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Ghanmi N, Bondok M, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S. Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies. Cureus 2024; 16:e60522. [PMID: 38883070 PMCID: PMC11180536 DOI: 10.7759/cureus.60522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
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Affiliation(s)
- Nibras Ghanmi
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Mostafa Bondok
- Department of Anesthesiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CAN
| | | | | | | | | | | | - Jeanne Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | | | - Sindeed Islam
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, CAN
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Paterson C, Mckie A, Turner M, Kaak V. Barriers and facilitators associated with the implementation of surgical safety checklists: A qualitative systematic review. J Adv Nurs 2024; 80:465-483. [PMID: 37675871 DOI: 10.1111/jan.15841] [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: 02/17/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
AIM Despite the documented benefits of the World Health Organisation Patient Safety Checklist compliance rates with implementation continue to cause risk to patient safety. This qualitative systematic review aimed to explore the reported factors that impact compliance and implementation processes related to surgical safety checklists in perioperative settings. DESIGN A qualitative systematic review. METHODS A systematic review using the Joanna Briggs Institute (JBI) approach to synthesize qualitative studies was conducted and reported according to PRISMA guidelines. Electronic databases were expansively searched using keywords and subject headings. Articles were assessed using a pre-selected eligibility criterion. Data extraction and quality appraisal was undertaken for all included studies and a meta-aggregation performed. DATA SOURCES The CINAHL, Medline and Scopus databases were searched in August 2022 and the search was repeated in June 2023. RESULTS 34 studies were included. Following the synthesis of the findings there were multiple interrelating barriers to checklist compliance that impacted implementation. There were more barriers than enablers reported in existing studies. Enablers included effective leadership, education and training, timely use of audit and feedback, local champions, and the option for local modifications to the surgical checklist. Further research should focus on targeted interventions that improve observed compliance rates to optimize patient safety. CONCLUSION This qualitative systematic review identified multiple key factors that influenced the uptake of the Surgical Safety Checklist in operating theatres. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Surgeon participation, hierarchical culture, complacency, and duplication of existing safety processes were identified which impacted the use and completion of the checklist.
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Affiliation(s)
- Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, Australia
- Caring Futures Institute, Flinders University, Australia
- Central Adelaide Local Health Network, Adelaide
- Robert Gordon University, Aberdeen, Scotland, UK
| | - A Mckie
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - M Turner
- Faculty of Health, University of Canberra, Bruce ACT, Australia
| | - V Kaak
- Faculty of Health, University of Canberra, Bruce ACT, Australia
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Parra DA, Gladkikh M, Jones LM. Factors influencing teamwork in healthcare applicable to interventional and diagnostic radiology. Clin Radiol 2023; 78:897-903. [PMID: 37813757 DOI: 10.1016/j.crad.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 09/12/2023] [Indexed: 10/11/2023]
Abstract
Teamwork in healthcare has been analysed extensively in the literature, mainly in acute healthcare settings such as the operating room, emergency room, and intensive care unit, with limited evidence related to diagnostic and interventional radiology. Multiple factors that affect teamwork in different domains have been described, such as communication, hierarchy, and distractions. Teamwork is an important patient safety, job satisfaction and patient outcome determinant, with interprofessional and interdisciplinary healthcare education playing a relevant role in the different domains affecting team performance. The aim of this article is to review the literature to describe domains and specific factors that influence teamwork in diagnostic and interventional radiology practice. This is of particular interest for radiologist involved in quality improvement and/or patient safety initiatives development and implementation. The review will conclude with a summary table highlighting the most important factors that, according to the authors, appear relevant to the radiology practice.
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Affiliation(s)
- D A Parra
- Division of Image Guided Therapy, Diagnostic Imaging Department, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
| | - M Gladkikh
- Diagnostic Imaging, McMaster University, Hamilton, ON, Canada
| | - L M Jones
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK
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Turcotte M, Etherington C, Rowe J, Duong A, Kaur M, Talbot Z, Mansour F, Mohamed J, Zahrai A, Fournier K, Boet S. Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review. J Interprof Care 2023; 37:904-921. [PMID: 36373205 DOI: 10.1080/13561820.2022.2137116] [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: 12/17/2021] [Revised: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.
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Affiliation(s)
- Michelle Turcotte
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Rowe
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ann Duong
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Manvinder Kaur
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Zoé Talbot
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fadi Mansour
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janna Mohamed
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Amin Zahrai
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
- Translational and Molecular Medicine Program, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, University of Ottawa Ottawa Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa Ottawa Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, Canada
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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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McNamara C, Markey K, O'Donnell C, Murphy J, O'Brien B. Factors that enhance compliance with the Surgical Safety Checklist. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:1080-1086. [PMID: 36416625 DOI: 10.12968/bjon.2022.31.21.1080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has reported that its Surgical Safety Checklist (SSC) has resulted in significant reductions in morbidity and mortality. Despite its proven success, meaningful compliance with the Surgical Safety Checklist initiative has been low. AIMS The authors sought to identify and explore published research on factors that enhance compliance with the SSC within surgical team members. METHODS A review of the literature published between January 2017 and January 2021 was undertaken. Six databases were searched, and 1340 studies were screened for eligibility. The 17 studies included were critically appraised using the Crowe Critical Appraisal Tool. FINDINGS Three main themes were identified: training and innovations; process adaptations and team leadership. CONCLUSION This review of the literature draws attention to the complexities of checklist compliance and identifies the need for training, leadership and adaptation to new safety processes.
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Affiliation(s)
- Claire McNamara
- University Teacher, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Kathleen Markey
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Claire O'Donnell
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Jill Murphy
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
| | - Brid O'Brien
- Lecturer, Department of Nursing and Midwifery, University of Limerick, Republic of Ireland
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Armstrong BA, Dutescu IA, Nemoy L, Bhavsar E, Carter DN, Ng KD, Boet S, Trbovich P, Palter V. Effect of the surgical safety checklist on provider and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:463-478. [PMID: 35393355 DOI: 10.1136/bmjqs-2021-014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships. METHODS A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects. RESULTS 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC's influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators. CONCLUSION There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
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Affiliation(s)
- Bonnie A Armstrong
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilinca A Dutescu
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Lori Nemoy
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ekta Bhavsar
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana N Carter
- General Surgery, Milton District Hospital, Milton, Ontario, Canada
| | | | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Trbovich
- Surgery, North York General Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Vanessa Palter
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Lindström P, Krupic F, Rahim Y, Grbic K. As a member of the surgical team, the nurse anesthetist's view of using the WHO surgical safety checklist in Swedish health care. Int J Appl Basic Med Res 2022; 12:111-116. [PMID: 35754663 PMCID: PMC9215185 DOI: 10.4103/ijabmr.ijabmr_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction: In Sweden, during specialty training, the nurse anesthetist learns how to ensure patient safety in a health-care setting by implementing the surgical checklist measures during perioperative care. To date, there are still considerable shortcomings when it comes to implementing these patient safety measures in Swedish hospitals. Aim: The purpose of this study is to describe the use of the WHO surgical safety checklist (WHOSSC) by surgical teams, with special emphasis on nurse anesthetists to increase patient safety. Materials and Methods: This descriptive questionnaire-based study was performed between September 2018 and March 2019 and included 196 health-care professionals who completed the questionnaire. The survey was carried out among all the health-care professionals at two surgical units at a university hospital during the data collection period. Results: The results reveal that the majority of health-care staff in this study agree with the need to implement the WHOSSC during surgery and the necessity of doing so to ensure patient safety. However, it is not clear whether this checklist needs to be made a matter of routine at the clinics and whether this is possible in emergency situations. Conclusion: The nurse anesthetists, as members of the surgical team, use the list all the time in emergency situations and conclude, like other members of the team, that the list improves patient safety. Clearer procedures are needed during surgery regarding the usage of the checklist in practice, and there should be a designated person in the surgical team responsible for implementing the checklist.
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Etherington C, Burns JK, Kitto S, Brehaut JC, Britton M, Singh S, Boet S. Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework. PLoS One 2021; 16:e0249576. [PMID: 33886580 PMCID: PMC8061974 DOI: 10.1371/journal.pone.0249576] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective. Methods This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers. Results A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts. Conclusions We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.
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Affiliation(s)
- Cole Etherington
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph K. Burns
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie C. Brehaut
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Boet
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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Leite GR, Martins MA, Maia LG, Garcia-Zapata MTA. Safe surgery checklist: evaluation in a neotropical region. Rev Col Bras Cir 2021; 48:e20202710. [PMID: 33852703 PMCID: PMC10683426 DOI: 10.1590/0100-6991e-20202710] [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: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE assess patient responses and associated factors of items on a safe surgery checklist, and identify use before and after protocol implementation from the records. METHODS a cohort study conducted from 2014 to 2016 with 397 individuals in stage I and 257 in stage II, 12 months after implementation, totaling 654 patients. Data were obtained in structured interviews. In parallel, 450 checklist assessments were performed in medical records from public health institutions in the Southwest II Health Region of Goiás state, Brazil. RESULTS six items from the checklist were evaluated and all of these exhibited differences (p < 0.000). Of the medical records analyzed, 69.9% contained the checklist in stage I and 96.5% in stage II, with better data completeness. In stage II, after training, the checklist was associated with surgery (OR; 1.38; IC95%: 1.25-1.51; p < 0.000), medium-sized hospital (OR; 1.11; CI95%; 1.0-1.17; p < 0.001), male gender (OR; 1.07; CI95%; 1.0-1.14; p < 0.010), type of surgery (OR; 1.7; CI95%: 1.07-1.14; p < 0.014) and antibiotic prophylaxis 30 to 60 min after incision (OR; 1.10; CI95%: 1.04-1.17; p < 0.000) and 30 to 60 min after surgery (OR; 1.23; CI95%: 1.04-1.45; p = 0.015). CONCLUSIONS the implementation strategy of the safe surgery checklist in small and medium-sized healthcare institutions was relevant and associated with better responses based on patient, data availability and completeness of the data.
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Affiliation(s)
- Giulena Rosa Leite
- - Universidade Federal de Goiás, Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina - Goiânia - GO - Brasil
- - Universidade Federal de Jataí, Curso de Enfermagem - Jataí - GO - Brasil
| | | | - Ludmila Grego Maia
- - Universidade Federal de Jataí, Curso de Enfermagem - Jataí - GO - Brasil
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Nilsen P, Potthoff S, Birken SA. Conceptualising Four Categories of Behaviours: Implications for Implementation Strategies to Achieve Behaviour Change. FRONTIERS IN HEALTH SERVICES 2021; 1:795144. [PMID: 36926485 PMCID: PMC10012728 DOI: 10.3389/frhs.2021.795144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
Background: Effectiveness of implementation strategies is influenced by the extent to which they are based on appropriate theories concerning the behaviours that the strategies intend to impact. Effectiveness may be limited simply because the strategies are based on theories that are limited in scope or are derived from partially inaccurate assumptions about the behaviours in question. It may therefore be important to combine insights from various theories to cover the range of influences on the behaviours that will be changed. Aim: This article aims to explore concepts, theories and empirical findings from different disciplines to categorise four types of behaviours and discuss the implications for implementation strategies attempting to change these behaviours. Influences on behaviours: Multilevel influences on behaviours are dichotomized into individual-level and collective-level influences, and behaviours that are guided by conscious cognitive processes are distinguished from those that rely on non-conscious processing. Combining the two dimensions (levels and cognitive modes) creates a 2 x 2 conceptual map consisting of four categories of behaviours. Explicitly conceptualising the levels and cognitive modes is crucial because different implementation strategies are required depending on the characteristics of the behaviours involved in the practise that needs to be changed. Conclusion: The 2 x 2 conceptual map can be used to consider and reflect on the nature of the behaviours that need to be changed, thus providing guidance on the type of theory, model or framework that might be most relevant for understanding and facilitating behaviour change.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
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Espin S, Indar A, Gross M, Labricciosa A, D'Arpino M. Processes and tools to improve teamwork and communication in surgical settings: a narrative review. BMJ Open Qual 2020; 9:bmjoq-2020-000937. [PMID: 32554445 PMCID: PMC7304801 DOI: 10.1136/bmjoq-2020-000937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | | | | | - Maryanne D'Arpino
- Safety Improvement and Capability Building, Canadian Patient Safety Institute, Ottawa, Ontario, Canada
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Wæhle HV, Haugen AS, Wiig S, Søfteland E, Sevdalis N, Harthug S. How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties. BMC Health Serv Res 2020; 20:111. [PMID: 32050960 PMCID: PMC7017532 DOI: 10.1186/s12913-020-4965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies. METHODS An ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. RESULTS We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSC's practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. CONCLUSION When the SSC is not integrated within existing risk management strategies, but perceived as an "add on", its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London, London, UK
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Taplin C, Romano L, Tacey M, Hodgson R. Everyone has Their Role to Play During the World Health Organisation Surgical Safety Checklist in Australia: A Prospective Observational Study. World J Surg 2020; 44:1755-1761. [DOI: 10.1007/s00268-020-05397-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Marshall SD, Touzell A. Human factors and the safety of surgical and anaesthetic care. Anaesthesia 2020; 75 Suppl 1:e34-e38. [PMID: 31903583 DOI: 10.1111/anae.14830] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2019] [Indexed: 11/28/2022]
Abstract
Safety of patients in the operating theatre relies on a cordial and efficient working relationship between all members of the theatre team. A team that communicates well, defines the roles of its members and is aware of their limitations will provide safe patient care. In this review, we will examine how human factors engineering - the science of how to design processes, equipment and environments to optimise the human contributions to performance - can be used to improve safety and efficiency of surgery. Although these are often dismissed as 'common sense', we will explain how these solutions emerge not from healthcare but from diverse disciplines such as psychology, design and engineering.
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Affiliation(s)
- S D Marshall
- Department of Anaesthesia and Peri-operative Medicine, Monash University, Frankston, Vic., Australia.,Department of Anaesthesia, Peninsula Health, Frankston, Vic., Australia
| | - A Touzell
- Department of Orthopaedic surgery, Peninsula Health, Frankston, Vic., Australia
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16
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Etherington N, Wu M, Cheng-Boivin O, Larrigan S, Boet S. Interprofessional communication in the operating room: a narrative review to advance research and practice. Can J Anaesth 2019; 66:1251-1260. [DOI: 10.1007/s12630-019-01413-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/26/2022] Open
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17
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Schwendimann R, Blatter C, Lüthy M, Mohr G, Girard T, Batzer S, Davis E, Hoffmann H. Adherence to the WHO surgical safety checklist: an observational study in a Swiss academic center. Patient Saf Surg 2019; 13:14. [PMID: 30918531 PMCID: PMC6419440 DOI: 10.1186/s13037-019-0194-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
Background The World Health Organization (WHO) Surgical Safety Checklist is used globally to ensure patient safety during surgery. Two years after its implementation in the University Hospital Basel's operating rooms, adherence to the protocol was evaluated. Methods This mixed method observational study took place in the surgical department of the University Hospital of Basel, Switzerland from April to August 2017. Data collection was via individual structured interviews with selected OR team members regarding checklist adherence and on-site non-participant observations of Team Time Out and Team Sign Out sequences in the OR. Data were subjected to thematic analysis and descriptive statistics compiled. Results Comprehensive local expert interviews indicated that individual, procedural and contextual variables influenced the application of the checklist. Facilitating factors included well-informed specialists who advocated the use of the Checklist, as well as teams focused on the checklist's intended process and on its content. In contrast, factors such as staff insecurity, a generally negative attitude towards the checklist, a lack of teamwork, and hesitance to complete the checklist, hindered its implementation.The checklist's application was evaluated in 104 on-site observations comprising of 72 Team Time Out (TTO) and 32 Team Sign Out (TSO) sections. Adherence to the protocol ranged between 96 and 100% in TTO and 22% in TSO respectively. Lack of implementation of the TSO was mainly due to the absence of one of the key OR team members, who were busy with other tasks or no longer present in the operating room. Conclusion The study illustrates factors, which foster and hinder consistent application of the WHO surgical safety checklist namely individual, procedural and contextual. It also demonstrates that the TTO was consistently and correctly applied, while the unavailability of key OR team members at sign-out time was the most common reason for omission or incomplete use of the TSO.
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Affiliation(s)
- René Schwendimann
- 1Patient Safety Office, University Hospital Basel, Spitalstrasse 22, 4031 Basel, Switzerland.,2Department Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel; Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Catherine Blatter
- 2Department Public Health DPH, Nursing Science, Faculty of Medicine, University of Basel; Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Marc Lüthy
- 3Department of Anesthesiology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Giulia Mohr
- 1Patient Safety Office, University Hospital Basel, Spitalstrasse 22, 4031 Basel, Switzerland
| | - Thierry Girard
- 3Department of Anesthesiology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Siegfried Batzer
- 3Department of Anesthesiology, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Erica Davis
- 1Patient Safety Office, University Hospital Basel, Spitalstrasse 22, 4031 Basel, Switzerland
| | - Henry Hoffmann
- 4Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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18
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Gleddie M, Stahlke S, Paul P. Nurses' perceptions of the dynamics and impacts of teamwork with physicians in labour and delivery. J Interprof Care 2018:1-11. [PMID: 30596305 DOI: 10.1080/13561820.2018.1562422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/29/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional teamwork is touted as essential to positive patient, staff, and organizational outcomes. However, differing understandings of teamwork and divergent professional cultures amongst healthcare providers influence the success of teamwork. In labour and delivery, nurse-physician teamwork is vital to safe, family-centered maternity care. In this focused ethnography, the perceptions of obstetrical nurses were sought to understand nurse-physician teamwork and the features that facilitate or impede it. These nurses acknowledged working in a normative hierarchy, with physicians ultimately responsible for patient care decision-making. They described myriad ways in which they navigated traditional power dynamics and smoothed working relationships with physicians, such as circumventing disrespectful behaviors, venting with each other, highlighting their own autonomy, using tactical communication, and managing unit resources. According to these nurses, key facilitators of functional nurse-physicians relationships were time, trust, respect, credibility, and social connection. Further, the nature of their working relationships with physicians influenced their perceptions regarding intent to stay, workplace morale, and patient outcomes.
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Affiliation(s)
- Megan Gleddie
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
| | - Sarah Stahlke
- b Faculty of Nursing , University of Alberta, Edmonton Clinic Health Academy , Alberta , Canada
| | - Pauline Paul
- a University of Alberta, Edmonton Clinic Health Academy , Edmonton , Alberta , Canada
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