation. The largest improvement was observed in primary health care facilities in which the SSC utilisation improved from 50.8% to 97.9% (p<0.0001). CONCLUSION This study demonstrates that onsite clinical capacity building, mentorship and collaborative cluster-based learning platforms can improve SSC utilisation across all levels of facilities performing surgery.
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Affiliation(s)
| | | | | | | | | | | | - Emily Bryce
- Jhpiego Corporation, Baltimore, Maryland, USA
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Lim PJH, Chen L, Siow S, Lim SH. Facilitators and barriers to the implementation of surgical safety checklist: an integrative review. Int J Qual Health Care 2023; 35:mzad086. [PMID: 37847116 DOI: 10.1093/intqhc/mzad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
Surgical procedures pose an immense risk to patients, which can lead to various complications and adverse events. In order to safeguard patients' safety, the World Health Organization initiated the implementation of the Surgical Safety Checklist (SSC) in operating theatres worldwide. The aim of this integrative review was to summarize and evaluate the use and implementation of SSC, focusing on facilitators and barriers at the individual, professional, and organizational levels. This review followed closely the integrative review method by Whittemore and Knafl. An English literature search was conducted across three electronic databases (PubMed, CINAHL, and EMBASE) and other hand search references. Keywords search included: 'acute care', 'surgical', 'adult patients', 'pre-operative', 'intra-operative', and 'post-operative'. A total of 816 articles were screened by two reviewers independently and all articles that met the pre-specified inclusion criteria were retained. Data extracted from the articles were categorized, compared, and further analysed. A total of 34 articles were included with the majority being observational studies in developed and European countries. Checklists had been adopted in various surgical specialities. Findings indicated that safety checklists improved team cohesion and communication, resulting in enhanced patient safety. This resulted in high compliance rates as healthcare workers expressed the benefits of SSC to facilitate safety within operating theatres. Barriers included manpower limitations, hierarchical culture, lack of staff involvement and training, staff resistance, and appropriateness of checklist. Common facilitators and barriers at individual, professional, and organizational levels have been identified. Staff training and education, conducive workplace culture, timely audits, and appropriate checklist adaptations are crucial components for a successful implementation of the SSC. Methods have also been introduced to counter barriers of SSC.
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Affiliation(s)
- Petrina Jia Hui Lim
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Lin Chen
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Serene Siow
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Siew Hoon Lim
- Nurse Clinician, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
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Nofal MR, Starr N, Negussie Mammo T, Trickey AW, Gebeyehu N, Koritsanszky L, Alemu M, Tara M, Alemu SB, Evans F, Kahsay S, Weiser TG. Addressing knowledge gaps in Surgical Safety Checklist use: statistical process control analysis of a surgical quality improvement programme in Ethiopia. Br J Surg 2023; 110:1511-1517. [PMID: 37551706 PMCID: PMC10564401 DOI: 10.1093/bjs/znad234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The WHO Surgical Safety Checklist reduces morbidity and mortality after surgery, but uptake remains challenging. In particular, low-income countries have been found to have lower rates of checklist use compared with high-income countries. The aim of this study was to determine the impact of educational workshops on Surgical Safety Checklist use implemented as part of a quality improvement initiative in five hospitals in Ethiopia that had variable experience with the Surgical Safety Checklist. METHODS From April 2019 to September 2020, each hospital implemented a 6-month surgical quality improvement programme, which included a Surgical Safety Checklist workshop. Statistical process control methodology was used to understand the variation in Surgical Safety Checklist compliance before and after workshops and a time-series analysis was performed using population-averaged generalized estimating equation Poisson regression. Checklist compliance was defined as correctly completing a sign in, timeout, and sign out. Incidence rate ratios of correct checklist use pre- and post-intervention were calculated and the change in mean weekly compliance was predicted. RESULTS Checklist compliance data were obtained from 2767 operations (1940 (70 per cent) pre-intervention and 827 (30 per cent) post-intervention). Mean weekly checklist compliance improved from 27.3 to 41.2 per cent (mean difference 13.9 per cent, P = 0.001; incidence rate ratio 1.51, P = 0.001). Hospitals with higher checklist compliance at baseline had the greatest overall improvements in compliance, more than 50 per cent over pre-intervention, while low-performing hospitals showed no improvement. CONCLUSION Surgical Safety Checklist workshops improved checklist compliance in hospitals with some experience with its use. Workshops had little effect in hospitals unfamiliar with the Surgical Safety Checklist, emphasizing the importance of multifactorial interventions and culture-change approaches. In receptive facilities, short workshops can accelerate behaviour change.
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Affiliation(s)
- Maia R Nofal
- Department of Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Fogarty International Center, Global Health Equity Scholars Program (D43TW010540), Washington, D.C., USA
- Lifebox Foundation, Addis Ababa, Ethiopia
| | - Nichole Starr
- Fogarty International Center, Global Health Equity Scholars Program (D43TW010540), Washington, D.C., USA
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Tihitena Negussie Mammo
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amber W Trickey
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Natnael Gebeyehu
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Luca Koritsanszky
- Department of Obstetrics and Gynecology, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mechale Alemu
- Department of Surgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia
| | - Mansi Tara
- Lifebox Foundation, Addis Ababa, Ethiopia
| | | | - Faye Evans
- Lifebox Foundation, Addis Ababa, Ethiopia
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Thomas G Weiser
- Department of Surgery, Stanford University, Palo Alto, California, USA
- Lifebox Foundation, Addis Ababa, Ethiopia
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Henry JC, Wong LY, Reyes AM, Jin JZ, Ferguson MK, Yip CH, Hill A. Achieving global surgical excellence: an evidence-based framework to guide surgical quality improvement programs in low and middle income countries. FRONTIERS IN HEALTH SERVICES 2023; 3:1096144. [PMID: 37609518 PMCID: PMC10441221 DOI: 10.3389/frhs.2023.1096144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
Objectives There is a lack of evidence-based guidelines for enhancing global surgical care delivery. We propose a set of recommendations to serve as a framework to guide surgical quality improvement and scale-up initiatives in low and middle income countries (LMICs). Methods From January-December 2019, we reviewed the available literature and their application toward LMIC settings. The first initiative was the establishment of Best Practices Recommendations intended to summarize best-level evidence around quality improvement processes that have shown to decrease morbidity and mortality in LMICs. The GRADE level of evidence and strength of the recommendation were assigned in accordance with the WHO handbook for guidelines development. The second initiative was the scale-up of principles and practices by establishing international expert consensus on the optimal organization of surgical services in LMICs using a modified Delphi methodology. Results Recommendations for three topic areas were established: reducing surgical site infections, improving quality of trauma systems, and interventions to reduce maternal and perinatal mortality. 27 studies were included in a quantitative synthesis and meta-analysis for interventions reducing surgical site infections, 27 studies for interventions improving the quality of trauma systems, and 14 studies for interventions reducing maternal and perinatal mortality. Using Delphi methodology, an international expert panel established consensus that district hospitals should place the highest priority on developing surgical services for low complexity, high volume conditions. At the national level, emergency and essential surgical care should be integrated within national Universal Health Coverage frameworks. Conclusions This project fills a critical cap in the rapidly developing field of global surgery: gathering evidence-based, practical, and cost-effective solutions that will serve as a guide for the efficient planning and allocation of resources necessary to promote quality and safe essential surgical services in LMICs.
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Affiliation(s)
- Jaymie Claire Henry
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States
| | - Ana M. Reyes
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
| | - James Z. Jin
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Mark K. Ferguson
- Department of Cardiothoracic Surgery, University of Chicago, Chicago, IL, United States
| | - Cheng Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Andrew Hill
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
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Surgical Safety Checklist. SCIENTIA MEDICA 2023. [DOI: 10.15448/1980-6108.2023.1.43223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
Objectives: the surgical safety checklist (SSC) is a document that is intended to increase patient safety in the operating theater by eliminating avoidable errors. The original document has been published in English by the WHO which recommends its obligatory use. The document’s name is often distorted when translated into European languages, for instance into the “surgical control list”. This article aims to assess the consequences of the distortion of the originally intended meaning for the completion of SSC in the operating theater. Methods: we compared the exactness of the meaning of translation in 29 European languages based on Google translator. Particular attention was paid to the presence of essential words such as “checklist” and “safety” in the translation.Results: we found that in 15 out of the 29 languages, the translation of these two words was incorrect, particularly in Slavic languages. The most often mistranslation was the “control card” or “control list”, which was a misnomer.Conclusions: the translation of the SSC name into native languages is inadequate in about one-half of the cases, which may jeopardize its proper use by team members of the operating theater, and thus the patient perioperative safety.
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McMillan MW. Surgical time-out procedures: a single centre audit of standardised surgical communications. J Small Anim Pract 2023; 64:69-77. [PMID: 36418012 DOI: 10.1111/jsap.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/01/2022] [Accepted: 10/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess deviation from a standardised structure of surgical time-out procedures in a multidisciplinary referral hospital. MATERIALS AND METHODS An observational process audit was performed on a convenience sample of surgical cases. A fly-on-the-wall observer assessed surgical time-out procedures in real-time. Pre-induction and recovery checklists were not assessed. Observations were recorded on standardised reporting forms including a checklist and free text. Analysis was performed using a validated framework of four conceptual domains: the purpose, occasion, audience and content of the communication. Field notes were taken to allow retrospective verification of assessments. Observations were compared to a predefined standardised surgical time-out procedure structure. RESULTS Twenty surgical time-out procedures were observed from a mixture of procedure types. Although all were performed at the specified time and place, only eight (40%) were considered to have fully achieved their purpose with potentially important sections of the communication being omitted in the others. Individuals were not ready for communication to begin in 14 (70%) and distractions occurred in 11 surgical time-out procedures (55%). In seven surgical time-out procedures (35%) superfluous information was communicated. CLINICAL SIGNIFICANCE In a busy operating theatre environment, surgical time-out procedures may not be performed as they are intended. Communication during surgical time-out procedures should be audited to highlight opportunities for improvement.
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Affiliation(s)
- M W McMillan
- The Ralph Veterinary Referral Centre, Fourth Avenue, Marlow, Buckinghamshire, UK
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15
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Pilkington M, Nelson G, Cauley C, Holder K, Ljungqvist O, Molina G, Oodit R, Brindle ME. Development of an Enhanced Recovery After Surgery Surgical Safety Checklist Through a Modified Delphi Process. JAMA Netw Open 2023; 6:e2248460. [PMID: 36753283 DOI: 10.1001/jamanetworkopen.2022.48460] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
IMPORTANCE Enhanced Recovery After Surgery (ERAS) guidelines and the World Health Organization Surgical Safety Checklist (SSC) are 2 well-established tools for optimizing patient outcomes perioperatively. OBJECTIVE To integrate the 2 tools to facilitate key perioperative decision-making. EVIDENCE REVIEW Snowball sampling recruited international ERAS users from multiple clinical specialties. A 3-round modified Delphi consensus model was used to evaluate 27 colorectal or gynecologic oncology ERAS recommendations for appropriateness to include in an ERAS SSC. Items attaining potential consensus (65%-69% agreement) or consensus (≥70% agreement) were used to develop ERAS-specific SSC prompts. These proposed prompts were evaluated in a second round by the panelists with regard to inclusion, modification, or exclusion. A final round of interactive discussion using quantitative consensus and qualitative comments was used to produce an ERAS-specific SSC. The panel of ERAS experts included surgeons, anesthesiologists, and nurses within diverse practice settings from 19 countries. Final analysis was conducted in May 2022. FINDINGS Round 1 was completed by 105 experts from 18 countries. Eleven ERAS components met criteria for development into an SSC prompt. Round 2 was completed by 88 experts. There was universal consensus (≥70% agreement) to include all 37 proposed prompts within the 3-part ERAS-specific SSC (used prior to induction of anesthesia, skin incision, and leaving the operating theater). A third round of qualitative comment review and expert discussion was used to produce a final ERAS-specific SSC that expands on the current WHO SSC to include discussion of analgesia strategies, nausea prevention, appropriate fasting, fluid management, anesthetic protocols, appropriate skin preparation, deep vein thrombosis prophylaxis, hypothermia prevention, use of foley catheters, and surgical access. The final products of this work included an ERAS-specific SSC ready for implementation and a set of recommendations to integrate ERAS elements into existing SSCs. CONCLUSIONS AND RELEVANCE The SSC could be modified to align with ERAS recommendations for patients undergoing major surgery within an ERAS protocol. The stakeholder- and expert-generated ERAS SSC could be adopted directly, or the recommendations for modification could be applied to an existing institutional SSC to facilitate implementation.
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Affiliation(s)
- Mercedes Pilkington
- Formerly at Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Surgery, Division of Pediatric Surgery, University of Toronto, Toronto, Canada
- Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Canada
| | - Christy Cauley
- Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA
| | | | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - George Molina
- Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA
| | - Ravi Oodit
- Global Surgery, University of Cape Town, Cape Town, South Africa
| | - Mary E Brindle
- Ariadne Labs, Harvard School of Public Health, Harvard University, Boston, MA
- Division of Pediatric Surgery, University of Calgary, Calgary, Canada
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Davidow EB, Owen T, Rishniw M. Knowledge and attitudes towards surgical safety checklists: a survey of veterinary professionals. J Am Vet Med Assoc 2023; 261:1-9. [PMID: 36626287 DOI: 10.2460/javma.22.09.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the knowledge and use of safe surgical checklists (SSCs) and surgical safety practices (SSPs) in different sectors of veterinary medicine. SAMPLE 1,235 small animal veterinarians who perform surgery in the United States and Canada. PROCEDURES An online survey was distributed to veterinarians through social media platforms, specialty listservs, and the Veterinary Information Network. Respondents provided information regarding their role, practice type, as well as knowledge, attitudes, and use of SSCs. Respondents also provided information about performance of SSPs including team introductions; confirmation of antibiotic prophylaxis, patient identity, procedure to be performed; and confirmation of completion of all procedures. RESULTS A greater proportion of Diplomates of the American College of Veterinary Surgeons (49/77 [64%]) reported using an SSC than other veterinarians (257/1157 [22%]; P < .0001). A greater proportion of veterinarians working in university and multispecialty hospitals reported using a SSC (71/142 [50%]) than in other practice settings (235/1092 [22%]; P < .0001). Use of a SSC correlated with consistent performance of surgical safety practices listed above (P < .0001). Primary care veterinarians commonly reported not using a SSC because they did not know about them (359/590 [61%]). Of the 507 respondents who had ever used a SSC, 333 (66%) believed the checklist had prevented an error or complication. CLINICAL RELEVANCE Despite widespread knowledge and adoption of SSC use in human medicine, knowledge and use of SSCs is lacking in primary care veterinary practice. Checklist use has previously been shown to decrease post operative complications and in this study was correlated with increased use of SSPs that decreased complications.
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Affiliation(s)
- Elizabeth B Davidow
- 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
| | - Tina Owen
- 1Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA
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Extension of patient safety initiatives to perioperative care. Curr Opin Anaesthesiol 2022; 35:717-722. [PMID: 36302210 DOI: 10.1097/aco.0000000000001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
PURPOSE OF REVIEW Patient safety has significantly improved during the intraoperative period thanks to the anesthesiologists, surgeons, and nurses. Nowadays, it is within the perioperative period where most of the preventable harm happened to the surgical patient. We aim to highlight the main issues and efforts to improve perioperative patient safety focusing and the relation to intraoperative safety strategies. RECENT FINDINGS There is ongoing research on perioperative safety strategies aiming to initiate multidisciplinary interventions on early stages of the perioperative period as well as an increasing focus on preventing harm from postoperative complications. SUMMARY Any patient safety strategy to be implemented needs to be framed beyond the operating room and include in the intervention the whole perioperative period.
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Daly Guris RJ, Lane-Fall MB. Checklists and cognitive aids: underutilized and under-researched tools to promote patient safety and optimize clinician performance. Curr Opin Anaesthesiol 2022; 35:723-727. [PMID: 36302211 DOI: 10.1097/aco.0000000000001193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE OF REVIEW Checklists and other cognitive aids serve multiple purposes in the peri-operative setting and have become nearly ubiquitous in healthcare. This review lays out the evidence for their use, shortcomings and pitfalls to be aware of, and how technology and innovation may improve checklist and cognitive aid relevance and usability. RECENT FINDINGS It has been difficult to show a direct link between the use of checklists alone and patient outcomes, but simulation studies have repeatedly demonstrated an association between checklist or cognitive aid use and improved performance. When implemented as part of a bundle of interventions, checklists likely have a positive impact, but the benefit of checklists and other cognitive aids may be both context- and user dependent. Advances in technology and automation demonstrate promise, but usability, design, and implementation research in this area are necessary to maximize effectiveness. SUMMARY Cognitive aids like checklists are powerful tools in the perioperative and critical care setting. Further research and innovation may elevate what is possible by improving the usability and relevance of these tools, possibly translating into improved patient outcomes.
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Affiliation(s)
- Rodrigo J Daly Guris
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania
- Children's Hospital of Philadelphia
- Center for Leadership and Innovation in Medical Education
- Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania
- Penn Center for Perioperative Outcomes Research and Transformation
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Varallo JE, Ruto D, Patted A. Surgical Burden of Disease in Women. Obstet Gynecol Clin North Am 2022; 49:795-808. [DOI: 10.1016/j.ogc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Paterson A, Maswime S, Hardy A, Pearse RM, Biccard BM. Postoperative outcomes associated with surgical care for women in Africa: an international risk-adjusted analysis of prospective observational cohorts. BJA OPEN 2022; 4:100100. [PMID: 37588786 PMCID: PMC10430807 DOI: 10.1016/j.bjao.2022.100100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 08/18/2023]
Abstract
Background Improving women's health is a critical component of the sustainable development goals. Although obstetric outcomes in Africa have received significant focus, non-obstetric surgical outcomes for women in Africa remain under-examined. Methods We did a secondary analysis of the African Surgical Outcomes Study (ASOS) and International Surgical Outcomes Study (ISOS), two 7-day prospective observational cohort studies of outcomes after adult inpatient surgery. This sub-study focuses specifically on the analysis of the female, elective, non-obstetric, non-gynaecological surgical data collected during these two large multicentre studies. The African data from both cohorts are compared with international (non-African) outcomes in a risk-adjusted logistic regression analysis using a generalised linear mixed-effects model. The primary outcome was severe postoperative complications including in-hospital mortality in Africa compared with non-African outcomes. Results A total of 1698 African participants and 18 449 international participants met the inclusion criteria. The African cohort were younger than the international cohort with a lower preoperative risk profile. Severe complications occurred in 48 (2.9%) of 1671, and 431 (2.3%) of 18 449 patients in the African and international cohorts, respectively, with in-hospital mortality after severe complications of 23/48 (47.9%) in Africa and 78/431 (18.1%) internationally. Women in Africa had an adjusted odds ratio of 2.06 (95% confidence interval, 1.17-3.62; P=0.012) of developing a severe postoperative complication after elective non-obstetric, non-gynaecological surgery, compared with the international cohort. Conclusions Women in Africa have double the risk adjusted odds of severe postoperative complications (including in-hospital mortality) after elective non-obstetric, non-gynaecological surgery compared with the international incidence.
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Affiliation(s)
- Amy Paterson
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
- Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Salome Maswime
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Anneli Hardy
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Rupert M. Pearse
- Critical Care and Perioperative Medicine Research Group, Queen Mary University of London, London, UK
| | - Bruce M. Biccard
- Global Surgery Division, Department of Surgery, University of Cape Town, Cape Town, South Africa
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
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Shah NT, Plough A. Why health care needs designers. J Hosp Med 2022. [PMID: 36380635 DOI: 10.1002/jhm.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Neel T Shah
- Maven Clinic, New York, New York, USA
- Harvard Medical School, Boston, Massachussetts, USA
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Identifying interventions to reduce peripartum haemorrhage associated with caesarean delivery in Africa: A Delphi consensus study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000455. [PMID: 36962699 PMCID: PMC10021587 DOI: 10.1371/journal.pgph.0000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/10/2022] [Indexed: 06/18/2023]
Abstract
Women in Africa are fifty times more likely than in high-income settings to die following caesarean delivery, and peripartum haemorrhage is most strongly associated with mortality. We aimed to establish consensus on which interventions are considered most feasible to implement and most effective at reducing haemorrhage associated with caesarean delivery across Africa. We conducted a Delphi consensus study, including obstetric and anaesthesia providers from across Africa. In round one the expert group proposed key interventions for consideration. In rounds two and three the interventions were ranked on a 9-point Likert scale for effectiveness and feasibility. Round four was an online discussion to establish consensus on effectiveness and feasibility of interventions for which this had not been reached in round three. Twenty-eight interventions were considered both highly effective and feasible in Africa. Interventions covered a range of fields, categorised into direct- or indirect interventions. Direct interventions included: risk assessment and screening; checklists and protocols; monitoring and surveillance; availability of resources; ability to perform technical skills. Indirect interventions included: community and maternal education; contraception and family planning; minimum training standards; referral patterns and delays; advocacy to key stakeholders; simulation and team training; and 24-hour access to safe emergency caesarean delivery. Interventions considered both effective and feasible in reducing peripartum haemorrhage associated with caesarean delivery in Africa were identified. A multi-layered implementation strategy, including immediately developing a perioperative caesarean delivery bundle of care, in addition to longer-term public health measures may have a profound impact on maternal mortality in Africa.
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Fridrich A, Imhof A, Staender S, Brenni M, Schwappach D. A Quality Improvement Initiative Using Peer Audit and Feedback to Improve Compliance with the Surgical Safety Checklist. Int J Qual Health Care 2022; 34:6622008. [PMID: 35770658 PMCID: PMC9290878 DOI: 10.1093/intqhc/mzac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Surgical Safety Checklist (SSC) published by the WHO in 2009 is used as standard in surgery worldwide to reduce perioperative patient mortality. However, compliance with the SSC and quality of its application are often not satisfactory. Internal audits and feedbacks seem promising for improving SSC application. Objective The purpose of this study is to investigate whether an intervention consisting of peer observation and immediate peer feedback can be implemented with high fidelity and acceptance. Method Data were obtained from a national pilot programme that was initiated in Switzerland in 2018 to measure and improve compliance with the SSC using peer audit and feedback. A total of 11 hospitals with 14 sites implemented the full intervention. Each hospital formed an interprofessional project team that should perform at least 30 observations with feedback on SSC application documented in an observation tool developed specifically for this programme. Since the SSCs of the study hospitals differ greatly regarding checklist items, for each of the three SSC sections standard items were defined: four at Sign In, five at Team Time Out and two at Sign Out. Frequency analyses were performed for initiation characteristics, SSC application at item level, feedback characteristics and programme evaluation. Results The 11 hospitals documented 715 valid observations, and feedback on SSC application was provided for 79% of the observations. In 61%, all team members stopped their work for the SSC application, and in 71%, the items were read off from the checklist (instead of recalled from memory). On average, 86% of the standard items were read out by the checklist coordinator, whilst the two items at Sign Out were read out only in 60% and 74%. Additional visual checks with another source (e.g. patient wristband) took place in only 41%, and verbal confirmation of the items (by someone else other than the checklist coordinator) was obtained on an average of 76% across all three checklist sections. The surgical teams reacted positively in 64% to the peer feedback. Conclusion Both implementation fidelity and acceptability of the intervention were high—the present intervention seems suitable for regular monitoring of the quality of SSC application with internal resources. Peer observation facilitated identifying weaknesses regarding the SSC process and application at item level. Across all hospitals, the Sign Out section in general, visual control for item checks and lack of work interruption of all team members during SSC application showed up as the main areas of improvement.
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Affiliation(s)
| | - Anita Imhof
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - Sven Staender
- Department of Anaesthesia & Intensive Care Medicine, Regional Hospital Maennedorf, Maennedorf, Switzerland
| | - Mirko Brenni
- Institute of Anesthesiology, Intensive Care Medicine, Emergency and Rescue Medicine, See-Spital, Horgen, Switzerland
| | - David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Armstrong BA, Dutescu IA, Nemoy L, Bhavsar E, Carter DN, Ng KD, Boet S, Trbovich P, Palter V. Effect of the surgical safety checklist on provider and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:463-478. [PMID: 35393355 DOI: 10.1136/bmjqs-2021-014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships. METHODS A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects. RESULTS 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC's influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators. CONCLUSION There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
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Affiliation(s)
- Bonnie A Armstrong
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilinca A Dutescu
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Lori Nemoy
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ekta Bhavsar
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana N Carter
- General Surgery, Milton District Hospital, Milton, Ontario, Canada
| | | | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Trbovich
- Surgery, North York General Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Vanessa Palter
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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25
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Gawria L, Rosenthal R, van Goor H, Dell-Kuster S. Classification of intraoperative adverse events in visceral surgery. Surgery 2022; 171:1570-1579. [PMID: 35177252 DOI: 10.1016/j.surg.2021.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intraoperative adverse events (iAEs) are frequent in visceral surgery, but severity and related postoperative outcome are poorly investigated. A novel classification of intraoperative adverse events, ClassIntra, includes surgical and anesthesiologic intraoperative adverse events using 5 severity grades and showed a high criterion and construct validity across all surgical disciplines. ClassIntra was studied for reproducibility in a prespecified group of patients undergoing visceral surgery. METHODS iAEs were recorded in all patients enrolled in the ClassIntra validation study (NCT03009929). Postoperative complications were assessed daily according to the Clavien-Dindo classification. Results of the visceral group were compared with those of the non-visceral group and the full cohort. The risk-adjusted association between most severe intra and postoperative complications was investigated in a multivariable proportional odds model. Second, risk-adjusted association between ClassIntra grade and Comprehensive Complication Index, and postoperative length of stay was investigated. RESULTS In total, 1,270 out of 2,520 patients (50%) underwent visceral surgery. Compared with the nonvisceral group and full cohort, more intraoperative (337/1270 [27%] vs 273/1250 [22%] vs 610/2520 [24%] patients) and postoperative complications (457/1270 [36%] vs 381/1250 [30%] vs 838/2520 [33%] patients) occurred. The risk for a more severe postoperative complication increased with each ClassIntra grade (odds ratio [95% confidence interval] I vs 0 1.10 [0.73 to 1.66], II vs 0 1.69 [1.10 to 2.60], III vs 0 2.31 [1.21 to 4.41], IV vs 0 2.35 [0.69 to 8.06]). Accordingly, CCI and postoperative length of stay increased with each ClassIntra grade in the visceral group, comparable with the nonvisceral and full cohort. CONCLUSION Consistent results for the association of intraoperative adverse events and patient outcomes render ClassIntra a valuable instrument in visceral surgery.
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Affiliation(s)
- Larsa Gawria
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Switzerland.
| | | | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Salome Dell-Kuster
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Switzerland; Clinic for Anaesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland; Department of Clinical Research, University of Basel, Switzerland
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26
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Oodit R, Biccard BM, Panieri E, Alvarez AO, Sioson MRS, Maswime S, Thomas V, Kluyts HL, Peden CJ, de Boer HD, Brindle M, Francis NK, Nelson G, Gustafsson UO, Ljungqvist O. Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation. World J Surg 2022; 46:1826-1843. [PMID: 35641574 PMCID: PMC9154207 DOI: 10.1007/s00268-022-06587-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 12/24/2022]
Abstract
Background This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low–middle-income countries (LMIC’s) for elective abdominal and gynecologic care. Methods The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC’s. The group consisted of seven members from the ERAS® Society and eight members from LMIC’s. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592–695, Nelson et al in Int J Gynecol Cancer 29(4):651–668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC’s and LMIC’s were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC’s. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC’s and determined through discussions and consensus. Results In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline. Conclusions These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC’s.
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Affiliation(s)
- Ravi Oodit
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Bruce M Biccard
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Eugenio Panieri
- Division of General Surgery, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Adrian O Alvarez
- Anesthesia Department, Hospital Italiano de Buenos Aires, Teniente General Juan Domingo Peron, 4190, C1199ABB, Beunos Aires, Argentina
| | - Marianna R S Sioson
- Head Section of Medical Nutrition, Department of Medicine and ERAS Team, The Medical City, Ortigas Avenue, Manila, Metro Manila, Philippines
| | - Salome Maswime
- Division of Global Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, Western Cape, South Africa
| | - Viju Thomas
- Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Francie Van Zyl Drive, Parow, Cape Town, Western Cape, South Africa
| | - Hyla-Louise Kluyts
- Department of Anaesthesiology, Sefako Makgatho Health Sciences University, Medunsa, Molotlegi Street, P.O. Box 60, Ga-Rankuwa, Pretoria, 0204, Gauteng, South Africa
| | - Carol J Peden
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Hans D de Boer
- Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Van Swietenplein 1, 9728 NT, Groningen, The Netherlands
| | - Mary Brindle
- Cumming School of Medicine, University of Calgary, London, Canada.,Alberta Children's Hospital, Calgary, Canada.,Safe Systems, Ariadne Labs, Stockholm, USA.,EQuIS Research Platform, Orebro, Canada
| | - Nader K Francis
- Division of Surgery and Interventional Science- UCL, Gower Street, London, WC1E 6BT, UK
| | - Gregg Nelson
- Department of Obstetrics & Gynecology, University of Calgary, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Ulf O Gustafsson
- Department of Clinical Sciences, Division of Surgery, Danderyd Hospital, Karolinska Institutet, Entrevägen 2, 19257, Stockholm, Danderyd, Sweden
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, 701 85, Örebro, Sweden.
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Albsoul R, Alshyyab MA, Al Odat BA, Al Dwekat NB, Al-masri BE, Alkubaisi FA, Flefil SA, Al-Khawaldeh MH, Sa'ed RA, Abu Ajamieh MW, Fitzgerald G. Surgical team perceptions of the surgical safety checklist in a tertiary hospital in Jordan: a descriptive qualitative study. TQM JOURNAL 2022. [DOI: 10.1108/tqm-02-2022-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan.Design/methodology/approachThis was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data.FindingsThree main themes emerged from data analysis namely compliance with the surgical safety checklist, the impact of surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus to accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist, and help enhance awareness about its importance.Originality/valueWhile steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges for consistent, complete and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.
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Fridrich A, Imhof A, Schwappach DLB. Compliance with the surgical safety checklist in Switzerland: an observational multicenter study based on self-reported data. Patient Saf Surg 2022; 16:17. [PMID: 35614454 PMCID: PMC9131675 DOI: 10.1186/s13037-022-00327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Since publication of the surgical safety checklist by the WHO in 2009, it has been introduced in many hospitals. However, frequency and quality of surgical safety checklist use is often low probably limiting the effectiveness of the checklist in preventing patient harm. The focus of this study was to examine the current state of compliance with the surgical safety checklist in Switzerland and to evaluate how the data relates to international comparative data. Methods Between November 2020 and March 2021 twelve hospitals with 15 sites collected for at least 200 surgical interventions each whether the three sections of the surgical safety checklist (Sign In, Team Time Out, Sign Out) have been applied. This data collection was part of a large quality improvement project focusing on measuring and improving compliance with the surgical safety checklist via peer observation and feedback. Descriptive statistics were used to analyze the data; chi-square tests were used to compare sub-samples. Results The hospitals collected valid compliance data for 8622 surgical interventions. Mean compliance rate was 91% when distinguishing between the two categories applied (including partially applied) and not applied. In line with previous research, Sign In (93%) and Team Time Out (94%) sections have been applied more frequently than Sign Out (86%). All three surgical safety checklist sections have been applied in 79% of the surgical interventions, no sections in 1%. Conclusions The results of this study indicate that the overall application of the surgical safety checklist in Switzerland can be considered high, although the completeness, especially of the Sign Out section, could be improved. At present, it seems difficult to compare compliance rates from different studies as measurement methods and definitions of compliance vary widely. A systematization and homogenization of the methodology within, but also beyond, national borders is desirable for the future.
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Affiliation(s)
- Annemarie Fridrich
- Swiss Patient Safety Foundation, Asylstrasse 77, 8032, Zurich, Switzerland.
| | - Anita Imhof
- Swiss Patient Safety Foundation, Asylstrasse 77, 8032, Zurich, Switzerland
| | - David L B Schwappach
- Swiss Patient Safety Foundation, Asylstrasse 77, 8032, Zurich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
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Domingo L, Sala M, Miret C, Montero-Moraga JM, Lasso de la Vega C, Comas M, Castells X. Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital. J Healthc Qual Res 2022; 37:52-59. [PMID: 34344625 DOI: 10.1016/j.jhqr.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.
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Affiliation(s)
- L Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain.
| | - M Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - C Miret
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - J M Montero-Moraga
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - C Lasso de la Vega
- Methodology, Quality and Nursing Research Department, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
| | - M Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
| | - X Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003 Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029 Madrid, Spain
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OUP accepted manuscript. Br J Surg 2022; 109:399-400. [DOI: 10.1093/bjs/znac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/12/2022]
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Assessing, grading, and reporting intraoperative adverse events during and after surgery. Br J Surg 2021; 109:301-302. [PMID: 34931669 DOI: 10.1093/bjs/znab438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 12/18/2022]
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Gong J, Ma Y, An Y, Yuan Q, Li Y, Hu J. The surgical safety checklist: a quantitative study on attitudes and barriers among gynecological surgery teams. BMC Health Serv Res 2021; 21:1106. [PMID: 34656136 PMCID: PMC8520325 DOI: 10.1186/s12913-021-07130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Implementation of the surgical safety checklist (SSC) plays a significant role in improving surgical patient safety, but levels of compliance to a SSC implementation by surgical team members vary significantly. We aimed to investigate the factors affecting satisfaction levels of gynecologists, anesthesiologists, and operating room registered nurses (OR-RNs) with SSC implementation. Methods We conducted a survey based on 267 questionnaires completed by 85 gynecologists from 14 gynecological surgery teams, 86 anesthesiologists, and 96 OR-RNs at a hospital in China from March 3 to March 16, 2020. The self-reported questionnaire was used to collect respondent’s demographic information, levels of satisfaction with overall implementation of the SSC and its implementation in each of the three phases of a surgery, namely sign-in, time-out, and sign-out, and reasons for not giving a satisfaction score of 10 to its implementation in all phases. Results The subjective ratings regarding the overall implementation of the SSC between the surgical team members were different significantly. “Too many operations to check” was the primary factor causing gynecologists and anesthesiologists not to assign a score of 10 to sign-in implementation. The OR-RNs gave the lowest score to time-out implementation and 82 (85.42%) did not assign a score of 10 to it. “Surgeon is eager to start for surgery” was recognized as a major factor ranking first by OR-RNs and ranking second by anesthesiologists, and 57 (69.51%) OR-RNs chose “Too many operations to check” as the reason for not giving a score of 10 to time-out implementation. “No one initiates” and “Surgeon is not present for ‘sign out’” were commonly cited as the reasons for not assigning a score of 10 to sign-out implementation. Conclusion Factors affecting satisfaction with SSC implementation were various. These factors might be essentially related to heavy workloads and lack of ability about SSC implementation. It is advisable to reduce surgical team members’ excessive workloads and enhance their understanding of importance of SSC implementation, thereby improving surgical team members’ satisfaction with SSC implementation and facilitating compliance of SSC completion.
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Affiliation(s)
- Junming Gong
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yushan Ma
- Department of Anesthesiology, West China Second University Hospital/West China School of Medicine, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yunfei An
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Qi Yuan
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yun Li
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Juan Hu
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China.
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Sotto KT, Burian BK, Brindle ME. Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis. J Am Coll Surg 2021; 233:794-809.e8. [PMID: 34592406 DOI: 10.1016/j.jamcollsurg.2021.08.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. STUDY DESIGN We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. CONCLUSIONS The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Affiliation(s)
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA
| | - Mary E Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB; Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
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Heiden BT, Tetteh E, Robbins KJ, Tabak RG, Nava RG, Marklin GF, Kreisel D, Meyers BF, Kozower BD, McKay VR, Puri V. Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study. Ann Thorac Surg 2021; 114:373-382. [PMID: 34499861 PMCID: PMC9112075 DOI: 10.1016/j.athoracsur.2021.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Dissemination and implementation (D&I) science is the practice of taking evidence-based interventions (EBI) and sustainably incorporating them in routine clinical practice. As a relatively young field, D&I techniques are underutilized in cardiothoracic surgery. This review offers an overview of D&I science from the context of the cardiothoracic surgeon. First, we provide a general introduction to D&I science and basic terminology that is used in the field. Second, to illustrate D&I techniques in a real-world example, we discuss a case study for implementing lung protective management (LPM) strategies for lung donor optimization nationally. Finally, we discuss challenges to successful implementation that are unique to cardiothoracic surgery and give several examples of EBIs that have been poorly implemented into surgical practice. We also provide examples of successful D&I interventions - including de-implementation strategies - from other surgical subspecialties. We hope that this review offers additional tools for cardiothoracic surgeons to explore when introducing EBIs into routine practice.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Emmanuel Tetteh
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Keenan J Robbins
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rachel G Tabak
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO; Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gary F Marklin
- Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Virginia R McKay
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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Oodit R, Biccard B, Nelson G, Ljungqvist O, Brindle ME. ERAS Society Recommendations for Improving Perioperative Care in Low- and Middle-Income Countries Through Implementation of Existing Tools and Programs: An Urgent Need for the Surgical Safety Checklist and Enhanced Recovery After Surgery. World J Surg 2021; 45:3246-3248. [PMID: 34455460 PMCID: PMC8476382 DOI: 10.1007/s00268-021-06279-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Ravi Oodit
- Global Surgery Unit, Department of Surgery, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa
| | - Bruce Biccard
- Department of Anesthesia and Perioperative Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa
| | - Gregg Nelson
- Departments of Obstetrics and Gynecology and Oncology, Cumming School of Medicine, University of Calgary, Canada 1331 29 Street NW, Calgary, AB, T2N 4N2, Canada
| | - Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Örebro University, Örebro, Sweden. .,Department of Surgery, Örebro University Hospital, 701 85, Örebro, Sweden.
| | - Mary E Brindle
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Canada and Safe Surgery and Safe Systems, Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital28 Oki Drive, Calgary, AB, T3B 6A8, Canada
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Implementation Strategies and the Uptake of the World Health Organization Surgical Safety Checklist in Low and Middle Income Countries: A Systematic Review and Meta-analysis. Ann Surg 2021; 273:e196-e205. [PMID: 33064387 DOI: 10.1097/sla.0000000000003944] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify the implementation strategies used in World Health Organization Surgical Safety Checklist (SSC) uptake in low- and middle-income countries (LMICs); examine any association of implementation strategies with implementation effectiveness; and to assess the clinical impact. BACKGROUND The SSC is associated with improved surgical outcomes but effective implementation strategies are poorly understood. METHODS We searched the Cochrane library, MEDLINE, EMBASE and PsycINFO from June 2008 to February 2019 and included primary studies on SSC use in LMICs. Coprimary objectives were identification of implementation strategies used and evaluation of associations between strategies and implementation effectiveness. To assess the clinical impact of the SSC, we estimated overall pooled relative risks for mortality and morbidity. The study was registered on PROSPERO (CRD42018100034). RESULTS We screened 1562 citations and included 47 papers. Median number of discrete implementation strategies used per study was 4 (IQR: 1-14, range 0-28). No strategies were identified in 12 studies. SSC implementation occurred with high penetration (81%, SD 20%) and fidelity (85%, SD 13%), but we did not detect an association between implementation strategies and implementation outcomes. SSC use was associated with a reduction in mortality (RR 0.77; 95% CI 0.67-0.89), all complications (RR 0.56; 95% CI 0.45-0.71) and infectious complications (RR 0.44; 95% CI 0.37-0.52). CONCLUSIONS The SSC is used with high fidelity and penetration is associated with improved clinical outcomes in LMICs. Implementation appears well supported by a small number of tailored strategies. Further application of implementation science methodology is required among the global surgical community.
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Jin J, Akau Ola S, Yip CH, Nthumba P, Ameh EA, de Jonge S, Mehes M, Waiqanabete HI, Henry J, Hill A. The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. World J Surg 2021; 45:2993-3006. [PMID: 34218314 DOI: 10.1007/s00268-021-06208-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in the effort to improve peri-operative outcomes. METHODS A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542. RESULT Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46-1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48-0.93). CONCLUSION There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.
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Affiliation(s)
- James Jin
- Department of Surgery, The University of Auckland, Auckland, 1010, New Zealand
| | - Salesi Akau Ola
- Surgery, Fiji National University, samabula fiji Lakeba Street Samabula, Suva, Fiji
| | - Cheng-Har Yip
- Surgery, University of Malaya, Subang Jaya Medical Centre, 50603, Kuala Lumpur, Malaysia
| | - Peter Nthumba
- AIC Kijabe Hospital Surgery, Kijabe Road Kijabe Lari Kiambu KE, Kijabe, Kenya
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, Northcentral University, 8667 E Hartford Dr Ste 100, Scottsdale, AZ, 85255, USA
| | - Stijn de Jonge
- Department of Surgery, Amsterdam UMC Locatie AMC, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands
| | | | | | - Jaymie Henry
- Department of Surgery, Florida Atlantic University, Boca Raton, USA.
| | - Andrew Hill
- Department of Surgery, University of Auckland, Auckland, 1010, New Zealand
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Rosato L, Lavorini E, Balzi D, Mondini G, Panier Suffat L. Morbidity and mortality analysis in general surgery operations. Is there any room for improvement? Minerva Surg 2021; 77:229-236. [PMID: 34160169 DOI: 10.23736/s2724-5691.21.08737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this work is to examine the performance of surgeries, by evaluating the results. The evaluation of the results, with particular attention to complications, is the corner stone to identify the causes leading to correction of any predisposing factors and reducing risks, to improve quality of care. METHODS We performed a retrospective analysis of 952 consecutive patients who had elective or emergency surgery from November 1, 2018 to October 31, 2019. We classified surgical intervention according to their complexity. The Clavien Dindo classification was used to categorize the complications. We performed a stepwise multivariate logistic-regression analysis, with the presence of post-operative complications as dependent variable and age, gender, BMI, ASA, type of surgery procedures, complexity of surgery, operative time as covariates. RESULTS A total of 952 surgical procedures were included in this study. Abdominal procedures were the most frequent type of surgery performed (52.1%). Post-operative complications occurred in 120 surgical procedures (12.6%), these are related to the increase of the ASA score and the longer average operative time, with an increase of developing complication of 5% for each additional 10 minutes of surgery. CONCLUSIONS many factors influence postoperative morbidity and mortality. Particular attention was due to complication's evaluation, about all in abdominal surgery and high complexity procedures. We argue that key factors which influence the favourable surgical outcome are: compliance with standardized safety procedures, volume of activity of the structure, presence of interdisciplinary care groups, and ability of health professionals in recognizing and promptly treating complications.
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Affiliation(s)
- Lodovico Rosato
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Eugenia Lavorini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, School of Medicine, University of Turin, Ivrea, Turin, Italy
| | - Daniela Balzi
- Epidemiology Unit, AUSL Tuscany Center, Florence, Italy
| | - Guido Mondini
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy -
| | - Luca Panier Suffat
- General Surgical Unit, Oncology and Surgery Departments ASL TO4 Piedmont Region, Ivrea Hospital, Ivrea, Turin, Italy
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Forrester JA, Starr N, Negussie T, Schaps D, Adem M, Alemu S, Amenu D, Gebeyehu N, Habteyohannes T, Jiru F, Tesfaye A, Wayessa E, Chen R, Trickey A, Bitew S, Bekele A, Weiser TG. Clean Cut (adaptive, multimodal surgical infection prevention programme) for low-resource settings: a prospective quality improvement study. Br J Surg 2021; 108:727-734. [PMID: 34157086 PMCID: PMC10364890 DOI: 10.1002/bjs.11997] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/17/2020] [Accepted: 07/23/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Clean Cut is an adaptive, multimodal programme to identify improvement opportunities and safety changes in surgery by enhancing outcomes surveillance, closing gaps in surgical infection prevention standards, and strengthening underlying processes of care. Surgical-site infections (SSIs) are common in low-income countries, so this study assessed a simple intervention to improve perioperative infection prevention practices in one. METHODS Clean Cut was implemented in five hospitals in Ethiopia from August 2016 to October 2018. Compliance data were collected from the operating room focused on six key perioperative infection prevention standards. Process-mapping exercises were employed to understand barriers to compliance and identify locally driven improvement opportunities. Thirty-day outcomes were recorded on patients for whom intraoperative compliance information had been collected. RESULTS Compliance data were collected from 2213 operations (374 at baseline and 1839 following process improvements) in 2202 patients. Follow-up was completed in 2159 patients (98·0 per cent). At baseline, perioperative teams complied with a mean of only 2·9 of the six critical perioperative infection prevention standards; following process improvement changes, compliance rose to a mean of 4·5 (P < 0·001). The relative risk of surgical infections after Clean Cut implementation was 0·65 (95 per cent c.i. 0·43 to 0·99; P = 0·043). Improved compliance with standards reduced the risk of postoperative infection by 46 per cent (relative risk 0·54, 95 per cent c.i. 0·30 to 0·97, for adherence score 3-6 versus 0-2; P = 0·038). CONCLUSION The Clean Cut programme improved infection prevention standards to reduce SSI without infrastructure expenses or resource investments.
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Affiliation(s)
- J A Forrester
- Department of Surgery, Stanford University, Stanford, USA
| | - N Starr
- Department of Surgery, University of California San Francisco, San Francisco California USA
| | - T Negussie
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - D Schaps
- Duke University School of Medicine, Durham North Carolina USA
| | - M Adem
- Department of Surgery, Menelik II Referral Hospital, Addis Ababa, Ethiopia
| | - S Alemu
- Departments of Surgery, , Jimma, Ethiopia
| | - D Amenu
- Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Jimma, Ethiopia
| | - N Gebeyehu
- Quality Improvement Department, St Peter's Specialized Hospital, Fitche, Ethiopia
| | - T Habteyohannes
- Department of Surgery, St Peter's Specialized Hospital, Addis Ababa Gulele Subcity, Fitche, Ethiopia
| | - F Jiru
- Department of Health Economics, Management, and Policy, Jimma University Medical Centre, Jimma, Ethiopia
| | - A Tesfaye
- Quality Improvement Department, St Peter's Specialized Hospital, Fitche, Ethiopia
| | - E Wayessa
- Fitche General Hospital, Fitche, Ethiopia
| | - R Chen
- Stanford‐Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, USA
| | - A Trickey
- Stanford‐Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, USA
| | - S Bitew
- Lifebox Ethiopia, Addis Ababa, Ethiopia
| | - A Bekele
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - T G Weiser
- Department of Surgery, Stanford University, Stanford, USA
- Stanford‐Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, USA
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK
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40
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Fridrich A, Imhof A, Schwappach DLB. How Much and What Local Adaptation Is Acceptable? A Comparison of 24 Surgical Safety Checklists in Switzerland. J Patient Saf 2021; 17:217-222. [PMID: 33323892 PMCID: PMC7984757 DOI: 10.1097/pts.0000000000000802] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In 2009, the World Health Organization (WHO) published the WHO Surgical Safety Checklist, and 3 years later, the Swiss Patient Safety Foundation adapted it for Switzerland. Several meta-analyses and systematic reviews showed ambiguous results on the effectiveness of surgical checklists. Most of them assume that the study checklists are almost identical, but in fact they are quite heterogeneous due to adaptations to local settings. This study aims to investigate the extent to which the checklists currently used in Switzerland differ and to discuss the consequences of local adaptations. METHODS For the analysis, 24 checklists used in 18 Swiss hospitals are analyzed. First, general checklist characteristics are examined. Second, the checklist items are compared with the checklist items of the WHO and the Swiss Patient Safety Foundation. RESULTS The checklists contain a median of 34.5 items (range, 15-76). Compared with the checklists of WHO and Patient Safety Switzerland, which contain 12 and 21 process checks and 10 and 9 conversation prompts, respectively, the study checklists contain a median of 15.5 process checks (range, 3-25) and a median of 4 conversation prompts (range, 0-10). CONCLUSIONS There are major differences between the study checklists and the reference checklists that raise doubts about the comparability of checklists. More resources must be invested in proper checklist adaptions and better guidance on how to adapt safety tools such as the surgical safety checklist needed to local conditions. In any case, details of the checklists used need to be clearly described in studies on checklist effectiveness.
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Affiliation(s)
| | - Anita Imhof
- From the Swiss Patient Safety Foundation, Zurich
| | - David L. B. Schwappach
- From the Swiss Patient Safety Foundation, Zurich
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Clarke M, Pittalis C, Borgstein E, Bijlmakers L, Cheelo M, Ifeanyichi M, Mwapasa G, Juma A, Broekhuizen H, Drury G, Lavy C, Kachimba J, Mkandawire N, Chilonga K, Brugha R, Gajewski J. Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study. BMJ Qual Saf 2021; 30:950-960. [PMID: 33727414 PMCID: PMC8606427 DOI: 10.1136/bmjqs-2020-012751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems. AIM To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia. METHODS A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers. RESULTS 53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms. CONCLUSIONS Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.
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Affiliation(s)
- Morgane Clarke
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland
| | - Chiara Pittalis
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mweene Cheelo
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Martilord Ifeanyichi
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gerald Mwapasa
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Adinan Juma
- East Central and Southern Africa Health Community, Arusha, United Republic of Tanzania
| | - Henk Broekhuizen
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Grace Drury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Nyengo Mkandawire
- Department of Surgery, University of Malawi College of Medicine, Blantyre, Malawi
| | - Kondo Chilonga
- Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Ruairí Brugha
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland
| | - Jakub Gajewski
- Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland
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42
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Kluyts HL, Biccard BM. The role of peri-operative registries in improving the quality of care in low-resource environments. Anaesthesia 2021; 76:888-891. [PMID: 33645733 DOI: 10.1111/anae.15445] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/20/2022]
Affiliation(s)
- H-L Kluyts
- Department of Anaesthesiology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - B M Biccard
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
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We Asked the Experts: The WHO Surgical Safety Checklist and the COVID-19 Pandemic: Recommendations for Content and Implementation Adaptations. World J Surg 2021; 45:1293-1296. [PMID: 33638023 PMCID: PMC7908955 DOI: 10.1007/s00268-021-06000-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. METHODS 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delphi technique to identify potential recommendations, assess agreement with proposed recommendations and address items not meeting consensus. RESULTS From an initial 29 recommendations identified in the first round, 12 were identified for inclusion in the second round. After discussion of recommendations without consensus for inclusion or exclusion, four additional recommendations were added for an eventual 16 recommendations. Nine of these recommendations were related to checklist content, while seven recommendations were related to implementation. CONCLUSIONS This multinational panel has identified 16 recommendations for sites looking to use the surgical safety checklist during the COVID-19 pandemic. These recommendations provide an example of how the SSC can adapt to meet urgent and emerging needs of surgical systems by targeting important processes and encouraging critical discussions.
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Muensterer OJ, Kreutz H, Poplawski A, Goedeke J. Timeout procedure in paediatric surgery: effective tool or lip service? A randomised prospective observational study. BMJ Qual Saf 2021; 30:622-627. [PMID: 33632757 PMCID: PMC8311082 DOI: 10.1136/bmjqs-2020-012001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022]
Abstract
Background For over a decade, the preoperative timeout procedure has been implemented in most paediatric surgery units. However, the impact of this intervention has not been systematically studied. This study evaluates whether purposefully introduced errors during the timeout routine are detected and reported by the operating team members. Methods After ethics board approval and informed consent, deliberate errors were randomly and clandestinely introduced into the timeout routine for elective surgical procedures by a paediatric surgery attending. Errors were randomly selected among wrong name, site, side, allergy, intervention, birthdate and gender items. The main outcome measure was how frequent an error was reported by the team and by whom. Results Over the course of 16 months, 1800 operations and timeouts were performed. Errors were randomly introduced in 120 cases (6.7%). Overall, 54% of the errors were reported; the remainder went unnoticed. Errors were pointed out most frequently by anaesthesiologists (64%), followed by nursing staff (28%), residents-in-training (6%) and medical students (1%). Conclusion Errors in the timeout routine go unnoticed by the team in almost half of cases. Therefore, even if preoperative timeout routines are strictly implemented, mistakes may be overlooked. Hence, the timeout procedure in its current form appears unreliable. Future developments may be useful to improve the quality of the surgical timeout and should be studied in detail.
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Affiliation(s)
- Oliver J Muensterer
- Pediatric Surgery, Johannes Gutenberg University, Mainz, Rhineland-Palatinate, Germany .,Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Bayern, Germany
| | - Hendrik Kreutz
- Pediatric Surgery, Johannes Gutenberg University, Mainz, Rhineland-Palatinate, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University, Mainz, Rheinland-Pfalz, Germany
| | - Jan Goedeke
- Pediatric Surgery, Johannes Gutenberg University, Mainz, Rhineland-Palatinate, Germany
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45
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Skjold-Ødegaard B, Søreide K. Standardization in surgery: friend or foe? Br J Surg 2021; 107:1094-1096. [PMID: 32749691 DOI: 10.1002/bjs.11573] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 01/13/2023]
Affiliation(s)
- B Skjold-Ødegaard
- Department of Surgery, Haugesund Hospital, Haugesund, Norway.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 PMCID: PMC8026747 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
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Abstract
The success of patient safety and quality improvement interventions depends, in part, on the effectiveness of implementation. Surgical safety checklists have been introduced into thousands of operating rooms across 6 continents since the debut of the original World Health Organization 19-item checklist in 2008. However, the effect of checklists on patient outcomes has varied. Here, we review 5 examples of large-scale efforts (eg, population level or across health systems) where surgical checklists were introduced into the operating room and the associated effects on patient outcomes. Each experience provides an opportunity to reflect on best practices that inform strategies for effective implementation.
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48
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Abstract
Critical events are rare and stressful. These properties make reliance on memory for clinical management highly susceptible to failure. In the past 10 to 20 years, health care has begun to accept the experience of aviation and other high-reliability organizations in addressing failure to rescue from these events through a combination of practice through simulation and the introduction of cognitive aids, known as checklists or emergency manuals. Cognitive aids have a persuasive body of evidence from simulation studies to establish their value in improving clinician performance. However, their introduction to practice is more complex than distribution of the tools.
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Affiliation(s)
- Alexander A Hannenberg
- Ariadne Labs, 401 Park Drive 3-West, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA.
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49
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Panda N, Koritsanszky L, Delisle M, Anyomih TTK, Desai EV, Sonnay Y, Molina G, Madani K, Vervoort D, Weiser TG, Benjamin EM, Haynes AB. Global Survey of Perceptions of the Surgical Safety Checklist Among Medical Students, Trainees, and Early Career Providers. World J Surg 2020; 44:2857-2868. [PMID: 32307554 PMCID: PMC7390667 DOI: 10.1007/s00268-020-05518-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The Surgical Safety Checklist (SSC) has been shown to reduce perioperative complications across global health systems. We sought to assess perceptions of the SSC and suggestions for its improvement among medical students, trainees, and early career providers. METHODS From July to September 2019, a survey assessing perceptions of the SSC was disseminated through InciSioN, the International Student Surgical Network comprising medical students, trainees, and early career providers pursuing surgery. Individuals with ≥2 years of independent practice after training were excluded. Respondents were categorized according to any clinical versus solely non-clinical SSC exposure. Logistic regression was used to evaluate associations between clinical/non-clinical exposure and promoting future use of the SSC, adjusting for potential confounders/mediators: training level, human development index, and first perceptions of the SSC. Thematic analysis was conducted on suggestions for SSC improvement. RESULTS Respondent participation rate was 24%. Three hundred and eighteen respondents were included in final analyses; 215 (67%) reported clinical exposure and 190 (60%) were promoters of future SSC use. Clinical exposure was associated with greater odds of promoting future SSC use (aOR 1.81 95% CI [1.03-3.19], p = 0.039). A greater proportion of promoters reported "Improved Operating Room Communication" as a goal of the SSC (0.21 95% CI [0.15-0.27]-vs.-0.12 [0.06-0.17], p = 0.031), while non-promoters reported the SSC goals were "Not Well Understood" (0.08 95% CI [0.03-0.12]-vs.-0.03 [0.01-0.05], p = 0.032). Suggestions for SSC improvement emphasized context-specific adaptability and earlier formal training. CONCLUSIONS Clinical exposure to the SSC was associated with promoting its future use. Earlier formal clinical training may improve perceptions and future use among medical students, trainees, and early career providers.
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Affiliation(s)
- Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB-425, Boston, MA, 02114, USA.
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA.
| | - Luca Koritsanszky
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
- Lifebox Foundation, 48 Charlotte Street, London, W1T 2NS, UK
| | - Megan Delisle
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
- Department of Surgery, University of Manitoba, 347-825 Sherbrook Street, Winnipeg, MB, R3T 2N2, Canada
| | | | - Eesha V Desai
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - Yves Sonnay
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - George Molina
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, GRB-425, Boston, MA, 02114, USA
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
- Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02215, USA
| | - Katayoun Madani
- International Student Surgical Network (InciSioN), Sint-Truiden, Belgium
- Saint George's University School of Medicine, 3500 Sunrise Highway, Great River, New York, 11739, USA
- Northwestern Trauma and Surgical Initiative, Arkes Family Pavilion (Suite 650), 676 North Saint Clair, Chicago, IL, 60611, USA
| | - Dominique Vervoort
- International Student Surgical Network (InciSioN), Sint-Truiden, Belgium
- Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Thomas G Weiser
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
- Lifebox Foundation, 48 Charlotte Street, London, W1T 2NS, UK
- Department of Surgery, Stanford Medicine, 300 Pasteur Drive, H3638, Stanford, CA, 94305, USA
| | - Evan M Benjamin
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - Alex B Haynes
- Ariadne Labs, Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 2601 Trinity Street, Building B, Austin, TX, 78712, USA
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Klein AA, Earnshaw JJ. Perioperative care and collaboration between surgeons and anaesthetists - it's about time. Br J Surg 2020; 107:e6-e7. [PMID: 31903591 DOI: 10.1002/bjs.11445] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022]
Affiliation(s)
- A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - J J Earnshaw
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GL1 3NN, UK
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