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All Team Members Must Participate in the Time Out. AORN J 2024; 119:P8. [PMID: 38804720 DOI: 10.1002/aorn.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 05/29/2024]
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Braverman A. Improving Team Members' Attention During the OR Briefing or Time Out. AORN J 2024; 119:421-427. [PMID: 38804746 DOI: 10.1002/aorn.14144] [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: 03/13/2023] [Revised: 09/25/2023] [Accepted: 11/05/2023] [Indexed: 05/29/2024]
Abstract
Effective coordination among health care professionals is crucial to achieving optimal outcomes. In the OR, even minor errors can have catastrophic consequences. To mitigate the risk of error, health care professionals have adopted a briefing culture like that used in the aviation industry. Briefings are essential to ensure that everyone involved in a procedure knows the plan and potential risks and is prepared to perform their duties safely and effectively. The fundamental human sense involved in briefings is auditory perception; although important, hearing alone does not equate to focused attention. To enhance the efficacy of briefings, engaging the use of a second sense by adding a visual checklist may increase attentiveness and the chances of early error detection and prevention. Using a projection device may enhance all team members' engagement and participation during the briefing or time-out process and can be an effective tool for improving communication and reducing errors.
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Enomoto T, Mikami S, Otsubo T, Hiwatari M, Tsukamoto Y, Hisatsune Y, Shimada J, Matsushita T. Retrospective observational cohort study of laparoscopic surgical strategies for gastrointestinal stromal tumors. Updates Surg 2024:10.1007/s13304-024-01816-4. [PMID: 38578408 DOI: 10.1007/s13304-024-01816-4] [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: 12/09/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Laparoscopic surgery has been used to treat gastric submucosal tumors (SMTs). Laparoscopic and endoscopic cooperative surgery (LECS) has been used when subtotal resection has been difficult, which enabled resection of these tumors. In this study, we reviewed the medical records of patients with gastric SMTs who underwent laparoscopic surgery in our hospital with the aim of reporting the surgical indications, procedures (especially for LECS), and outcomes of surgery. This study involved 55 patients who underwent laparoscopic surgery between April 2014 and March 2021. We classified the patients into two groups: laparoscopy-assisted surgery group (non-LECS group, n = 30) and LECS group (n = 25). LECS was performed in the upper stomach, in the greater curvature of the lower stomach, and in both intraluminal and intramural locations in the middle stomach. Non-LECS was selected for extraluminal and intramural tumors in the greater curvature of the upper stomach. There were no severe complications associated with the operation. There was one postoperative complication in the LECS group. The length of postoperative hospital stay did not significantly differ between the LECS and non-LECS groups. We reported the surgical procedures for gastric SMTs in our hospital. It is essential to make full use of the multiple techniques reported in this article and examine the location of the tumor to avoid excess or insufficient resection. Our review of the present case series allowed us to select the appropriate surgical approach for gastric SMTs based on the lesion location and type of development.
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Affiliation(s)
- Takeharu Enomoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Shinya Mikami
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Takehito Otsubo
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Masaki Hiwatari
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yoshitsugu Tsukamoto
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Yasuhito Hisatsune
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Jin Shimada
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Tsunehisa Matsushita
- Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
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Hooven K, Altmiller G. Creating a Just Culture in the Perioperative Setting. AORN J 2024; 119:152-160. [PMID: 38275261 DOI: 10.1002/aorn.14074] [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: 11/22/2022] [Revised: 01/28/2023] [Accepted: 02/26/2023] [Indexed: 01/27/2024]
Abstract
There has been an increased perioperative focus on avoiding adverse events and providing safe patient care since To Err Is Human: Building a Safer Health System published in 2000. Adverse events continue to occur in perioperative areas and are likely underreported. The interdisciplinary nature and high cost of perioperative care may discourage personnel from speaking up for fear of retribution and punishment when reporting. Organization leaders can implement a just culture that focuses on improving patient care processes and safety rather than placing blame after an adverse event. A tenet of just culture is achieving balanced accountability between systems and individuals. Strategies for just culture implementation include leader support, policies and procedures for reporting, accessibility of reporting systems, provision of information for staff members, identification of support champions, and creation of a good catch program. Leaders also should measure and track progress associated with the just culture in their facility.
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Robertson SC. Enhanced Recovery After Surgery (ERAS) Spine Pathways and the Role of Perioperative Checklists. Adv Tech Stand Neurosurg 2024; 49:73-94. [PMID: 38700681 DOI: 10.1007/978-3-031-42398-7_5] [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: 06/01/2024]
Abstract
Enhanced recovery after surgery (ERAS) proposes a multimodal, evidence-based approach to perioperative care. ERAS pathways have been shown to help reduce complications, hospital length of stay (LOS), 30-day readmission rates, pain scores, and ultimately surgical costs, while improving patient satisfaction scores and outcomes in multiple surgical subspecialties [1-6]. Numerous specialties have implemented ERAS programs across the globe, providing a foundation for spine surgeons to begin the process themselves. Over the last few years, a significant number of papers have been addressing ERAS pathways for spinal surgery [7-19]. The majority have addressed the lumbar spine [9, 20-26]. The number of cervical ERAS pathways has been limited [27-29]. Many spine programs have begun the implementation of ERAS pathways, incorporating principles and interventions to various spine surgical procedures. Although differences in implementation across programs exist, there are a few common elements that promote a successful enhanced recovery approach [11, 16, 23, 25, 30-33]. All spinal ERAS pathways have three major elements, which are preoperative, perioperative, and postoperative phases. Within these phases some common elements include preoperative and intraoperative surgical checklists. Intraoperative checklist in addition to the "surgical time out" has been integrated into the workflow of most hospitals doing surgeries and have become a standard of care. The surgical checklist is designed to help reduce surgical errors and prevent wrong site/patient surgeries. Several surgical checklists have been developed throughout the years. Despite these safety protocols wrong site/level and other surgical errors continue to occur. Many cases of wrong level spine surgery (WLSS) still occur even when intraoperative imaging is performed [34, 35]. One survey reported that about 50% of spine surgeons have performed at least one WLSS during their career [36, 37]. Another survey reported that 36% of spine surgeons had performed at least one WLSS that was not recognized intraoperatively [38]. On a similar account, about 30% of spine surgery fellows have experienced wrong-site surgery [39]. From raw incidence rates, WLSS may seem rare, but these surveys show that the experience of WLSS is rather common among spine surgeons. WLSS is not yet a "never event." This may be due to poor quality of the intraoperative images, hindering subsequent level identification [34, 35, 38, 40]. Errors in interpretation of the imaging may also occur, including inconsistency in numbering vertebrae, inconsistency in landmark usage for level counting, and problems with numbering vertebrae due to lumbosacral transitional vertebrae (LSTV) and other anatomical variants [34, 38, 41-43]. This chapter will describe a framework for the development and implementation of ERAS pathway for patients undergoing spine surgery. In addition, we will propose preoperative imaging guidelines and a comprehensive spine surgical checklist to incorporate into the perioperative phase to help reduce further surgical errors and WLSS.
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Levy BE, Wilt WS, Lantz S, Ballert E, Harris A. Standardization and Visualization of the Surgical Time-Out. J Patient Saf 2023; 19:453-459. [PMID: 37729643 DOI: 10.1097/pts.0000000000001156] [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: 09/22/2023]
Abstract
INTRODUCTION The time-out (TO) can prevent adverse events but is subject to TO engagement. We hypothesize transforming the TO to an auditable, active process will improve compliance and engagement. METHODS The passive nature of the current TO was identified as a potential safety issue on staff patient safety culture surveys. Subsequently, the Time Out Engagement and Standardization quality improvement initiative was developed and included a whiteboard checklist to be used in the operating room. As a baseline, 11 TOs were audited concerning engagement and content. Key stakeholders were engaged to determine potential interventions. A TO consisting of 15 elements using a TO whiteboard checklist with role-specific objectives was developed. Plan, Do, Study, Act cycles commenced. After implementation, 17 TOs were audited based on engagement and content. RESULTS Before intervention, engagement varied with nurse participating in 100% compared with anesthesia provider or surgeon participating in 18%. No TO included all 15 elements and only 13% of elements included in all TOs. After implementation of Time Out Engagement and Standardization, anesthesia and surgeon who participated increased to 100% and 76.5%, respectively (P < 0.0001, P = 0.006). The 15 standardized elements of the TO were discussed in 90% of cases. Overall, preintervention 88 elements (57.1%) were completed across all TOs, while postintervention 243 elements (98.8%) were completed (P < 0.001). CONCLUSIONS We identified a need for increased engagement of the TO based on staff concerns, which were verified through auditing. Implementation of a team-driven intervention and 3 rapid Plan, Do, Study, Act cycles led to measurable improvement of the surgical TO.
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Affiliation(s)
| | - Wesley S Wilt
- From the Department of Surgery, University of Kentucky
| | - Sherry Lantz
- Department of Surgery, Lexington Veteran's Affairs Medical Center
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Dokdok M, Ballı HT. Compliance of Interventional Radiologists With Interventional Oncology Accreditation Standards. Cureus 2023; 15:e42608. [PMID: 37641765 PMCID: PMC10460535 DOI: 10.7759/cureus.42608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE We aimed to evaluate interventional radiologists' compliance with patient care and the quality management process of cancer patients using a national survey. METHODS An electronic survey was designed with questions derived from the core criteria of the International Accreditation System for Interventional Oncology (IASIOS), with the approval of the IASIOS council. Among the interventional radiologists contacted by e-mail through the national association, 34 responded to the questionnaire. The agreement of the participants with the core requirements was evaluated in five questions consisting of 34 articles using the 5-point Likert scale. RESULTS Regarding the years of experience in interventional radiology (IR), the mean scale for the less than five-year group was 118.4, while that for the group with more than 15 years was 145.17 (p = 0.030). The mean scale of the five- to 15-year-old group was 121.75, versus that of more than 15 years, which was 145.17 (p = 0.028). Thus, significant differences arose between 15 years and five to 15 years versus >15 years groups; later groups were more likely to comply. There was also a statistical difference between the groups formed according to the ratio of oncological interventions (<25% vs. 25%-50%) in the daily workload (p = 0.010). CONCLUSION Increased experience in IR and more relay on oncological interventions appear to augment compliance with the IASIOS criteria. We believe that interventional radiologists who have distinct territorial praxis could benefit from such a framework with improved self-awareness.
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Affiliation(s)
- Murat Dokdok
- Radiology Department, Anadolu Medical Center, Kocaeli, TUR
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Soares RV, Barel PS, Leite CC, Letícia Dos Santos L, Junior FCS, de Carvalho ER, Gianotto-Oliveira R, Cecilio-Fernandes D. Implementation of Escape Room as an Educational Strategy to Strengthen the Practice of Safe Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:907-911. [PMID: 37258344 DOI: 10.1016/j.jsurg.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/31/2023] [Accepted: 04/28/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Describe a safe surgery learning experience based on interactive escape room activities to engage and train nursing and physician teams. DESIGN This paper is based on the authors' participatory and observational experiences creating the Escape Room activity. SETTING Jundiai Regional Hospital, Surgical Department. PARTICIPANTS Nurses, nurses assistant/technician and physicians and medical residents who work in the surgical center. RESULTS Results identified were promising, which broadens the perspective for further studies using the Escape Room activity in the hospital environment through structured research that can assess its implications for teaching and learning. CONCLUSION We see opportunities for using the escape room activity as a teaching tool to implement other learning objectives.
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Affiliation(s)
- Renata Vicente Soares
- School of Medical Sciences - University of Campinas, Campinas, Brazil; Instituto de Responsabilidade Social Sírio Libanês - Jundiaí Regional Hospital, Jundiaí, Brazil.
| | | | - Camila Canhoella Leite
- Instituto de Responsabilidade Social Sírio Libanês - Jundiaí Regional Hospital, Jundiaí, Brazil
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Bowman CL, De Gorter R, Zaslow J, Fortier JH, Garber G. Identifying a list of healthcare 'never events' to effect system change: a systematic review and narrative synthesis. BMJ Open Qual 2023; 12:e002264. [PMID: 37364940 PMCID: PMC10314656 DOI: 10.1136/bmjoq-2023-002264] [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: 01/17/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Never events (NEs) are patient safety incidents that are preventable and so serious they should never happen. To reduce NEs, several frameworks have been introduced over the past two decades; however, NEs and their harms continue to occur. These frameworks have varying events, terminology and preventability, which hinders collaboration. This systematic review aims to identify the most serious and preventable events for targeted improvement efforts by answering the following questions: Which patient safety events are most frequently classified as never events? Which ones are most commonly described as entirely preventable? METHODS For this narrative synthesis systematic review we searched Medline, Embase, PsycINFO, Cochrane Central and CINAHL for articles published from 1 January 2001 to 27 October 2021. We included papers of any study design or article type (excluding press releases/announcements) that listed NEs or an existing NE framework. RESULTS Our analyses included 367 reports identifying 125 unique NEs. Those most frequently reported were surgery on the wrong body part, wrong surgical procedure, unintentionally retained foreign objects and surgery on the wrong patient. Researchers classified 19.4% of NEs as 'wholly preventable'. Those most included in this category were surgery on the wrong body part or patient, wrong surgical procedure, improper administration of a potassium-containing solution and wrong-route administration of medication (excluding chemotherapy). CONCLUSIONS To improve collaboration and facilitate learning from errors, we need a single list that focuses on the most preventable and serious NEs. Our review shows that surgery on the wrong body part or patient, or the wrong surgical procedure best meet these criteria.
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Affiliation(s)
- Cara L Bowman
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
| | - Ria De Gorter
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
| | - Joanna Zaslow
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
| | - Jacqueline H Fortier
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
| | - Gary Garber
- Safe Medical Care Research, Canadian Medical Protective Association, Ottawa, Ontario, Canada
- Department of Medicine, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rickert J. On Patient Safety: Quit Skipping Your Checklist-Based Time-Outs. Clin Orthop Relat Res 2023; 481:867-869. [PMID: 36999918 PMCID: PMC10097586 DOI: 10.1097/corr.0000000000002644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/07/2023] [Indexed: 04/01/2023]
Affiliation(s)
- James Rickert
- President, The Society for Patient Centered Orthopedics, Bloomington, IN, USA
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Culebras Diaz AM, Gordo C, Mateo R, Núñez-Córdoba JM. Associations of wrong surgery with other critical healthcare quality and patient safety challenges: a cross-sectional nationwide study of 100 general hospitals in Spain. Surg Today 2023; 53:269-273. [PMID: 36056963 DOI: 10.1007/s00595-022-02580-x] [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: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 01/28/2023]
Abstract
Wrong surgery (wrong-site, wrong-procedure, or wrong-patient surgery) is among the most feared patient safety problems in hospitals. We aimed to evaluate associations between numeric assessment of risk assigned to wrong surgery with that of other healthcare quality and patient safety challenges. This nationwide study collected information from healthcare quality experts in charge of a clinical quality and/or patient safety department in general hospitals of ≥ 150 beds in Spain. Out of the 100 included hospitals, the highest strength of associations were observed with risk priority number (RPN) for hospital-acquired pressure ulcers, RPN for venous thromboembolism in hospitalized patients, RPN for incorrect patient identification, RPN for lack of informed consent for diagnostic or therapeutic procedures, RPN for catheter-related bacteremia, and RPN for adverse events and injuries due to medical devices related to use and/or design. These results are of potential interest for designing combined and coordinated strategies to improve patient safety in hospitals.
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Affiliation(s)
| | - Cristina Gordo
- Healthcare Quality Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ricardo Mateo
- Department of Business, School of Economics and Business, University of Navarra, Pamplona, Spain
| | - Jorge M Núñez-Córdoba
- Research Support Service, Central Clinical Trials Unit, Clínica Universidad de Navarra, Pamplona, Spain.
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Van der Voorden M, Ahaus K, Franx A. Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands. BMJ Open 2023; 13:e063175. [PMID: 36604123 PMCID: PMC9827266 DOI: 10.1136/bmjopen-2022-063175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Although previous studies largely emphasize the positive effects of patient participation in patient safety, negative effects have also been observed. This study focuses on bringing together the separate negative effects that have been previously reported in the literature. This study set out to uncover how these negative effects manifest themselves in practice within an obstetrics department. DESIGN An exploratory qualitative interview study with 16 in-depth semistructured interviews. The information contained in the interviews was deductively analysed. SETTING The study was conducted in one tertiary academic healthcare centre in the Netherlands. PARTICIPANTS Patients (N=8) and professionals (N=8) from an obstetrics department. RESULTS The results of this study indicate that patient participation in patient safety comes in five different forms. Linked to these different forms, four negative effects of patient participation in patient safety were identified. These can be summarised as follows: patients' confidence decreases, the patient-professional relationship can be negatively affected, more responsibility can be demanded of the patient than they wish to accept and the professional has to spend additional time on a patient. CONCLUSION This study identifies and brings together four negative effects of patient participation in patient safety that have previously been individually identified elsewhere. In our interviews, there was a consensus among patients and professionals on five different forms of participation that would allow patients to positively participate in patient safety. Further studies should investigate ways to prevent and to mitigate the potential negative effects of patient participation.
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Affiliation(s)
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Department of Health Services Management & Organization, Erasmus University Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - Arie Franx
- Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
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Krenzischek DA, Card E, Mamaril M, Rossol N, Doerner M, MacDonald R. Patients' Perceptions of Importance for Self-Administered Correct Site Surgery Checklist: A Multisite Study. J Perianesth Nurs 2022; 37:827-833. [PMID: 35490143 DOI: 10.1016/j.jopan.2022.01.001] [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: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to describe and validate the association between patient's self-administered correct site checklist and perceptions of importance for safe surgery. DESIGN A multisite nonexperimental, quantitative, descriptive study. METHODS A convenience sample of 173 adult patients from four different geographical multisite hospitals was included in the study. Inclusion criteria were age 18 to 75 years old, scheduled for surgery/procedure with laterality and ability to follow instructions. After IRB approval, investigators explained the purpose of the study, process and obtained consent from willing participants. Participants with clinical or behavioral limitations were excluded from the study. Participants completed a 24 item survey before and during surgery using a four-point Likert scale from one (not important) to four (extremely important). Descriptive data was analyzed using means, standard deviations, and percentage. All data was summarized and analyzed with STATA 12. FINDINGS Most of the participants perceived the importance of the survey checklist items positively implying that the active engagement is an important role for safe surgery. However, a few participants reported some of the items as not important/somewhat important: "It is on my left or right side" (6.9%); "surgery on my: (state your limb) and (right or left site) (1.9-3%); "check electronic access or copy of imaging with correct name and site" (14.9%); "state your name and birthday" (4%), "check correct ID bracelet information" (2.9%) and "believe in having an active role in preventing error" (2.3%). Some participants responded, "My surgeon knows it or surgery has been scheduled". Findings indicated that even though the importance of correct site surgery is critical for patient's surgery, a few patients reported it as noncritical and relied on healthcare team for their safety. CONCLUSIONS This study validated the importance of the patients' perceived roles in promoting safe, correct site surgery and by engaging patients in mitigating correct site surgical errors. Therefore, inclusion of patients as an integral part of the healthcare team is necessary through education and encouragement to speak out.
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Keller S, Tschan F, Semmer NK, Trelle S, Manser T, Beldi G. StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room-study protocol. Trials 2022; 23:878. [PMID: 36258223 PMCID: PMC9580155 DOI: 10.1186/s13063-022-06775-y] [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: 06/15/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Surgical care, which is performed by intensely interacting multidisciplinary teams of surgeons, anesthetists, and nurses, remains associated with significant morbidity and mortality. Intraoperative communication has been shown to be associated with surgical outcomes, but tools ensuring efficient intraoperative communication are lacking. In a previous study, we developed the StOP?-protocol that fosters structured intraoperative communication. Before the critical phases of the operation, the responsible surgeon initiates and leads one or several StOP?s. During a StOP?, the surgeon informs about the progress of the operation (status), next steps and proximal goals (objectives), and possible problems (problems) and encourages all team members to voice their observations and ask questions (?). In a before-after study performed mainly in visceral surgery, we found effects of the StOP?-protocol on mortality, length of hospital stay, and reoperation. We intend to assess the impact of the StOP?-protocol in a cluster randomized trial, in a wider variety of surgical specialties (i.e., general, visceral, thoracic, vascular surgery, surgical urology, and gynecology). The primary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces patient mortality within 30 days after the operation. The secondary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces unplanned reoperations, length of hospital stay, and unplanned hospital readmissions. Methods This study is designed as a multicenter, cluster-randomized parallel-group trial. Board-certified surgeons of participating clinical departments will be randomized 1:1 to the StOP? intervention group or to the standard of care (control) group. The intervention group will undergo a training to use the StOP?-protocol and receive regular feedback on their compliance with the protocol. The surgeons in the control group will communicate as usual during their operations. The unit of observation will be operations performed by cluster surgeons. Consecutive patients will be enrolled over 4 months per cluster. A total of 400 surgeons will be recruited, and we expect to collect patient outcome data for 14,000 surgical procedures. Discussion The StOP?-protocol was designed as a tool to structure communication during surgical procedures. Testing its effects on patient outcomes will contribute to implementing evidenced-based interventions to reduce surgical complications. Trial registration ClinicalTrials.gov NCT05356962. Registered on May 2, 2022 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06775-y.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Abraham J, Meng A, Montes de Oca A, Politi M, Wildes T, Gregory S, Henrichs B, Kannampallil T, Avidan MS. An ethnographic study on the impact of a novel telemedicine-based support system in the operating room. J Am Med Inform Assoc 2022; 29:1919-1930. [PMID: 35985294 PMCID: PMC10161534 DOI: 10.1093/jamia/ocac138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/07/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The Anesthesiology Control Tower (ACT) for operating rooms (ORs) remotely assesses the progress of surgeries and provides real-time perioperative risk alerts, communicating risk mitigation recommendations to bedside clinicians. We aim to identify and map ACT-OR nonroutine events (NREs)-risk-inducing or risk-mitigating workflow deviations-and ascertain ACT's impact on clinical workflow and patient safety. MATERIALS AND METHODS We used ethnographic methods including shadowing ACT and OR clinicians during 83 surgeries, artifact collection, chart reviews for decision alerts sent to the OR, and 10 clinician interviews. We used hybrid thematic analysis informed by a human-factors systems-oriented approach to assess ACT's role and impact on safety, conducting content analysis to assess NREs. RESULTS Across 83 cases, 469 risk alerts were triggered, and the ACT sent 280 care recommendations to the OR. 135 NREs were observed. Critical factors facilitating ACT's role in supporting patient safety included providing backup support and offering a fresh-eye perspective on OR decisions. Factors impeding ACT included message timing and ACT and OR clinician cognitive lapses. Suggestions for improvement included tailoring ACT message content (structure, timing, presentation) and incorporating predictive analytics for advanced planning. DISCUSSION ACT served as a safety net with remote surveillance features and as a learning healthcare system with feedback/auditing features. Supporting strategies include adaptive coordination and harnessing clinician/patient support to improve ACT's sustainability. Study insights inform future intraoperative telemedicine design considerations to mitigate safety risks. CONCLUSION Incorporating similar remote technology enhancement into routine perioperative care could markedly improve safety and quality for millions of surgical patients.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alicia Meng
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Arianna Montes de Oca
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary Politi
- Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Troy Wildes
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Stephen Gregory
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Bernadette Henrichs
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Biology and Biomedical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Computer Science & Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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16
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Rae CL, Farley M, Jeffery KJ, Urai AE. Climate crisis and ecological emergency: Why they concern (neuro)scientists, and what we can do. Brain Neurosci Adv 2022; 6:23982128221075430. [PMID: 35252586 PMCID: PMC8891852 DOI: 10.1177/23982128221075430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
Our planet is experiencing severe and accelerating climate and ecological breakdown caused by human activity. As professional scientists, we are better placed than most to understand the data that evidence this fact. However, like most other people, we ignore this inconvenient truth and lead our daily lives, at home and at work, as if these facts weren’t true. In particular, we overlook that our own neuroscientific research practices, from our laboratory experiments to our often global travel, help drive climate change and ecosystem damage. We also hold privileged positions of authority in our societies but rarely speak out. Here, we argue that to help society create a survivable future, we neuroscientists can and must play our part. In April 2021, we delivered a symposium at the British Neuroscience Association meeting outlining what we think neuroscientists can and should do to help stop climate breakdown. Building on our talks (Box 1), we here outline what the climate and ecological emergencies mean for us as neuroscientists. We highlight the psychological mechanisms that block us from taking action, and then outline what practical steps we can take to overcome these blocks and work towards sustainability. In particular, we review environmental issues in neuroscience research, scientific computing, and conferences. We also highlight the key advocacy roles we can all play in our institutions and in society more broadly. The need for sustainable change has never been more urgent, and we call on all (neuro)scientists to act with the utmost urgency.
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Affiliation(s)
| | - Martin Farley
- Sustainable UCL, University College London, London, UK
- Research Management & Innovation Directorate, King’s College London, London, UK
| | - Kate J. Jeffery
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Anne E. Urai
- Cognitive Psychology Unit, Leiden University, Leiden, The Netherlands
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17
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A Case Study of a Whole System Approach to Improvement in an Acute Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031246. [PMID: 35162269 PMCID: PMC8835196 DOI: 10.3390/ijerph19031246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022]
Abstract
Changes in healthcare tend to be project-based with whole system change, which acknowledges the interconnectedness of socio-technical factors, not the norm. This paper attempts to address the question of whole system change posed by the special issue and brings together other research presented in this special issue. A case study approach was adopted to understand the deployment of a whole system change in the acute hospital setting along four dimensions of a socio-technical systems framework: culture, system functioning, action, and sense-making. The case study demonstrates evidence of whole system improvement. The approach to change was co-designed by staff and management, projects involving staff from all specialities and levels of seniority were linked to each other and to the strategic objectives of the organisation, and learnings from first-generation projects have been passed to second and third-generation process improvements. The socio-technical systems framework was used retrospectively to assess the system change but could also be used prospectively to help healthcare organisations develop approaches to whole system improvement.
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18
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Surgical Safety Checklist: Polychromatic or Achromatic Design. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:11-16. [PMID: 34970728 DOI: 10.1007/5584_2021_699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Surgical Safety Checklist (SSC) has been created based on the recommendations of the WHO and obligatorily introduced worldwide. SSC is used to increase the patient's safety and reduce complications while in the hospital, especially in the perioperative period. The original SSC template was of a multicolor polychromatic design. However, an achromatic black-and-white or gray-gray design on plain printer paper appears often used in clinical practice. This review aims to assess the level of SSC use in the polychromatic versus achromatic versions and the pros and cons of using either in practice. We used the Google browser for the identification and collection of SSC graphic images available as of June 2021 using the following search commands: "surgical safety checklist WHO" or "surgical safety checklist" or "SSC WHO." The commands were repeated in 103 languages representing the five continents with the back answers provided in 41 languages. The successive top 10 thematically relevant images or fewer if not available in the cases of some foreign languages were considered for analysis, providing a mean of 5 ±2 images per language. The numbers of achromatic and polychromatic two-color or multicolor images were calculated. The number of images corresponding to the respective color designs ranged as follows: 0-6 (27.6%), 0-9 (41.6%), and 0-6 (27.6%) We conclude that polychromatic imaging of SSC documents predominates in practical use. The polychromatic SSC design catches the doctor's eye, which likely increases the effectiveness of completing the document.
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19
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Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Compliance with the Surgery Safety Checklist: An Update on the Status. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:1-9. [PMID: 34773633 DOI: 10.1007/5584_2021_661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHO has recommended the implementation of the Surgery Safety Checklist (SSC) to reign in often simple logistic errors that lead to numerous complications, some of them being fatal, in the perioperative period. This study aims to discuss doubts presented in the medical literature concerning the effectiveness of SSC in the currently existing form. The article is based on the literature search performed in PubMed using the command phrase "Surgery Safety Checklist". The search yielded 1,476 articles up to March 2021. Out of this group, we selected 811 articles for further detailed analysis. The selection was based on the meritorious SSC-related topicality and scrutinized content of the articles. Out of these articles, we identified 59 studies that specifically raised the issue of the effectiveness of SSC use in its current form, which we discussed herein in detail. The review distinctly indicates that the SSC reduces perioperative complications including fatalities. However, there are issues reported with the itemized content of the checklist that hardly corresponds to the diverseness of patients' conditions and operating room settings. Further, it is unclear if a reduction in the complications stems from the use of SSC or the algorithms for performing procedures it contains. The consensus arises that SSC should be periodically updated so that it would catch up with the advances in medical knowledge and the emerging technologies, which would safeguard the SSC from becoming just another paperwork nuisance for the operating room staff.
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Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczyslaw Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
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20
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Iliff HA, El-Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan-Pak-Kee V, O'Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia 2021; 77:82-95. [PMID: 34545943 PMCID: PMC9291554 DOI: 10.1111/anae.15585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 12/16/2022]
Abstract
Haematoma after thyroid surgery can lead to airway obstruction and death. We therefore developed guidelines to improve the safety of peri‐operative care of patients undergoing thyroid surgery. We conducted a systematic review to inform recommendations, with expert consensus used in the absence of high‐quality evidence, and a Delphi study was used to ratify recommendations. We highlight the importance of multidisciplinary team management and make recommendations in key areas including: monitoring; recognition; post‐thyroid surgery emergency box; management of suspected haematoma following thyroid surgery; cognitive aids; post‐haematoma evacuation care; day‐case thyroid surgery; training; consent and pre‐operative communication; postoperative communication; and institutional policies. The guidelines support a multidisciplinary approach to the management of suspected haematoma following thyroid surgery through oxygenation and evaluation; haematoma evacuation; and tracheal intubation. They have been produced with materials to support implementation. While these guidelines are specific to thyroid surgery, the principles may apply to other forms of neck surgery. These guidelines and recommendations provided are the first in this area and it is hoped they will support multidisciplinary team working, improving care and outcomes for patients having thyroid surgery.
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Affiliation(s)
- H A Iliff
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - J Davis
- Department of Otolaryngology Head and Neck Surgery, Medway NHS Foundation Trust, Gillingham, UK
| | - A Harris
- Patient Representative, London, UK
| | - S Khan
- Department of Endocrine Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - V Lan-Pak-Kee
- Department of Anaesthesia, Barts Health NHS Trust, London, UK
| | - J O'Connor
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
| | - L Powell
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK.,Health Education and Improvement Wales, Cardiff, UK
| | - G Rees
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board, Merthyr, UK
| | - T S Tatla
- Department of Otolaryngology Head and Neck Surgery, London North West University Healthcare NHS Trust, London, UK
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21
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Hirche C, Kneser U. What We Really can Learn From Aviation: Checklist-based Team Time-Out in Conjunction With Interpersonal Competence Training for the Daily Management of a Surgical Department. Surg Innov 2021; 28:642-646. [PMID: 34319815 DOI: 10.1177/15533506211018439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Aviation and affiliated training concepts have gained a pioneering role in the establishment of interpersonal competence training for physicians and in particular for surgical disciplines. Strengthening interpersonal competence in conjunction with standardized processes and tools aims at implementing safety and error culture in the clinical surroundings while improving patient safety. In a surgical center, safety culture starts with decisive day-to-day management, continues with WHO team time-out and optimal surroundings for the operation, and goes beyond mortality and morbidity conferences and reevaluation of the daily work. Nevertheless, operational day-to-day management has been only little in the focus of security and error culture in surgical literature yet. Method. Interpersonal competence training has been introduced in the hospital group. In 2017, a checklist-based team time-out was implemented to optimize day-to-day management so that conflicts and collisions can be identified timely. Results. The daily completed checklist addresses changes in staff and resource availability, patient-relevant, and other organizational factors. The introduction has provided a significant level of stability and proven itself as part of the safety culture and exemplary leadership beyond the "classical" fields in surgery. Conclusion. This "simple" instrument from the aviation toolbox in conjunction with interpersonal competence training can be recommended to improve the management and safety culture in a surgical clinic to streamline operations and positively affect patient safety and staff development as well as employee satisfaction. Nevertheless, it is not sufficient to implement standard operation procedures templates and checklists, and they have to be lived daily and by everyone.
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Affiliation(s)
- Christoph Hirche
- Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation-Centre, 72067Unfallklinik Frankfurt/Main gGmbH, Academic Teaching Hospital of Goethe-University of Frankfurt, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Plastic, Hand and Reconstructive Microsurgery, Hand-Trauma and Replantation-Centre, 72067Unfallklinik Frankfurt/Main gGmbH, Academic Teaching Hospital of Goethe-University of Frankfurt, Ludwigshafen, Germany
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22
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Peñataro-Pintado E, Díaz-Agea JL, Castillo I, Leal-Costa C, Ramos-Morcillo AJ, Ruzafa-Martínez M, Rodríguez-Higueras E. Self-Learning Methodology in Simulated Environments (MAES©) as a Learning Tool in Perioperative Nursing. An Evidence-Based Practice Model for Acquiring Clinical Safety Competencies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157893. [PMID: 34360190 PMCID: PMC8345589 DOI: 10.3390/ijerph18157893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Background: The self-learning Methodology in Simulated Environments (Spanish acronym: MAES©, (Murcia, Spain) is a type of self-directed and collaborative training in health sciences. The objective of the present study was to compare the level of competence of postgraduate surgical nursing students in the clinical safety of surgical patients, after training with the MAES© methodology versus traditional theoretical–practical workshops, at different points in time (post-intervention, after three months, six months post-intervention, and at the end of the clinical training period, specifically nine months post-intervention). Methods: We conducted a prospective study with an experimental group of surgical nursing postgraduate students who participated in MAES© high-fidelity simulation sessions, and a control group of postgraduate nursing students who attended traditional theoretical–practical sessions at two universities in Catalonia (Spain). The levels of competence were compared between the two groups and at different time points of the study. Results: The score was higher and statistically significantly different in the experimental group for all the competencies, with a large effect size at every measurement point previously mentioned. Conclusions: The postgraduate nurses were the most competent in the clinical safety of surgical patients when they trained with the MAES© methodology than when they learned through traditional theoretical–practical workshops. The learning of surgical safety competencies was more stable and superior in the experimental group who trained with MAES©, as compared to the control group.
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Affiliation(s)
- Ester Peñataro-Pintado
- Nursing Department, University School of Nursing and Occupational Therapy of Terrassa (EUIT), 08221 Terrassa, Spain;
- Nursing Department, International University of Catalonia (UIC), Campus Sant Cugat, 08195 Sant Cugat del Vallès, Spain; (I.C.); (E.R.-H.)
| | - José Luis Díaz-Agea
- Nursing Department, Catholic University of Murcia (UCAM), 30107 Guadalupe de Maciascoque, Spain
- Correspondence: (J.L.D.-A.); (A.J.R.-M.)
| | - Isabel Castillo
- Nursing Department, International University of Catalonia (UIC), Campus Sant Cugat, 08195 Sant Cugat del Vallès, Spain; (I.C.); (E.R.-H.)
- Nursing Department, University General Hospital of Catalonia (UIC), 08195 Sant Cugat del Vallès, Spain
| | - César Leal-Costa
- Nursing Department, University of Murcia, 30003 Murcia, Spain; (C.L.-C.); (M.R.-M.)
| | - Antonio Jesús Ramos-Morcillo
- Nursing Department, University of Murcia, 30003 Murcia, Spain; (C.L.-C.); (M.R.-M.)
- Correspondence: (J.L.D.-A.); (A.J.R.-M.)
| | | | - Encarna Rodríguez-Higueras
- Nursing Department, International University of Catalonia (UIC), Campus Sant Cugat, 08195 Sant Cugat del Vallès, Spain; (I.C.); (E.R.-H.)
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23
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Poveda VDB, Lemos CDS, Lopes SG, Pereira MCDO, Carvalho RD. Implementation of a surgical safety checklist in Brazil: cross-sectional study. Rev Bras Enferm 2021; 74:e20190874. [PMID: 33950112 DOI: 10.1590/0034-7167-2019-0874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the implementation process of the World Health Organization Surgical Safety Checklist in Brazilian hospitals. METHODS this is a cross-sectional study with 531 participants during a Congress of Perioperative Nursing, promoted by the Brazilian Association of Operating Room Nurses, Anesthetic Recovery and Material and Sterilization Center, in 2017. RESULTS among the nursing professionals included, 84.27% reported the checklist implementation in the workplace. Regarding daily application in the Sign-in stage, 79.65% of professionals confirmed patient identification with two indicators; in the Time-out stage, 51.36% of surgeries started regardless of confirmation of one of the items. In the Sign-out stage, 69.34% of professionals did not count or occasionally counted the surgical instruments and suture needles, and only 36.36% reviewed concerns about postoperative recovery. CONCLUSION this study identified needs for improvements in applying the checklist in the Brazilian reality, to guarantee safer surgical procedures.
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24
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Reine E, Aase K, Raeder J, Thorud A, Aarsnes RM, Rustøen T. Exploring postoperative handover quality in relation to patient condition: A mixed methods study. J Clin Nurs 2021; 30:1046-1059. [PMID: 33434381 DOI: 10.1111/jocn.15650] [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: 03/23/2020] [Revised: 12/03/2020] [Accepted: 12/31/2020] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe postoperative handover reporting and tasks in relation to patient condition and situational circumstances, in order to identify facilitators for best practices. BACKGROUND High-quality handovers in postoperative settings are important for patient safety and continuity of care. There is a need to explore handover quality in relation to patient condition and other affecting factors. DESIGN Observational mixed methods convergent design. METHODS Postoperative patient handovers were observed collecting quantitative (n = 109) and qualitative data (n = 48). Quantitative data were collected using the postoperative handover assessment tool (PoHAT), and a scoring system assessing patient condition. Qualitative data were collected using free-text field notes and an observational guide. The study adheres to the GRAMMS guideline for reporting mixed methods research. RESULTS Information omissions in the handovers observed ranged from 1-13 (median 7). Handovers of vitally stable and comfortable patients were associated with more information omissions in the report. A total of 50 handovers (46%) were subjected to interruptions, and checklist compliance was low (13%, n = 14). Thematic analysis of the qualitative data identified three themes: "adaptation of handover," "strategies for information transfer" and "contextual and individual factors." Factors facilitating best practices were related to adaptation of the handover to patient condition and situational circumstances, structured verbal reporting, providing patient assessments and dialogue within the handover team. CONCLUSIONS The variations in items reported and tasks performed during the handovers observed were related to patient conditions, situational circumstances and low checklist compliance. Adaptation of the handover to patient condition and situation, structured reporting, dialogue within the team and patient assessments contributed to quality. RELEVANCE TO CLINICAL PRACTICE It is important to acknowledge that handover quality is related to more than transfer of information. The present study has described how factors related to the patient and situation affect handover quality.
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Affiliation(s)
- Elizabeth Reine
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Johan Raeder
- Department of Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Thorud
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Reidunn M Aarsnes
- Department of Nurse Anaesthesia, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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25
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Blake H, Yildirim M, Wood B, Knowles S, Mancini H, Coyne E, Cooper J. COVID-Well: Evaluation of the Implementation of Supported Wellbeing Centres for Hospital Employees during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249401. [PMID: 33333913 PMCID: PMC7768437 DOI: 10.3390/ijerph17249401] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
Supported Wellbeing Centres have been set up in UK hospital trusts in an effort to mitigate the psychological impact of COVID-19 on healthcare workers, although the extent to which these are utilised and the barriers and facilitators to access are not known. The aim of the study was to determine facility usage and gather insight into employee wellbeing and the views of employees towards this provision. The study included (i) 17-week service use monitoring, (ii) employee online survey with measures of wellbeing, job stressfulness, presenteeism, turnover intentions, job satisfaction, and work engagement, as well as barriers and facilitators to accessing the Wellbeing Centres. Over 17 weeks, 14,934 facility visits were recorded across two sites (peak attendance in single week n = 2605). Facilities were highly valued, but the service model was resource intensive with 134 wellbeing buddies supporting the centres in pairs. 819 hospital employees completed an online survey (88% female; 37.7% working in COVID-19 high risk areas; 52.4% frontline workers; 55.2% had accessed a wellbeing centre). There was moderate-to-high job stress (62.9%), low wellbeing (26.1%), presenteeism (68%), and intentions to leave (31.6%). Wellbeing was higher in those that accessed a wellbeing centre. Work engagement and job satisfaction were high. Healthcare organisations are urged to mobilise access to high-quality rest spaces and psychological first aid, but this should be localised and diversified. Strategies to address presenteeism and staff retention should be prioritised, and the high dedication of healthcare workers should be recognised.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
- Correspondence:
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
| | - Ben Wood
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Steph Knowles
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Helen Mancini
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Emma Coyne
- Clinical Psychology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Joanne Cooper
- Nursing and Midwifery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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26
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Peñataro-Pintado E, Rodríguez E, Castillo J, Martín-Ferreres ML, De Juan MÁ, Díaz Agea JL. Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study. Nurs Inq 2020; 28:e12390. [PMID: 33152131 DOI: 10.1111/nin.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022]
Abstract
Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.
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Affiliation(s)
- Ester Peñataro-Pintado
- Nursing Department, University School of Nursing and Occupational Therapy of Terrassa (EUIT), Autonomous University of Barcelona (UAB), Terrassa, Spain
| | - Encarna Rodríguez
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - Jordi Castillo
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain.,Hospital Universitari de Bellvitge (HUB), Barcelona, Spain
| | - María Luisa Martín-Ferreres
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - María Ángeles De Juan
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - José Luis Díaz Agea
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
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Ferreira RP, Abreu P, Tomasich FDS, Preti VB. Quality management in surgery: improving clinical and surgical outcomes. ACTA ACUST UNITED AC 2020; 47:e20202726. [PMID: 33111835 DOI: 10.1590/0100-6991e-20202726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
Quality is a term used by various specialists, from different perspectives, having as a common point to identify focuses that promote their development in institutional management. Quality processes allow us to improve assistance, reducing complication and death rates and reducing costs. Currently, the positive experience of the patient is highly valued and should be sought by all institutions. The benefits of quality procedures are extensive. There is evidence of lower complication and mortality rates, cost reduction, uniformity of care, improved communication and opportunity for health education. There is a need for financial investment by the institutions, but they can be converted in the future. The idea that these are just bureaucratic steps must be fought because individualistic attitudes are no longer part of safe medicine. The success of a quality process requires interdisciplinarity, integration with quality offices for effective communication. The implementation of feasible attitudes should be sought, with a high adherence rate to seek patient satisfaction and safety. We will address historical aspects, the requirements for the implementation of a quality program, the concepts of indicators and the aspects that influence the quality in surgery, in addition to presenting benefits that such a program can offer to the surgeon and the institution.
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Affiliation(s)
- Raphaella Paula Ferreira
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Área de Fígado e Hipertensão Portal - São Paulo - SP - Brasil
| | - Phillipe Abreu
- - Faculdade de Ciências Médicas da Santa Casa de São Paulo, Departamento de Cirurgia, Área de Fígado e Hipertensão Portal - São Paulo - SP - Brasil
| | | | - Vinicius Basso Preti
- -Hospital Erasto Gaertner, Departamento de Cirurgia, Serviço de Cirurgia Abdominal e Tórax - Curitiba - PR - Brasil
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Khatkar H, Prokopenko M. A commentary on "The WHO safer surgery checklist time out procedure revisited: Strategies to optimise compliance and safety" [International Journal of Surgery 69 (2019) 19-22]. Int J Surg 2019; 72:135-136. [PMID: 31712052 DOI: 10.1016/j.ijsu.2019.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/31/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Harman Khatkar
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Max Prokopenko
- Oxford University Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
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Dawka S. Commentary on: 'The WHO safer surgery checklist time out procedure revisited: Strategies to optimise compliance and safety'. Int J Surg 2019; 68:180. [PMID: 31351145 DOI: 10.1016/j.ijsu.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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