Protocolo de Cirurgia Segura da OMS: O grau de conhecimento dos ortopedistas brasileiros

Medical errors, affected sites, and adverse consequences among patients in the orthopaedic department: Does age matter?

Background

Orthopaedics have become the focus of research on patient safety due to the high incidence of medical errors. Previous studies were based on all orthopaedic patients and rarely conducted empirical analyses from the perspective of age. This study aimed to fill the academic gap in the age variable by comparing medical errors, affected sites, and adverse consequences in orthopaedic patients.

Methods

This retrospective study included 329 litigation claims against orthopaedists using data from China Judgments Online. First, we performed computer crawling and screened 5,237 litigation documents using keywords, including medical errors. Second, 2,536 samples were retained through systematic random sampling, and 549 irrelevant cases were deleted after manual reading. Finally, three clinicians from different medical departments selected 329 incidents related to orthopaedics for further analysis, according to the description of the lawsuits. Three other professional orthopaedists evaluated the patients' ages, affected sites of medical errors, and adverse consequences.

Results

The greatest number of medical errors was observed in the joints (30.43%) for all orthopaedic patients. However, adult patients (aged 18-60 years) were most susceptible to errors in the extremities (30.42%). A higher rate of complications was associated with a higher rate of morbidity/mortality for the corresponding patients. Medical errors correlated with complications occurred in the following sites: joints (15.38%), extremities (12.50%), spine (16.95%), multiple sites (15.38%), and hands and feet (14.81%). In addition to surgical errors, over 10% of all orthopaedic patients experienced missed diagnoses. The incidence of insufficient adherence to informed consent obligations was 13.5% among adult patients and was much higher in paediatric and older adults patients. When orthopaedic patients suffered from medical technical errors, iatrogenic mortality/morbidity would decrease by 0.3% for one unit increase in age.

Conclusion

Dividing patients into different ages demonstrated diverse results in terms of medical errors and affected sites. Negligence in diagnosis and examination can be fatal factors that endanger safety, and complications may cause morbidity/mortality. When patients suffered from technical errors, age is inversely proportional to mortality/morbidity. Special attention needs to be paid to technical errors in the younger older adults population (60-64 years old), which has inspired implications in promoting aging and public health.

Causes and Effects of Introducing Surgery Safety Checklist: A Review

The medical treatment process, particularly surgery, is inescapably bound to potential complications or undesirable adverse events. This narrative review aims to present the causes and effects of the introduction of the WHO Surgery Safety Checklist (SSC), the use of which is expected to reduce the number of perioperative errors, complications, and mortality. To achieve this objective, we performed a bibliometric analysis of medical citations indexed in the PubMed database using the SSC subject heading. Findings revealed a total of 1441 articles meeting inclusion status, with 1171 published during the last decade. After the screening of titles and abstracts, the members of the research team selected 75 articles, deemed most relevant for inclusion in the review, which were then thoroughly analyzed. All in all, the findings were that the use of SSC appreciably reduced the number of simple logistic errors in the perioperative period decreasing the frequency of resulting complications and mortality.

Impact of the "Mind the risk" Campaign of Sociedade Brasileira de Ortopedia e Traumatologia on Risk Perception and Use of the Surgical Checklist by Brazilian Orthopedists

Objective  To analyze the impact of the educational actions included in the "Mind the Risk" campaign of Sociedade Brasileira de Traumatologia e Ortopedia (Brazilian Society of Traumatology and Orthopedics, SBOT, in Portuguese), to increase the perception of the risk involved in the surgical activity and the use of the surgical checklist. Methods  A comparative research was performed during the 50th Brazilian Congress on Orthopedics and Traumatology (50° CBOT, in Portuguese) in November 2018, using a questionnaire similar to the one used in previous two versions. Results  The number of participants was 730, corresponding to 18,7% of the total of 3,903 enrolled in the 50° CBOT. Among the participants, 542 orthopedists (74,2%) reported having experienced errors within the surgical units and 218 (29,8%) surgeries in wrong sites. In total, 624 participants (85,5%) reported marking the surgical site and 402 (55%) using the surgical checklist systematically. Conclusion  In the sample studied, it was evidenced that SBOT's efforts to disseminate the World Health Organization (WHO) protocol were effective, reducing the number of orthopedists who were unaware of it from 65.3% (in 2012) to 20.7% (in 2018), and expanding its use. In 2018, 402 participants (55%) reported the systematic use of the protocol, compared with 301 (40,8%) in 2014. These data confirm the need for educational campaigns and systematic training, not only to promote behavioral change, but especially a cultural change.

Cross-sectional study of surgical quality with a novel evidence-based tool for low-resource settings

BACKGROUND

Adverse events from surgical care are a major cause of death and disability, particularly in low-and-middle-income countries. Metrics for quality of surgical care developed in high-income settings are resource-intensive and inappropriate in most lower resource settings. The purpose of this study was to apply and assess the feasibility of a new tool to measure surgical quality in resource-constrained settings.

METHODS

This is a cross-sectional study of surgical quality using a novel evidence-based tool for quality measurement in low-resource settings. The tool was adapted for use at a tertiary hospital in Amazonas, Brazil resulting in 14 metrics of quality of care. Nine metrics were collected prospectively during a 4-week period, while five were collected retrospectively from the hospital administrative data and operating room logbooks.

RESULTS

183 surgeries were observed, 125 patient questionnaires were administered and patient charts for 1 year were reviewed. All metrics were successfully collected. The study site met the proposed targets for timely process (7 hours from admission to surgery) and effective outcome (3% readmission rate). Other indicators results were equitable structure (1.1 median patient income to catchment population) and equitable outcome (2.5% at risk of catastrophic expenditure), safe outcome (2.6% perioperative mortality rate) and effective structure (fully qualified surgeon present 98% of cases).

CONCLUSION

It is feasible to apply a novel surgical quality measurement tool in resource-limited settings. Prospective collection of all metrics integrated within existing hospital structures is recommended. Further applications of the tool will allow the metrics and targets to be refined and weighted to better guide surgical quality improvement measures.

Patient safety awareness among 309 surgeons in Enugu, Nigeria: a cross-sectional survey

Background

Adverse healthcare events are major public health problem with the heaviest burden in the low and middle-income countries. Patient safety awareness among healthcare professionals is known to impact this outcome; thus we set out to appraise the patient safety awareness among surgeons in Enugu, Nigeria.

Methods

A multi-institutional cross-sectional survey was carried out among surgeons in Enugu, Nigeria and data obtained were analyzed using the statistical package for scientific solutions (SPSS) version 20 software.

Results

A total of 309 surgeons were surveyed. Majority of the surgeons (51.9%) had poor perception of patient safety issues. One hundred and twenty respondents (38.8%) have awareness of any institutional protocol for preventing wrong-site surgery while only 35 respondents (11.3%) regularly practiced an institutional protocol for preventing wrong-site surgery. The professional status of the surgeons and years in service showed significant association with perception of patient safety issues.

Conclusion

The patient safety awareness and practice among the surgeons in Enugu, Nigeria is apparently low and this was found to be influenced by the professional status and years in service of the surgeon.

Safety check list in outpatient surgery teaching

This article proposes the use of a safe surgical checklist in the teaching of the discipline of Ambulatory Surgery during medical graduation. It discusses its benefits and potential implementation and adherence difficulties. It underscores the importance of developing a patient safety culture and active learning methodologies to train students for greater commitment and accountability with the quality of care provided to the community in the academic outpatient clinic of the school hospital.

Checklist de cirurgia segura: adesão ao preenchimento, inconsistências e desafios

RESUMO Objetivo: identificar a adesão ao checklist de cirurgia segura, a partir do seu preenchimento, em um hospital geral de referência do interior do Estado de Minas Gerais, bem como, verificar os fatores associados à sua utilização. Métodos: trata-se de estudo transversal, documental, retrospectivo de abordagem quantitativa. A coleta de dados foi realizada por meio da revisão retrospectiva de prontuários de uma amostra de pacientes operados no período de um ano. Foram incluídos os atendimentos de pacientes cirúrgicos de todas as especialidades, com idade de 18 anos ou mais, e período de internação igual ou maior do que 24 horas. A amostra probabilística foi de 423 casos. Resultados: o checklist estava presente em 95% dos prontuários. Porém, apenas 67,4% deles estavam com preenchimento completo. A presença do checklist no prontuário apresentou associação significativa com o risco anestésico do paciente. Não houve diferença no percentual de preenchimento entre os três momentos do checklist: antes da indução anestésica (sign in), antes da incisão cirúrgica (time out ou parada cirúrgica) e antes do paciente deixar a sala de cirurgia (sign out). Também não foram encontradas diferenças significativas em relação ao percentual de preenchimento dos itens de responsabilidade do cirurgião. Considerando o procedimento cirúrgico realizado, foram encontradas incoerências no item lateralidade. Conclusão: apesar do elevado percentual de prontuários com checklist, a presença de incompletude e incoerência pode comprometer os resultados esperados na segurança do paciente cirúrgico.

Surgical teams' attitudes and opinions towards the safety of surgical procedures in public hospitals in the Brazilian Federal District

Background

According to the World Health Organization, the WHO surgical safety checklist can prevent complications, improve communication and contribute to postsurgical safety culture; hence, there is a need to investigate the attitudes and opinions of surgical teams regarding safety utilizing the WHO instrument. The aim of this study was to assess the attitudes and opinions towards surgical safety among operating room professionals in three public hospitals in the Brazilian Federal District.

Methods

A cross-sectional study was conducted with the use of a checklist based on the safety attitudes questionnaire-operating room, sent out during the pre- and post-intervention surveys of the WHO surgical safety checklist (period I and period II) between 2012 and 2014.

Results

About 470 professionals, mostly nurse technicians, responded to the questionnaire in both periods. Regarding the perception of safety and agreement about the collaboration of the operating team, a significant statistical improvement of the nursing staff and anesthesiologists was observed in the operating room after the checklist was implemented. After utilizing the checklist before each surgical procedure, concerns about patient safety and compliance with standards as well as rules and hand-washing practices in the operating room statistically improved after the post-intervention, especially by the nursing staff. The checklist was considered easy and quick to use by most respondents. They also believed that the checklist inclusion improved communication, reflecting significant differences. At least 90.0 % of respondents from each team agreed that the checklist helps prevent errors in the operating room.

Conclusions

The study results showed progress in relation to the attitudes and opinions regarding surgical safety from operating teams in relation to the checklist response in the surveyed units. However, difficulties in its implementation are experienced, especially in relation to checklist use acceptance by the surgeons. New studies are needed to verify the sustainability of the surgical teams’ changes in attitudes in the hospitals studied.

Adherence to the use of the surgical checklist for patient safety

Objective: Evaluate adherence to the checklist of the Programa Cirurgias Seguras (safe surgery programme) at a teaching hospital. Methods: Evaluative study conducted at a teaching hospital in the south of Brazil in 2012. Data were collected by means of non-participant observation in 20 hip and knee replacement surgeries and an instrument that was created for research based on the checklist and used by the institution. Results: In the observed procedures (n = 20) there was significant adhesion (p<0.05) to the instrument in relation to the verification of documentation, fasting, hair removal in the surgical site, absence of nail varnish and accessories, identification of the patient and surgical site on admission to the surgical unit, availability of blood and functionality of materials. However, there was no significant adherence to the checklist in the operating room in relation to patient identification, procedure and laterality, team introduction, surgical break and materials count. Conclusion: The results showed that the items on the checklist were verified nonverbally and there was no significant adherence to the instrument.