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Catchpole K, Cohen T, Alfred M, Lawton S, Kanji F, Shouhed D, Nemeth L, Anger J. Human Factors Integration in Robotic Surgery. HUMAN FACTORS 2024; 66:683-700. [PMID: 35253508 PMCID: PMC11268371 DOI: 10.1177/00187208211068946] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Using the example of robotic-assisted surgery (RAS), we explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. BACKGROUND New operating room technologies offer potential benefits for patients and staff, yet also present challenges for physical, procedural, team, and organizational integration. Historically, RAS implementation has focused on establishing the technical skills of the surgeon on the console, and has not systematically addressed the new skills required for other team members, the use of the workspace, or the organizational changes. RESULTS Human factors studies of robotic surgery have demonstrated not just the effects of these hidden complexities on people, teams, processes, and proximal outcomes, but also have been able to analyze and explain in detail why they happen and offer methods to address them. We review studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. CONCLUSION There is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.Precis: The introduction of robotic surgery has exposed under-acknowledged complexities of introducing complex technology into operating rooms. We explore the methodological and practical challenges, provide examples of evidence-based improvements, and discuss the implications for systems engineering and clinical human factors research and practice.
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Affiliation(s)
- Ken Catchpole
- Medical University of South Carolina, Charleston, USA
| | - Tara Cohen
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Sam Lawton
- Medical University of South Carolina, Charleston, USA
| | | | | | - Lynne Nemeth
- Medical University of South Carolina, Charleston, USA
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Andreasen EM, Berg H, Steinsbekk A, Høigaard R, Haraldstad K. The effect of using desktop VR to practice preoperative handovers with the ISBAR approach: a randomized controlled trial. BMC MEDICAL EDUCATION 2023; 23:983. [PMID: 38124094 PMCID: PMC10731819 DOI: 10.1186/s12909-023-04966-y] [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: 04/27/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
AIM The aim was to investigate whether second-year undergraduate nursing students practicing the Identification-Situation-Background-Assessment-Recommendation (ISBAR) communication approach in a desktop virtual reality (VR) application had a non-inferior learning outcome compared with the traditional paper-based method when sorting patient information correctly based on the ISBAR structure. METHODS A non-inferior parallel group assessor blinded randomized controlled trial, conducted in simulation sessions as part of preparation for clinical placements in March and April 2022. After a 20-minute introductory session, the participants were randomized to self-practice the ISBAR approach for 45 minutes in groups of three in either an interactive desktop VR application (intervention) or traditional paper-based (TP) simulation. The primary outcome concerned the proportion of nursing students who sorted all 11 statements of patient information in the correct ISBAR order within a time limit of 5 min. The predefined, one-sided, non-inferiority limit was 13 percentage points in favor of traditional paper-based simulation. RESULTS Of 210 eligible students, 175 (83%) participated and were allocated randomly to the VR (N = 87) or TP (N = 88) group. Practicing in the desktop VR application (36% of everything correct) was non-inferior to the traditional paper-based method (22% everything correct), with a difference of 14.2 percentage points (95% CI 0.7 to 27.1) in favor of VR. The VR group repeated the simulation 0.6 times more (95% CI 0.5 to 0.7). Twenty percent more (95% CI 6.9 to 31.6) of the students in the VR group reported liked how they practiced. All the other outcomes including the System Usability Scale indicated non-inferiority or were in favor of VR. CONCLUSIONS Self-practicing with the ISBAR approach in desktop VR was non-inferior to the traditional paper-based method and gave a superior learning outcome. TRIAL REGISTRATION NUMBER ISRCTN62680352 registered 30/05/2023.
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Affiliation(s)
- Eva Mari Andreasen
- Department of Health and Nursing Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway.
| | - Helen Berg
- Department of Health Sciences, Norwegian University of Science and Technology, P.O. Box 1517, 6025, Ålesund, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8900, 7491, Trondheim, Norway
| | - Rune Høigaard
- Department of Sport Science and Physical Education, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing Sciences, University of Agder, P.O. Box 422, 4604, Kristiansand, Norway
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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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Gerstein NS, Panikkath PV, Mirrakhimov AE, Lewis AE, Ram H. Cardiopulmonary Bypass Emergencies and Intraoperative Issues. J Cardiothorac Vasc Anesth 2022; 36:4505-4522. [PMID: 36100499 DOI: 10.1053/j.jvca.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 11/11/2022]
Abstract
Cardiopulmonary bypass (CPB) is a complex biomechanical engineering undertaking and an essential component of cardiac surgery. However, similar to all complex bioengineering systems, CPB activities are prone to a variety of safety and biomechanical issues. In this narrative review article, the authors discuss the preventative and intraoperative management strategies for a number of intraoperative CPB emergencies, including cannulation complications (dissection, malposition, gas embolism), CPB equipment issues (heater-cooler failure, oxygenator issues, electrical failure, and tubing rupture), CPB circuit thrombosis, medication issues, awareness during CPB, and CPB issues during transcatheter aortic valve replacement.
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Affiliation(s)
- Neal S Gerstein
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
| | - Pramod V Panikkath
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Aibek E Mirrakhimov
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Alexander E Lewis
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM
| | - Harish Ram
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, FL
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Wani MM, Gilbert JHV, Mohammed CA, Madaan S. Factors Causing Variation in World Health Organization Surgical Safety Checklist Effectiveness-A Rapid Scoping Review. J Patient Saf 2022; 18:e1150-e1159. [PMID: 35675706 DOI: 10.1097/pts.0000000000001035] [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: 11/26/2022]
Abstract
INTRODUCTION This review was conducted to determine what factors might be responsible for prejudicing the outcomes after the implementation of a World Health Organization Surgical Safety Checklist (WHO SSC), grouping them appropriately and proposing strategies that enable the SSC a more helpful and productive tool in the operating room. METHODS It was a rapid scoping review conducted as per Preferred Reporting Items for Systematic Review and Meta-analyses extension guidelines for scoping reviews (PRISMA-Scr). Comprehensive search on MEDLINE and Embase was carried out, to include all relevant studies published during last 5 years. Twenty-seven studies were included in analysis. The barriers to SSC implementation were classified into 5 main groups, with further subdivisions in each. RESULTS The results of review revealed that there are 5 major barriers to SSC at the following levels: organizational, checklist, individual, technical, and implementation. Each of these major barriers, on further evaluation, was found to have more than one contributing factors. All these factors were analyzed individually. CONCLUSIONS This rapid scoping review has consolidated data, which may pave the way for experts to further examine steps that might be taken locally or globally in order that the WHO SSC to successfully achieve all its desired goals.
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Affiliation(s)
| | | | - Ciraj Ali Mohammed
- Medical Education, MAHE-FAIMER International Institute for Leadership in Interprofessional Education, Manipal Academy of Higher Education, India and Professor and Head, Medical Education, College of Medicine and Health Sciences, National University of Science and Technology, Sohar, Muscat, Oman
| | - Sanjeev Madaan
- Department Of Urology, Darent Valley Hospital, Dartford Visiting Professor, Canterbury Christ Church University, Canterbury, United Kingdom
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Crisis Preparedness: A Systems-Based Framework for Avoiding Harm in Surgery. J Am Coll Surg 2022; 235:622-623. [PMID: 35709377 DOI: 10.1097/xcs.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Thomé ARCS, Bernardo THL, Sarmento PDA, Coelho JAPDM, Fedocci EMM. Validação de checklist para utilização em cirurgia cardíaca segura. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220025.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo Construir e validar um instrumento no formato checklist para utilização em cirurgia cardíaca segura. Método Pesquisa metodológica realizada nas seguintes etapas: revisão da literatura; construção dos itens e validação de conteúdo por especialistas em duas etapas, a nível regional com 9 e nacional com 14 juízes. Para análise dos dados, aplicou-se a taxa de concordância por item construído. Resultados A construção da versão 1 resultou em 49 itens, a versão 2 apresentou 46 itens, e a versão final 41 itens distribuídos em Sign in (1 a 27), Time out (28 a 32) e Sign out (33 a 41). Na versão final, todos os itens foram validados com concordância superior a 80%. Conclusão O checklist foi construído e validado quanto ao conteúdo, composto por 41 itens,e poderá ser utilizado na área de cirurgia cardíaca para a implementação de assistência segura aos pacientes submetidos a esses procedimentos.
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Thomé ARCS, Bernardo THL, Sarmento PDA, Coelho JAPDM, Fedocci EMM. Checklist validation for use in safe heart surgery. Rev Gaucha Enferm 2022; 43:e20220025. [DOI: 10.1590/1983-1447.2022.20220025.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/24/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective Build and validate an instrument in checklist format for use in safe cardiac surgery. Method Methodological research carried out in the following stages: literature review; national construction of items and content validation by experts in two stages, at regional level 9 and with 41 judges. For data analysis, the agreement rate per constructed item was determined. Results The construction of version 1 resulted in 49 items, version 2 presented 46 items, and the final version 41 items distributed in Sign in (1 to 27), Time out (28 to 32) and Sign out (33 to 41). All items obtained agreement greater than 80%, considering validated. Conclusion The checklist was built and validated in terms of content, consisting of 41 items, and can be used in the area of cardiac surgery for the implementation of safe care for patients undergoing these procedures.
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Maran E, Matsuda LM, Marcon SS, Haddad MDCFL, Costa MAR, Magalhães AMMD. ADAPTATION AND VALIDATION OF A MULTIDISCIPLINARY CHECKLIST FOR ROUNDS IN THE INTENSIVE CARE UNIT. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to perform the adaptation, content validation and semantic analysis of a Multidisciplinary Checklist used in rounds in Intensive Care Units for adults. Method: a methodological study, consisting of three stages: Adaptation of the checklist, performed by one of the authors; Content validation, performed by seven judges/health professionals from a public teaching hospital in Paraná; and Semantic analysis, performed in a philanthropic hospital in the same state. Agreement of the judges and of the target audience in the content validation and semantic analysis stages was calculated using the Content Validity Index and the Agreement Index, respectively, with a minimum acceptable value of 0.80. Results: in the content validation stage, the checklist obtained a total agreement of 0.84. Of the 16 items included in the instrument, 11 (68.75%) were readjusted and four (25%) were excluded for not reaching the minimum agreement. The readjusted items referred to sedation; analgesia; nutrition; glycemic control; headboard elevation; gastric ulcer prophylaxis; prophylaxis for venous thromboembolism; indwelling urinary catheter, central venous catheter; protective mechanical ventilation and spontaneous breathing test. Regarding the items excluded, they referred to the cuff pressure of the orotracheal tube and to Nursing care measures such as taking the patient out of the bed, pressure injury prophylaxis, and ophthalmoprotection. In the semantic analysis, the final agreement of the instrument's items was 0.96. Conclusion: after two evaluation rounds by the judges, testing in critically-ill patients and high inter-evaluator agreement index, the Multidisciplinary Checklist is found with validated content suitable for use in rounds in intensive care.
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Affiliation(s)
- Edilaine Maran
- Universidade Estadual de Maringá, Brasil; Universidade Estadual do Paraná, Brasil
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Alberto EC, Jagannath S, McCusker ME, Keller S, Marsic I, Sarcevic A, O’Connell KJ, Burd RS. Classification strategies for non-routine events occurring in high-risk patient care settings: A scoping review. J Eval Clin Pract 2021; 27:464-471. [PMID: 33249690 PMCID: PMC7961264 DOI: 10.1111/jep.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Non-routine events (NREs) are atypical or unusual occurrences in a pre-defined process. Although some NREs in high-risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will facilitate the comparison of results between studies. METHODS We conducted a literature search in PubMed, CINAHL, and EMBASE to identify studies related to NREs in high-risk domains and evaluated the methods used for event observation and description. We applied The Joint Commission on Accreditation of Healthcare Organization (JCAHO) taxonomy (cause, impact, domain, type, prevention, and mitigation) to the descriptions of NREs from the literature. RESULTS We selected 25 articles that met inclusion criteria for review. Real-time documentation of NREs was more common than a retrospective video review. Thirteen studies used domain experts as observers and seven studies validated observations with interrater reliability. Using the JCAHO taxonomy, "cause" was the most frequently applied classification method, followed by "impact," "type," "domain," and "prevention and mitigation." CONCLUSIONS NREs are frequent in high-risk medical settings. Strengths identified in several studies included the use of multiple observers with domain expertise and validation of the event ascertainment approach using interrater reliability. By applying the JCAHO taxonomy to the current literature, we provide an example of a structured approach that can be used for future analyses of NREs.
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Affiliation(s)
- Emily C. Alberto
- Division of Trauma and Burns, Children’s National Hospital, Washington, DC, USA
| | - Swathi Jagannath
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Maureen E. McCusker
- Office of Institutional Research and Decision Support, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Keller
- Department of Nursing Science Professional Practice and Quality, Children’s National Hospital, Washington, DC, USA
| | - Ivan Marsic
- Department of Electrical and Computer Engineering, Rutgers University, Piscataway, NJ, USA
| | - Aleksandra Sarcevic
- College of Computing and Informatics, Drexel University, Philadelphia, PA, USA
| | - Karen J. O’Connell
- Division of Emergency Medicine, Children’s National Hospital, Washington, DC, USA
| | - Randall S. Burd
- Division of Trauma and Burns, Children’s National Hospital, Washington, DC, USA
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Gibson DR. Mindset First, Strategy Second: Finding the Savings and Performance in Changing Culture. Mil Med 2021; 185:17-24. [PMID: 33002147 DOI: 10.1093/milmed/usaa190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Resolving major challenges for health care organizations is a constant challenge. Each military service provides its leaders with superb education and training to lead the constant needs and changes of the mission requirements. The primary trap we leaders may fall into, though, is when we mistake our own expertise and perspectives as the solutions to our organizational challenges. To fully unleash the potential of our people and organizations, we must be deliberate in setting a culture that leverages all the diversity within our organization. At the Carl R. Darnall Army Medical Center, Fort Hood, TX, our leadership team initiated an effort to shift the organizational mindset to create this cultural soil. The seeds of our education, training and strategic initiatives then were able to flourish and address our organizational challenges, but only after we addressed our own leadership mindset gap. By establishing and modeling a foundational outward mindset to ensure our team focused on the impact of our actions, we nurtured a culture that was inquisitive, collaborative, and without blame. In doing so, we eliminated negative financial and safety outcomes that threatened our institution and transformed it into a leading Army Medical Center.
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Affiliation(s)
- David R Gibson
- Vizient, Inc. Senior Principal, Member Performance, 4401 Woodbine Lane, Prosper, TX 75078
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Tan J, Ngwayi JRM, Ding Z, Zhou Y, Li M, Chen Y, Hu B, Liu J, Porter DE. Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China. Patient Saf Surg 2021; 15:3. [PMID: 33407718 PMCID: PMC7788865 DOI: 10.1186/s13037-020-00276-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Background Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. Methods A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. Results A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the ‘time-out’ component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. Conclusion The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.
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Affiliation(s)
- Jie Tan
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
| | | | - Zhaohan Ding
- Medical Department, Linyi Tumour Hospital, Linyi, 276002, China
| | - Yufa Zhou
- Anaesthesiology Department, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China
| | - Ming Li
- Anaesthesiology Department, Ningbo Medical Center Lihuili Hospital, Ningbo, 315040, China
| | - Yujie Chen
- Department of Trauma and Bone Tumour, Tongji Hospital, Tongji University, Shanghai, 200065, China
| | - Bingtao Hu
- Department of Spine Surgery, Luohe Central Hospital, Luohe Medical College, Luohe, 462000, China
| | - Jinping Liu
- Operating Department, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, 100016, China
| | - Daniel Edward Porter
- Department of Orthopaedic Surgery, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, 100016, China
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Batistini HC, de Sant'Anna ALGG, Dellacrode Giovanazzi RS, Rosa de Freitas V, Martins da Costa SAC, Machado RC. Checklist validation for care provided to patients in the immediate postoperative period of cardiac surgery. J Clin Nurs 2020; 29:4171-4179. [PMID: 32761985 DOI: 10.1111/jocn.15446] [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: 03/03/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES We created and validated a checklist for nursing care of patients in the immediate postoperative period of cardiac surgery. BACKGROUND Cardiovascular diseases (CVD) account for about 30% of all deaths recorded in Brazil. There is an arsenal of clinical and surgical treatments for CVD, with a significant number of patients evolving to surgical treatment. Thus, health professionals working in the perioperative period of cardiovascular surgeries need to be updated, trained and qualified to provide adequate and safe care to patients. DESIGN We developed a checklist that defined essential parameters for quality care, to ensure greater agility and patient safety. METHODS This methodology validation study comprised two stages: checklist creation for care provided by nurses to patients in the IPO of cardiac surgery, and content validation using the Delphi method. Participants were selected through an advanced survey conducted on the Lattes Platform website of the National Council for Scientific and Technological Development. The STROBE checklist was used to guide the study. RESULTS Three rounds of analysis by specialists resulted in average CVIs of: 95.8% for objectivity, 97.9% for simplicity, 91.0% for clarity, 93.1% for relevance and 96.5% for variety, suggesting high agreement among specialists. CONCLUSIONS The checklist focused on nursing care of patients in the IPO of cardiac surgery and was validated with three topics, four categories, 16 items and 86 sub-items of care assignments to be applied in clinical practice. RELEVANCE TO CLINICAL PRACTICE This is a validated instrument that guides nurses' actions by admitting postoperative cardiac surgery patients to the ICU based on evidence, which provides more scientific and professional support to health teams' performance, with the objective of strengthening roles and establishing routines; thus presenting a powerful tool for planning nursing actions, providing quality care to patients, and facilitating communication between teams, thereby minimising risks.
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Affiliation(s)
| | - Ana Lucia Gargione Galvão de Sant'Anna
- Graduate Program in Nursing, Federal University of São Carlos, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil
| | - Rosemeire Simone Dellacrode Giovanazzi
- Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,UNOESTE College of Medicine Jaú Campus, Presidente Prudente, São Paulo, Brazil.,Faculty of Medicine UNOESTE Campus Jaú, Presidente Prudente, São Paulo, Brazil
| | | | - Suelen Alves Creste Martins da Costa
- Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,UNOESTE College of Medicine Jaú Campus, Presidente Prudente, São Paulo, Brazil.,Faculty of Medicine UNOESTE Campus Jaú, Presidente Prudente, São Paulo, Brazil
| | - Regimar Carla Machado
- Graduate Program in Nursing, Federal University of São Carlos, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, Health Technology and Innovation Research Laboratory-LAPeTIS, São Paulo, Brazil.,Paulista School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Spanjersberg AJ, Ottervanger JP, Nierich AP, Speekenbrink RG, Stooker W, Hoogendoorn M, van Veghel D, Houterman S, Brandon Bravo Bruinsma GJ. Implementation of a specific safety check is associated with lower postoperative mortality in cardiac surgery. J Thorac Cardiovasc Surg 2020; 159:1882-1890.e2. [DOI: 10.1016/j.jtcvs.2019.07.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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Near-Miss Event With the Xoft Breast Intraoperative Radiation Therapy System. Pract Radiat Oncol 2019; 9:e443-e446. [DOI: 10.1016/j.prro.2019.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/14/2019] [Accepted: 04/29/2019] [Indexed: 11/22/2022]
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Implementing Medical Technological Equipment in the OR: Factors for Successful Implementations. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:8502187. [PMID: 30245784 PMCID: PMC6136550 DOI: 10.1155/2018/8502187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Abstract
Operating rooms (ORs) more and more evolve into high-tech environments with increasing pressure on finances, logistics, and a not be neglected impact on patient safety. Safe and cost-effective implementation of technological equipment in ORs is notoriously difficult to manage, specifically as generic implementation activities omit as hospitals have implemented local policies for implementations of technological equipment. The purpose of this study is to identify success factors for effective implementations of new technologies and technological equipment in ORs, based on a systematic literature review. We accessed ten databases and reviewed included articles. The search resulted in 1592 titles for review, and finally 37 articles were included in this review. We distinguish influencing factors and resulting factors based on the outcomes of this research. Six main categories of influencing factors on successful implementations of medical equipment in ORs were identified: “processes and activities,” “staff,” “communication,” “project management,” “technology,” and “training.” We identified a seventh category “performance” referring to resulting factors during implementations. We argue that aligning the identified influencing factors during implementation impacts the success, adaptation, and safe use of new technological equipment in the OR and thus the outcome of an implementation. The identified categories in literature are considered to be a baseline, to identify factors as elements of a generic holistic implementation model or protocol for new technological equipment in ORs.
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Trowbridge ER, Dreisbach CN, Sarosiek BM, Dunbar CP, Evans SL, Hahn LA, Hullfish KL. Review of enhanced recovery programs in benign gynecologic surgery. Int Urogynecol J 2017; 29:3-11. [DOI: 10.1007/s00192-017-3442-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/24/2017] [Indexed: 01/03/2023]
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Gillespie BM, Harbeck E, Kang E, Steel C, Fairweather N, Chaboyer W. Correlates of non-technical skills in surgery: a prospective study. BMJ Open 2017; 7:e014480. [PMID: 28137931 PMCID: PMC5293872 DOI: 10.1136/bmjopen-2016-014480] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. METHODS We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. RESULTS We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. CONCLUSIONS Miscommunications and interruptions impact on team NTS performance.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
| | - Emma Harbeck
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Evelyn Kang
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Catherine Steel
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Nicole Fairweather
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Wendy Chaboyer
- National Centre for Research Excellence in Nursing (NCREN), Menzies Health Institute Qld (MHIQ), Griffith University, Gold Coast, Queensland, Australia
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Anderson BR. Improving health care by embracing Systems Theory. J Thorac Cardiovasc Surg 2016; 152:593-4. [PMID: 27113625 DOI: 10.1016/j.jtcvs.2016.03.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY.
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