Attitude toward perioperative safety among operation room clinicians at Ethiopian University Hospital

Patient safety is a fundamental of good quality and also a high priority for the health-care system. Maintaining patient safety reduces errors and harm that patients can suffer during health care. The operating room clinicians have a vital role in ensuring patient safety. The general objective of this study was to assess attitudes towards perioperative safety and associated factors among the operation room clinicians at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2022. A cross-sectional study was conducted on operation room clinicians at UoGCSH. The data were collected by using a self-administered structured questionnaire that included the Safety Attitude Questionnaire (SAQ). Binary logistic regression analysis was employed, and the strength of association was described in adjusted odds ratios with a 95% confidence interval (CI). A total of 260 (76% response rate) operation room clinicians have participated in this study. The mean ± SD of attitude toward perioperative safety was 57.8 ± 0.9. Only 32 (12.3%) operation room clinicians have shown a favorable attitude toward perioperative safety. Most of the clinicians were found to have unfavorable attitudes toward all domains of SAQ except the stress recognition domain. Age >30 years [adjusted odds ratios (AOR): 3.1, CI: 1.1, 8.7, P = .035], working for ≥40 h/week (AOR: 3.9, CI: 1.4, 11.1, P = .01), working in ophthalmologic (AOR: 12.0, CI: 3.8, 38.8, P < .001) and gynecologic (AOR: 3.6, CI: 1.1, 12.7, P = .04) operation rooms, and having training on perioperative safety (AOR: 2.6, CI: 1.1, 6.5, P < .03) were found associated with having favorable attitude toward perioperative safety. Most operation room clinicians had an unfavorable attitude toward perioperative safety and all the domains of SAQ except the stress recognition domain. Older age  ≥ 30 years, working for ≥40 h/week, having safety-related training, and working in ophthalmologic and gynecologic operation rooms were found associated with having a favorable attitude toward perioperative safety.

Training in robotic-assisted surgery: a systematic review of training modalities and objective and subjective assessment methods

INTRODUCTION

The variety of robotic surgery systems, training modalities, and assessment tools within robotic surgery training is extensive. This systematic review aimed to comprehensively overview different training modalities and assessment methods for teaching and assessing surgical skills in robotic surgery, with a specific focus on comparing objective and subjective assessment methods.

METHODS

A systematic review was conducted following the PRISMA guidelines. The electronic databases Pubmed, EMBASE, and Cochrane were searched from inception until February 1, 2022. Included studies consisted of robotic-assisted surgery training (e.g., box training, virtual reality training, cadaver training and animal tissue training) with an assessment method (objective or subjective), such as assessment forms, virtual reality scores, peer-to-peer feedback or time recording.

RESULTS

The search identified 1591 studies. After abstract screening and full-texts examination, 209 studies were identified that focused on robotic surgery training and included an assessment tool. The majority of the studies utilized the da Vinci Surgical System, with dry lab training being the most common approach, followed by the da Vinci Surgical Skills Simulator. The most frequently used assessment methods included simulator scoring system (e.g., dVSS score), and assessment forms (e.g., GEARS and OSATS).

CONCLUSION

This systematic review provides an overview of training modalities and assessment methods in robotic-assisted surgery. Dry lab training on the da Vinci Surgical System and training on the da Vinci Skills Simulator are the predominant approaches. However, focused training on tissue handling, manipulation, and force interaction is lacking, despite the absence of haptic feedback. Future research should focus on developing universal objective assessment and feedback methods to address these limitations as the field continues to evolve.

An interview study about how nurses and physicians talk about the same concepts differently

BACKGROUND

How healthcare professionals understand and use concepts of social and cognitive capabilities will influence their behaviour and their understanding of others' behaviour. Differing understandings of concepts might lead to healthcare professionals not acting in accordance with other healthcare professionals' expectations. Therefore, part of the problem concerning errors and adverse incidents concerning social and cognitive capabilities might be due to varying understandings of concepts among different healthcare professionals. This study aimed to examine the variations in how educators at the Copenhagen Academy for Medical Education and Simulation talk about social and cognitive capabilities.

METHODS

The study was conducted using semi-structured interviews and directed content analysis. The codes for the analysis process were derived from existing non-technical skills models and used to show variations in how the participants talk about the same concepts.

RESULTS

Educators with a background as nurses and physicians, talked differently about leadership and decision-making, with the nurses paying greater attention to group dynamics and external factors when describing both leadership and decision-making, whereas physicians focus on their individual efforts.

CONCLUSION

We found patterned differences in how the participants described leadership and decision-making that may be related to participants' professional training/background. As it can create misunderstandings and unsafe situations if nurses and physicians disagree on the meaning of leadership and decision-making (without necessarily recognising this difference), it could be beneficial to educate healthcare professionals to be aware of the specificity of their own concepts, and to communicate what exactly they mean by using a particular concept, e.g. "I want you to coordinate tasks" instead of "I want better leadership".

Observation of behavioural skills by medical simulation facilitators: a cross-sectional analysis of self-reported importance, difficulties, observation strategies and expertise development

BACKGROUND

The association between team performance and patient care was an immense boost for team-based education in health care. Behavioural skills are an important focus in these sessions, often provided via a mannikin-based immersive simulation experience in a (near) authentic setting. Observation of these skills by the facilitator(s) is paramount for facilitated feedback with the team. Despite the acknowledgement that trained facilitators are important for optimal learning, insight into this observation process by facilitators is limited.

OBJECTIVES

What are the self-reported current practices and difficulties regarding the observation of behavioural skills amongst facilitators during team training and how have they been trained to observe behavioural skills?

METHODS

This cross-sectional study used a pilot-tested, content-validated, multi-linguistic online survey within Europe, distributed through a non-discriminative snowball sampling method. Inclusion was limited to facilitators observing behavioural skills within a medical team setting.

RESULTS

A total of 175 persons filled in the questionnaire. All aspects of behavioural skill were perceived as very important to observe. The self-perceived difficulty of the behavioural skill aspects ranged from slightly to moderately difficult. Qualitative analysis revealed three major themes elaborating on this perceived difficulty: (1) not everything can be observed, (2) not everything is observed and (3) interpretation of observed behavioural skills is difficult. Additionally, the number of team members health care facilitators have to observe, outnumbers their self-reported maximum. Strategies and tools used to facilitate their observation were a blank notepad, co-observers and predefined learning goals. The majority of facilitators acquired observational skills through self-study and personal experience and/or observing peers. Co-observation with either peers or experts was regarded as most learn some for their expertise development. Overall, participants perceived themselves as moderately competent in the observation of behavioural skills during team training.

CONCLUSIONS

Observation of behavioural skills by facilitators in health care remains a complex and challenging task. Facilitators' limitations with respect to attention, focus and (in)ability to perform concomitant tasks, need to be acknowledged. Although strategies and tools can help to facilitate the observation process, they all have their limitations and are used in different ways.

Evaluation of the impact of technical physicians on improving individual patient care with technology

BACKGROUND

The rapid introduction of technical innovations in healthcare requires that professionals are adequately prepared for correct clinical use of medical technology. In response to the technological transformation of healthcare, a new type of professional, the Technical Physician (TP), was created and is trained to improve individual patient care using technology tailored to the needs of individual patients. This study investigates the TPs' impact on patient care in terms of innovation, effectiveness, efficiency, and patient safety.

METHOD

Semi-structured, in-depth interviews were conducted with 30 TPs and 17 medical specialists (MSs) working in academic or teaching hospitals in the Netherlands. The pre-structured and open-ended interview questions focused on: 1) the perceived impact on innovation, effectiveness, efficiency, and safety, and 2) opportunities and challenges in daily work.

RESULTS

TPs and MSs unanimously experienced that TPs contributed to innovation. A majority indicated that effectiveness (TP 57%; MS 71%) and efficiency (TP 67%; MS 65%) of clinical practice had increased. For safety, 87% of TPs but only 47% of MSs reported an increase. The main explanation given for TPs positive impact was combining medical and technical knowledge. Mainly organizational barriers were mentioned as a potential cause for a less visible contribution of TPs.

CONCLUSION AND DISCUSSION

TPs and MSs unanimously agreed that TPs contributed to innovating patient care through their integrative medical and technical competencies. Most TPs and MSs also reported increased effectiveness, efficiency, and safety of patient care due to the TPs' work. TPs and MSs expected that the TPs' impact on direct and indirect patient care will be enhanced once organizational barriers are removed.

Prediction of laparoscopic skills: objective learning curve analysis

INTRODUCTION

Prediction of proficiency of laparoscopic skills is essential to establish personalized training programs. Objective assessment of laparoscopic skills has been validated in a laparoscopic box trainer with force, motion and time recognition. The aim of this study is to investigate whether acquiring proficiency of laparoscopic skills can be predicted based on performance in such a training box.

METHODS

Surgical residents in their first year of training performed six different tasks in the Lapron box trainer. Force, motion and time data, three objective measures of tissue manipulation and instrument handling, were collected and analyzed for the six different tasks. Linear regression tests were used to predict the learning curve and the number of repetitions required to reach proficiency.

RESULTS

A total of 6010 practice sessions performed by 42 trainees from 13 Dutch hospitals were assessed and included for analysis. Proficiency level was determined as a mean result of seven experts performing 42 trials. Learning curve graphs and prediction models for each task were calculated. A significant relationship between force, motion and time during six different tasks and prediction of proficiency was present in 17 out of 18 analyses.

CONCLUSION

The learning curve of proficiency of laparoscopic skills can accurately be predicted after three repetitions of six tasks in a training box with force, path length and time recognition. This will facilitate personalized training programs in laparoscopic surgery.

Developing guidance for the management of intraoperative anaesthetic machine failure

Intraoperative anaesthetic machine failure represents an immediate risk to patient safety, as well as risking long-term harm in the form of accidental awareness under general anaesthesia. Currently, there is no widely accepted consensus guidance for the management of such an event. Based upon institutional experiences of anaesthetic machine failure and the principles of delivering good-quality care under emergency scenarios, we devised a single-sheet guideline for management of this event. This guidance assigns clear roles in the management of the event, identifies the key priorities for immediate care, and makes provisions for ensuring ongoing high-quality care following the event. Discussion is given to the rationale for the key components, and the importance of involving the whole perioperative team in developing such guidance. Further discussion involves the crucial elements of local implementation, making sure that guidance is location and personnel specific. Key future steps in this important patient safety project are also discussed.

Research Hotspots and Trend Exploration on the Clinical Translational Outcome of Simulation-Based Medical Education: A 10-Year Scientific Bibliometric Analysis From 2011 to 2021

BACKGROUND

In recent decades, an increasing number of studies have focused on the clinical translational effect of simulation-based medical education (SBME). However, few scientific bibliometric studies have analyzed the research hotspots and publication trends. This study aimed to investigate research hotspots and future direction in the clinical translational outcome of SBME via bibliometrics.

METHOD

Relevant publications on the clinical translational outcomes of SBME from 2011 to 2021 were identified and retrieved from the Web of Science Core Collection (WOSCC). Software including VOSviewer (1.6.17) and CiteSpace (5.8R3) and a platform (bibliometric.com) were employed to conduct bibliographic and visualized analysis on the literature.

RESULTS

A total of 1,178 publications were enrolled. An increasing number of publications were observed in the past decades from 48 in 2011 to 175 in 2021. The United States accounted for the largest number of publications (488, 41.4%) and citations (10,432); the University of Toronto and Northwestern University were the leading institutions. Academic Medicine was the most productive journal concerning this field. McGaghie W C and Konge L were the most influential authors in this area. The hot topic of the translational outcome of SBME was divided into 3 stages, laboratory phase, individual skill improvement, and patient outcome involving both technical skills and non-technical skills. Translational research of comprehensive impact and collateral outcomes could be obtained in the future.

CONCLUSION

From the overall trend of 10 years of research, we can see that the research is roughly divided into three phases, from laboratory stage, individual skill improvement to the patient outcomes, and comprehensive impacts such as skill retention and collateral effect as cost-effectiveness is a major trend of future research. More objective evaluation measurement should be designed to assess the diverse impact and further meta-analysis and randomized controlled trials are needed to provide more clinical evidence of SBME as translational science.

The QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score: a cross-validation study

OBJECTIVES

Interhospital transports of critically ill patients are high-risk medical interventions. Well-established parameters to quantify the quality of transports are currently lacking. We aimed to develop and cross-validate a score for interhospital transports.

SETTING

An expert panel developed a score for interhospital transport by a Mobile Intensive Care Unit (MICU), the QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score. The QUIT-EMR score is an overall sum score that includes component scores of monitoring and intervention variables of the neurological (proxy for airway patency), respiratory and circulatory organ systems, ranging from -12 to +12. A score of 0 or higher defines an adequate transport. The QUIT-EMR score was tested to help to quantify the quality of transport.

PARTICIPANTS

One hundred adult patients were randomly included and the transport charts were independently reviewed and classified as adequate or inadequate by four transport experts (ie, anaesthetists/intensivists).

OUTCOME MEASURES

Subsequently, the level of agreement between the QUIT-EMR score and expert classification was calculated using Gwet's AC₁.

RESULTS

From April 2012 to May 2014, a total of 100 MICU transports were studied. The median (IQR) QUIT-EMR score was 1 (0-2). Experts classified six transports as inadequate. The percentage agreement between the QUIT-EMR score and experts' classification for adequate/inadequate transport ranged from 84% to 92% (Gwet's AC₁0.81-0.91). The interobserver agreement between experts was 87% to 94% (Gwet's AC₁0.89-0.98).

CONCLUSION

The QUIT-EMR score is a novel validated tool to score MICU transportation adequacy in future studies contributing to quality control and improvement.

TRIAL REGISTRATION NUMBER

NTR 4937.

A Delphi study identifying operating room nurses' non-technical skills

AIM

To identify the non-technical skills of operating room nurses. This is the first empirical study that includes scrub and circulating operating room nurses.

DESIGN

A three-round modified online Delphi technique was used for this study.

METHODS

Eligible participants (n = 106) with a minimum of 2 years of operating room nursing experience were selected for the expert panel by self-recruitment from a population (N = 1640) of operating room nurses. Data were collected through online surveys, based on crew recourse management theory, between April and September 2020. Descriptive statistics analysis was used for the quantitative data, and deductive thematic analysis for the qualitative data. Consensus was determined using stability between the survey rounds.

RESULTS

A consensus was obtained to maintain the non-technical skills categories of situation awareness, leadership, decision-making, communication and teamwork. The qualitative data revealed several novel non-technical skills, including independent decision-making and leadership skills.

CONCLUSION

The non-technical skills of operating room nurses are more extensive than previously identified. This study has contributed to a verbalization of the tacit knowledge and skills of the operating room nurses. In addition, a list of non-technical skills that should be included in the education of operating room nurses to ensure patient safety in the operating room has been prepared.

IMPACT

This study addresses the lack of research on the non-technical skills of operating room nurses. When exploring the non-technical skills of scrub and circulating nurses, a diversity of novel non-technical skills was uncovered. This research will provide input for the development of a new training, supervision and assessment tool for accelerated development of the non-technical skills of operating room nurses. This contribution to the verbalization of the formerly tacit non-technical skills may facilitate clinical and formal teaching of such skills and may subsequently impact surgery-related patient safety.

The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments

BACKGROUND

The Team Emergency Assessment Measure (TEAM) questionnaire is designed for rating the non-technical performance of emergency medical teams during emergencies, e.g., resuscitation or trauma management. Originally developed in Australia it has today been translated and validated into eleven languages, but a Swedish version is lacking. The aim was therefore to cross-culturally translate and evaluate the reliability and validity of the TEAM questionnaire in a Swedish health care setting.

METHODS

The instrument was forward and backward translated and adapted into a Swedish context according to established guidelines for cross-cultural adaptation of survey-based measures. The translated version was tested through 78 pairwise assessments of 39 high-priority codes at the emergency departments of two major hospitals. The raters observed the teams at work in real time and filled in the questionnaires immediately afterwards independently of each other. Psychometric properties of the instrument were evaluated.

RESULTS

The original instrument was translated by pairs of translators independently of each other and reviewed by an expert committee of researchers, nurses and physicians from different specialties, a linguist and one of the original developers of the tool. A few adaptations were needed for the Swedish context. A principal component factor analysis confirmed a single 'teamwork' construct in line with the original instrument. The Swedish version showed excellent reliability with a Cronbach's alpha of 0.955 and a mean inter-item correlation of 0.691. The mean item-scale correlation of 0.82 indicated high internal consistency reliability. Inter-rater reliability was measured by intraclass correlation and was 0.74 for the global score indicating good reliability. Individual items ranged between 0.52 and 0.88. No floor effects but ceiling effects were noted. Finally, teams displaying clear closed-loop communication had higher TEAM scores than teams with less clear communication.

CONCLUSIONS

Real time observations of authentic, high priority cases at two emergency departments show that the Swedish version of the TEAM instrument has good psychometric properties for evaluating team performance. The TEAM instrument is thus a welcome tool for assessing non-technical skills of emergency medical teams.

Increasing hand-hygiene compliance in clinical settings using a baby-eyes sticker

This double-blind field study tested the effectiveness of a baby-eyes image in promoting healthcare workers’ hand-hygiene compliance in a hospital setting. Adults are inclined to take care of babies and aspire to be their role models; therefore, they should wash their hands thoroughly when being watched by babies. Participants were healthcare workers from the obstetrical and neonatology units of a women’s hospital in Hangzhou. We recorded and coded 3,360 hours and 10,325 hand-hygiene events over a five-week period—from 16 October to 20 November 2018. Three types of stickers, depicting baby eyes, adult eyes, or flowers, were placed above handwashing basins to compare hand-hygiene behavior between the three conditions. Each condition continued for one week, and experimenters interchanged the stickers in each unit to control for the location and sequence effects. Participants in the baby-eyes condition (72.9%) were more likely to use sanitizer than those in the flowers condition (69.4%; χ2 = 9.74, p < .01, φc = 0.034). Moreover, participants in the baby-eyes condition were more likely to use sanitizer than those in the adult-eyes condition (70.8%); however, the difference only trended towards significance ( χ2 = 2.38, p = .066, φc = 0.023). The mean handwashing time between the three conditions was significant (Welch’s F(2, 3488.436) = 3.50, p < .05, η2 = 0.001). Washing time in the baby-eyes condition (17.41 ± 12.02) was significantly longer than in the adult-eyes condition (16.36 ± 11.47; p < .05). The presence of a baby-eyes image promoted hand-hygiene compliance in the hospital environment. This finding can be adopted to change public health behaviors. It also holds theoretical implications that enhance our understanding of how being monitored by children can enhance responsible behaviors.

Preparing Anesthesiology Residents for Operating Room Communication Challenges: A New Approach for Conflict Resolution Training

BACKGROUND

The hierarchical culture in high-stake areas such as operating rooms (ORs) may create volatile communication challenges. This unfunded exploratory study sought to establish whether a conflict resolution course was effective in preparing anesthesiology residents to handle and deescalate disagreements that may arise in the clinical environment, especially when challenging a surgeon.

METHODS

Thirty-seven anesthesiology residents were assessed for ability to deescalate conflict. Nineteen had completed a conflict resolution course, and 18 had not. The 2-hour course used 10 videotaped vignettes that showed attending anesthesiologists, patients, and surgeons challenging residents in a potentially confrontational situation. Guided review of the videos and discussions was focused on how the resident could optimally engage in conflict resolution. To determine efficacy of the conflict resolution course, we used simulation-based testing. The setting was a simulated OR with loud music playing (75-80 dB) under the control of the surgeon. The music was used as a tool to create a potential, realistic confrontation with the surgeon to test conflict resolution skills. The initial evaluation of the resident was whether they ignored the music, asked for the surgeon to turn it off, or attempted to turn it off themselves. The second evaluation was whether the resident attempted to deescalate (eg, calmly negotiate for the music to be turned off or down) when the surgeon was scripted to adamantly refuse. Two trained observers evaluated residents' responses to the surgeon's refusal.

RESULTS

Of the residents who experienced the confrontational situation and had not yet taken the conflict resolution course, 1 of 5 (20.0%; 95% CI, 0.5-71.6) were judged to have deescalated the situation. In comparison, of those who had taken the course, 14 of 15 (93.3%; 95% CI, 68.1-99.8) were judged to have deescalated the situation (P = .002). Only 2 of 19 (10.5%; 95% CI, 1.3-33.1) of those who completed the course ignored the music on entering the OR versus 10 of 18 (55.6%; 95% CI, 30.8-78.5) who did not complete the course (P = .004).

CONCLUSIONS

This study suggests that a conflict resolution course may improve the ability of anesthesiology residents to defuse clinical conflicts. It also demonstrated the effectiveness of a novel, simulation-based assessment of communication skills used to defuse OR confrontation.

Tools for Assessing the Performance of Pediatric Perioperative Teams During Simulated Crises: A Psychometric Analysis of Clinician Raters' Scores

INTRODUCTION

The pediatric perioperative setting is a dynamic clinical environment where multidisciplinary interprofessional teams interact to deliver complex care to patients. This environment requires clinical teams to possess high levels of complex technical and nontechnical skills. For perioperative teams to identify and maintain clinical competency, well-developed and easy-to-use measures of competency are needed.

METHODS

Tools for measuring the technical and nontechnical performance of perioperative teams were developed and/or identified, and a group of raters were trained to use the instruments. The trained raters used the tools to assess pediatric teams managing simulated emergencies. A psychometric analysis of the trained raters' scores using the different instruments was performed and the agreement between the trained raters' scores and a reference score was determined.

RESULTS

Five raters were trained and scored 96 recordings of perioperative teams managing simulated emergencies. Scores from both technical skills assessment tools demonstrated significant reliability within and between ratings with the scenario-specific performance checklist tool demonstrating greater interrater agreement than scores from the global rating scale. Scores from both technical skills assessment tools correlated well with the other and with the reference standard scores. Scores from the Team Emergency Assessment Measure nontechnical assessment tool were more reliable within and between raters and correlated better with the reference standard than scores from the BARS tool.

CONCLUSIONS

The clinicians trained in this study were able to use the technical performance assessment tools with reliable results that correlated well with reference scores. There was more variability between the raters' scores and less correlation with the reference standard when the raters used the nontechnical assessment tools. The global rating scale used in this study was able to measure the performance of teams across a variety of scenarios and may be generalizable for assessing teams in other clinical scenarios. The Team Emergency Assessment Measure tool demonstrated reliable measures when used to assess interprofessional perioperative teams in this study.

Student supervision using the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS-no): A qualitative study

BACKGROUND

The importance of non-technical skills in the prevention of adverse events in the operating room is well documented through research. With the increased attention to non-technical skills, the need for structured training to support the development of such skills has emerged. The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) is an instrument for structuring observation as well as rating and feedback of non-technical skills for operating room nurses, and it can be used for student supervision and self-reflection. SPLINTS-no is the Norwegian translation and adaptation of SPLINTS.

OBJECTIVE

To explore the experiences of operating room nurse preceptors using SPLINTS-no in the supervision of operating room students' non-technical skills.

DESIGN

An explorative qualitative design was used.

METHODS

Data were collected using semi-structured qualitative interviews with 10 operating room nurse preceptors in a Norwegian university hospital. The data were analysed by inductive qualitative content analysis.

RESULTS

The operating room nurse preceptors experienced that the use of SPLINTS-no had an impact on the quality of student supervision. They improved their supervision competencies, and the use of SPLINTS-no contributed to consistency in observation and supervision. There were also findings supporting that reflection over non-technical skills contributed to building an increased awareness of these skills.

CONCLUSIONS

SPLINTS-no has an impact on clinical student supervision through an increased awareness on non-technical skills. It is well accepted by the operating room nurses as a supportive tool in the supervision of non-technical skills of student operating room nurses during clinical placement.

Psychometric Testing of a Structured Assessment Instrument for Non-technical Skills (NANTS-no) for Use in Clinical Supervision of Student Nurse Anesthetists

BACKGROUND

This study evaluated psychometric properties of a structured behavioral assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no). It estimated whether reliable assessments of nontechnical skills (NTS) could be made after taking part in a workshop. An additional objective was to evaluate the instrument's acceptability and usability.

METHODS

An explorative design was used. Nurse anesthetists (n = 46) involved in clinical supervision attended a 6-hour workshop on NTS, then rated NTS in video-recorded simulated scenarios and completed a questionnaire.

RESULTS

High reliability and dependability were estimated in this setting. Participants regarded the instrument as useful for clinical supervision of student nurse anesthetists (SNAs).

CONCLUSIONS

Findings suggest that NANTS-no may be reliable for performing clinical assessments of SNAs and encouraging critical reflection. However, further research is needed to explore its use in clinical settings.

Nurse-Led Randomized Controlled Trials in the Perioperative Setting: A Scoping Review

PURPOSE

Nurses provide care at each phase of the complex, perioperative pathway and are well placed to identify areas of care requiring investigation in randomized controlled trials. Yet, currently, the scope of nurse-led randomized controlled trials conducted within the perioperative setting are unknown. This scoping review aims to identify areas of perioperative care in which nurse-led randomized controlled trials have been conducted, to identify issues impacting upon the quality of these trials and identify gaps for future investigation.

METHODS

This scoping review was conducted in reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Searches were conducted in PubMed, Embase, Cumulative Index for Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials, with a date range of 2014-19. Sources of unpublished literature included Open Grey, and ProQuest Dissertation and Theses, Clinical Trials.gov and the Australian and New Zealand Clinical Trials Registry. After title and abstract checking, full-text retrieval and data extraction, studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklists for randomized controlled trials. Data were synthesized according to the main objectives. Key information was tabulated.

RESULTS

From the 86 included studies, key areas where nurses have led randomized controlled trials include patient or caregiver anxiety; postoperative pain relief; surgical site infection prevention: patient and caregiver knowledge; perioperative hypothermia prevention; postoperative nausea and vomiting; in addition to other diverse outcomes. Issues impacting upon quality (including poorly reported randomization), and gaps for future investigation (including a focus on vulnerable populations), are evident.

CONCLUSION

Nurse-led randomized controlled trials in the perioperative setting have focused on key areas of perioperative care. Yet, opportunities exist for nurses to lead experimental research in other perioperative priority areas and within different populations that have been neglected, such as in the population of older adults undergoing surgery.

Treating patients in a safe environment: a cross-sectional study of patient safety attitudes among doctors in the Gaza Strip, Palestine

BACKGROUND

Patient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes.

METHODS

Doctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace.

RESULTS

A total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain "Working hours as a cause of errors" (4.16) and the lowest score by "Importance of Patient Safety in the Curriculum" (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety.

CONCLUSION

Doctors in Gaza demonstrated relatively positive patient safety attitudes in areas of "team functioning" and "working hours as a cause for error", but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.

Simulation-based acquisition of non-technical skills to improve patient safety

Traditional surgical training has focused on the acquisition of technical skills and knowledge with minimal focus on teaching nontechnical skills. Patient safety depends on both technical and nontechnical skills, with a higher rate of non-technical skills failure leading to patient harm. Many surgical training and regulatory bodies have incorporated nontechnical skills in the required competencies of a surgeon, but few have introduced formal training in nontechnical skills. Emerging research shows simulation-based education to be a powerful tool to teach nontechnical skills to individual surgeons and surgeons in training, and to interprofessional surgical teams with subsequent improvement of patient safety outcomes.

Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort

BACKGROUND

Surgeons are at high risk of developing musculoskeletal disorders.

STUDY DESIGN

This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed.

RESULTS

Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures.

CONCLUSIONS

This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.

Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses

Aim: This study examines how OR nurses experience intraoperative prevention of SSIs.

Introduction: Infections related to surgical procedures create both great patient suffering and high costs for society. Therefore, prevention of Surgical Site Infections (SSIs) should be a high priority for all surgical settings. All details of intraoperative care need to be investigated and evaluated to ensure best practices are evidence-based.

Methods: This study uses the Reflective Lifeworld Research (RLR) approach, which is grounded in phenomenology. Participants were OR nurses with at least one year of clinical experience. In total, 15 participants from seven hospitals made contact and were included in this interview study.

Results: Prevention of SSIs takes both head and hand. It requires long-term, continuous, and systematic work in several parallel processes, both intellectually and organisationally. The hierarchical tradition of the operating room is often ambiguous, shielded by its safe structures but still restricted by traditional patterns. Confident relations and resolute communication within the team generate favorable conditions for preventing SSIs.

Conclusions: By setting up mutual platforms and forums for quality development, increasing legitimacy for OR nurses and establishing fixed teams, prevention of SSIs will continue to improve, ensuring the patients’ safety during intraoperative care.

Impact of the World Health Organization Surgical Safety Checklist on Patient Safety

The incidence of surgical complications has remained largely unchanged over the past two decades. Inherent complexity in surgery, new technology possibilities, increasing age and comorbidity in patients may contribute to this. Surgical safety checklists may be used as some of the tools to prevent such complications. Use of checklists may reduce critical workload by eliminating issues that are already controlled for. The global introduction of the World Health Organization Surgical Safety Checklist aimed to improve safety in both anesthesia and surgery and to reduce complications and mortality by better teamwork, communication, and consistency of care. This review describes a literature synthesis on advantages and disadvantages in use of surgical safety checklists emphasizing checklist development, implementation, and possible clinical effects and using a theoretical framework for quality of provided healthcare (structure-process-outcome) to understand the checklists' possible impact on patient safety.

Nurses keeping patients safe by managing risk in perioperative settings: A classic grounded theory study

AIM

To develop and expand how nurses promote safety in perioperative settings.

BACKGROUND

This article presents orchestrating a sub-core category from the theory of anticipatory vigilance in promoting safety within preoperative settings (Journal of Clinical Nursing, 27, 2018, 247). Orchestrating explains this and involves effective planning, delegating, co-ordinating and communication.

METHOD

A classic grounded theory methodology was used. Ethical approval was granted. Data comprised of 37 interviews and 33 hr of non-participant observation. Data analysis followed the principals of classic grounded theory.

RESULTS

Orchestrating is fundamental in promoting safety and minimizing risk of errors and adverse events in the perioperative setting. Nurses achieve this through four categories: macro orchestrating, locational orchestrating, situational orchestrating and being in the know.

CONCLUSION(S)

Nurses minimize risk by fostering a culture of safety, risk awareness, effective management and leadership.

IMPLICATIONS

Effective management structures and support systems are essential in promoting a culture of safety in perioperative setting.

Understanding and improving multidisciplinary team working in geriatric medicine

Geriatric medicine is a speciality that has historically relied on team working to best serve patients. The nature of frailty in older people means that people present with numerous comorbidities, which in turn require a team-based approach to be managed, including allied health professionals, social work and nursing alongside medicine. The 'engine room' of the speciality has thus for many years been the multidisciplinary team (MDT) meeting-something other specialities have discovered only recently. Yet, rather paradoxically, the speciality has been slow compared to others (e.g. trauma, surgery, cancer) to reflect more formally on how team working can be enhanced, trained and supported in geriatric teams. This paper is a reflective review, grounded on our respective expertise in geriatric medicine and improvement science, on practice and its changing patterns within geriatric medicine, and the role of MDTs within it (Part 1). It offers a perspective from behavioural safety science, which has been studying team-working in healthcare for the last 20 years (Part 2) and concludes with practical suggestions, based on evidence, on how to integrate evidence and best practice into modern geriatric medicine-to address current and future challenges (Part 3).

The Alternative Surgical Curriculum

Surgical training has focused on the development of technical competency. Interpersonal and cognitive skills are essential to working as an interdisciplinary team, which translates into safety for the patient and well-being for the surgeon and colleagues. This article offers an "alternative" surgical curriculum topic list to augment the technical skill sets traditionally taught to trainees.

The co-design, implementation and evaluation of a serious board game 'PlayDecide patient safety' to educate junior doctors about patient safety and the importance of reporting safety concerns

BACKGROUND

We believe junior doctors are in a unique position in relation to reporting of incidents and safety culture. They are still in training and are also 'fresh eyes' on the system providing valuable insights into what they perceive as safe and unsafe behaviour. The aim of this study was to co-design and implement an embedded learning intervention - a serious board game - to educate junior doctors about patient safety and the importance of reporting safety concerns, while at the same time shaping a culture of responsiveness from senior medical staff.

METHODS

A serious game based on the PlayDecide framework was co-designed and implemented in two large urban acute teaching hospitals. To evaluate the educational value of the game voting on the position statements was recorded at the end of each game by a facilitator who also took notes after the game of key themes that emerged from the discussion. A sample of players were invited on a voluntary basis to take part in semi-structured interviews after playing the game using Flanagan's Critical Incident Technique. A paper-based questionnaire on 'Safety Concerns' was developed and administered to assess pre-and post-playing the game reporting behaviour. Dissemination workshops were held with senior clinicians to promote more inclusive leadership behaviours and responsiveness to junior doctors raising of safety concerns from senior clinicians.

RESULTS

The game proved to be a valuable patient safety educational tool and proved effective in encouraging deep discussion on patient safety. There was a significant change in the reporting behaviour of junior doctors in one of the hospitals following the intervention.

CONCLUSION

In healthcare, limited exposure to patient safety training and narrow understanding of safety compromise patients lives. The existing healthcare system needs to value the role that junior doctors and others could play in shaping a positive safety culture where reporting of all safety concerns is encouraged. Greater efforts need to be made at hospital level to develop a more pro-active safe and just culture that supports and encourages junior doctors and ultimately all doctors to understand and speak up about safety concerns.

Anaesthesiology students' Non-Technical skills: development and evaluation of a behavioural marker system for students (AS-NTS)

BACKGROUND

Non-Technical Skills (NTS) are becoming more important in medical education. A lack of NTS was identified as a major reason for unsafe patient care, favouring adverse events and team breakdown. Therefore, the training of NTS should already be implemented in undergraduate teaching. The goal of our study was to develop and validate the Anaesthesiology Students' Non-Technical Skills (AS-NTS) as a feasible rating tool to assess students' NTS in emergency and anaesthesiology education.

METHODS

The development of AS-NTS was empirically grounded in expert- and focus groups, field observations and data from NTS in medical fields. Validation, reliability and usability testing was conducted in 98 simulation scenarios, during emergency and anaesthesiology training sessions.

RESULTS

AS-NTS showed an excellent interrater reliability (mean 0.89), achieved excellent content validity indexes (at least 0.8) and was rated as feasible and applicable by educators. Additionally, we could rule out the influence of the raters' anaesthesiology and emergency training and experience in education on the application of the rating tool.

CONCLUSIONS

AS-NTS provides a structured approach to the assessment of NTS in undergraduates, providing accurate feedback. The findings of usability, validity and reliability indicate that AS-NTS can be used by anaesthesiologists in different year of postgraduate training, even with little experience in medical education.

Who's who? Championing the '#TheatreCapChallenge'

Our Developing Perioperative Practice service improvement project, sponsored by the Royal Bournemouth Hospital, addressed whether the remarkably simple idea of putting names and roles on hats in theatre would improve communication and patient care. We were inspired by our own experiences as a group of student Operating Department Practitioners: unfamiliarity with members of the team, wanting to feel included in the work but not out of our depth, and by social media campaigns such as the '#TheatreCapChallenge' and '#hellomynameis', aiming to humanise care and increase patient safety. Researching, clinically trialling and presenting this project gave us a systematic approach to improving the quality of care within the theatre environment.

Improving safety and reducing error in endoscopy: simulation training in human factors

Patient safety incidents occur throughout healthcare and early reports have exposed how deficiencies in 'human factors' have contributed to mortality in endoscopy. Recognising this, in the UK, the Joint Advisory Group for Gastrointestinal Endoscopy have implemented a number of initiatives including the 'Improving Safety and Reducing Error in Endoscopy' (ISREE) strategy. Within this, simulation training in human factors and Endoscopic Non-Technical Skills (ENTS) is being developed. Across healthcare, simulation training has been shown to improve team skills and patient outcomes. Although the literature is sparse, integrated and in situ simulation modalities have shown promise in endoscopy. Outcomes demonstrate improved individual and team performance and development of skills that aid clinical practice. Additionally, the use of simulation training to detect latent errors in the working environment is of significant value in reducing error and preventing harm. Implementation of simulation training at local and regional levels can be successfully achieved with collaboration between organisational, educational and clinical leads. Nationally, simulation strategies are a key aspect of the ISREE strategy to improve ENTS training. These may include integration of simulation into current training or development of novel simulation-based curricula. However used, it is evident that simulation training is an important tool in developing safer endoscopy.

Effective Surgical Teams: An Integrative Literature Review

It is imperative to understand the factors that contribute to effective surgical teams. The aim of this integrative review was to evaluate the aids and barriers for perioperative teams in functioning effectively, preventing adverse events, and fostering a culture of safety. The literature search was undertaken of 15 databases, which resulted in 70 articles being included. It was found perioperative teamwork was not widely understood. Findings indicated barriers to effective surgical teams comprised of confusion in tasks and responsibilities, existing hierarchies and prevailing misconceptions and understanding among team members. Although numerous quality initiatives exist, the introduction of protocols and checklists, team effectiveness in the perioperative setting is still insufficient and challenges in establishing effective surgical teams continue. Further research is recommended to obtain a comprehensive perception of environmental influences and barriers surgical teams encounter in the delivery of safe quality care.

Role of Perioperative Surgical Safety Checklist in Reducing Morbidity and Mortality among Patients: An Observational Study

Background:

Safe Surgery Saves Lives. Patient safety is a fundamental of good quality health care, and complications due to the health-care system are well-documented and constitute an important public health problem. Implementation of the checklist in medicine and surgery can help to decrease the risk of adverse events thus can improve patient safety.

Materials and Methods:

After the Institutional Ethical Committee clearance, a total of 500 patients were enrolled and divided into two equal groups. In Group 1 (n = 250), patients underwent surgery before regular implementation of the World Health Organization (WHO) surgical safety checklist (SSC), whereas in Group 2 (n = 250), patients underwent surgery after the WHO SSC was regularly implemented. All the patients were followed up after the surgery, and patients were looked for and compared for the postoperative complications.

Results:

We found that 27 patients (10.8%) in Group 1 and 13 patients (5.2%) in Group 2 developed major wound disruption (P < 0.05). There were 73 patients (29.2%) in Group 1 and 34 patients (13.6%) in the Group 2 who developed an infection of the surgical site (P < 0.05). There were five patients (2%) in Group 1 while none of the patients in Group 2 developed sepsis during the study (P < 0.05).

Conclusions:

We found that implementation of the WHO SSC significantly reduces surgical site infections, major disruptions of the wound, and sepsis.

Problem-based learning for anesthesia resident operating room crisis management training

BACKGROUND

Senior anesthesia residents must acquire competency in crisis management for operating room (OR) emergencies. We conducted problem based learning (PBL) OR emergency scenarios for anesthesia residents, focused on emergencies in 'Airway', 'Circulation', 'Central venous catheter', and 'Pain management complications'. Non-technical skills are an integral component of team-based OR emergency management.

METHODS

Prior to integrated OR emergency clinical and non-technical skills PBL training, participating 35 anesthesia residents completed two 5-point scale surveys regarding frequency of emergency experiences in the operating room, and self-confidence for anesthesia-related crisis management. Repeat administration of the self-confidence survey was completed immediately following PBL training.

RESULTS

Post-PBL resident clinical management self- confidence improved (P<0.05) in all scenarios on Circulation, Central venous catheter, and Pain treatment related complication topics. Impossible intubation, impossible oxygenation, and awake intubation did not show significant difference following PBL.

CONCLUSION

Our findings suggest that PBL for OR emergency management can improve resident self- confidence in anesthesia residents.

Safer paediatric surgical teams: A 5-year evaluation of crew resource management implementation and outcomes

Objective

Evaluate longitudinal changes in technical and non-technical skills (teamwork, situation monitoring, communication and leadership), safety culture, and clinical outcomes before and after implementation of a crew resource management (CRM) safety program.

Design

A multi-level prospective single case study in accordance with the SQUIRE-guidelines for reporting quality improvement efforts.

Setting

Large university paediatric surgical service.

Participant(s)

All 153 managers and staff.

Interventions

Training of staff in CRM, systematic risk assessments, and the redesign of work practices captured and reinforced through the development, implementation and refinement of SOPs.

Main Outcome Measure(s)

Data were collected related to: 1) Relevance of CRM training (survey), 2) Safety culture (survey), 3) Team behaviours in clinical practice (non-participatory observations with MedPACT protocol) and 4) Effects on perioperative care for laparoscopic appendectomies-a representative and frequently performed surgical procedure (electronic medical records and administrative data for length of stay, unplanned readmissions and returns to the Operating Room).

Results

Non-technical skills, the use of safety tools, as well as adherence to guidelines for appendectomies all improved significantly over time. Significant safety culture improvements were found in teamwork across and within units, supervisors' expectations and actions, non-punitive response to adverse events, and perceptions of overall patient safety. Unplanned readmissions following appendectomy declined significantly.

Conclusions

Implementation of a comprehensive CRM program including associated safety tools created sustained adherence to new work practices and improved non-technical and technical skills, surgical outcomes and safety culture.

Factors that affect scrub practitioner non-technical skills: A literature review

Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.

Anesthetic management and human factors in the intraoperative MRI environment

PURPOSE OF REVIEW

The use of intraoperative MRI technology during neurosurgery has become increasingly more common over the past several years. These surgical procedures require a specialized operating room designed to accommodate an MRI machine, as well as MRI-compatible anesthesia equipment and monitors. The MRI environment also poses unique risks and challenges to both patients and medical staff.

RECENT FINDINGS

General anesthesia in the MRI operating room suite poses several challenges not routinely experienced in a conventional operating room suite, and anesthesia providers delivering care in these suites must complete specialized training and screening. The presence of a magnetic field, as well as reduced access to the patient during the MRI scan, require high levels of vigilance.

SUMMARY

The use of checklists and teamwork training can maximize both patient and provider safety in the intraoperative MRI environment.

Impact of disruptions on anaesthetic workflow during anaesthesia induction and patient positioning: A prospective study

BACKGROUND

Work disruption in operating rooms hinders flow of patients and increases chances of error. Previous studies have largely considered the types of disruption occurring in operating rooms, but have not analysed systematically the objective impact of disruption.

OBJECTIVE

The objective was to evaluate the impact of disruption on time efficiency in preoperative anaesthetic work in the operating room and to link disruption to failures in co-ordination of care.

DESIGN

Prospective, cross-sectional and observational study.

SETTING

Disruptions were evaluated in operating rooms of five hospitals across three countries: Australia (one community hospital, one teaching hospital); Thailand (two community hospitals); China (one teaching hospital).

PARTICIPANTS

The preoperative phase of anaesthesia induction/patient positioning of 64 surgical patients across specialities was prospectively evaluated (Australia = 33; Thailand = 12; China = 10). Further, interviews were carried out with 16 consultant anaesthetists and surgeons and 13 senior operating room nurses involved in the care of these patients.

MAIN OUTCOME MEASURES

Disruptions were identified by trained observers in real time during the preoperative phase; four types of care co-ordination problems were identified from the interviews with senior anaesthetists, surgeons and nurses, and linked to the disruptions. Descriptive analyses of time efficiency were performed.

RESULTS

Complete data were available from 55 cases. Good inter-observer agreement was obtained across measurements (range 74 to 92%). An average of three disruptions per case during the preoperative phase, were observed (range 2 to 9). 'Disruption types': disruptive staff activities were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 4 min 45 s per case). 'Care co-ordination problems': co-ordination lapses within the operating room team, and between them and the preoperative team were associated with most timewasting (median = 1 min per case, range 0 min 0 s to 5 min 0 s per case).

CONCLUSION

The study quantifies time inefficiencies affecting anaesthetic work during the preoperative phase. Work disruption wastes time and is preventable.

Measuring surgical safety during minimally invasive surgical procedures: a validation study

BACKGROUND

During the implementation of new interventions (i.e., surgical devices and technologies) in the operating room, surgical safety might be compromised. Current safety measures are insufficient in detecting safety hazards during this process. The aim of the study was to observe whether surgical teams are capable of measuring surgical safety, especially with regard to the introduction of new interventions.

METHODS

A Surgical Safety Questionnaire was developed that had to be filled out directly postoperative by three surgical team members. A potential safety concern was defined as at least one answer between (strongly) disagree and indifferent. The validity of the questionnaire was assessed by comparison with the results from video analysis. Two different observers annotated the presence and effect of surgical flow disturbances during 40 laparoscopic hysterectomies performed between November 2010 and April 2012.

RESULTS

The surgeon reported a potential safety concern in 16% (85/520 questions). With respect to the scrub nurse and anesthesiologist, this was both 9% (46/520). With respect to the preparation, functioning, and ease of use of the devices in 37.5-47.5% (15-19/40 procedures) a potential safety concern was reported by one or more team members. During procedures after which a potential safety concern was reported, surgical flow disturbances lasted a higher percentage of the procedure duration [9.3 ± 6.2 vs. 2.9 ± 3.7% (mean ± SD), p < .001]. After procedures during which a new instrument or device was used, more potential safety concerns were reported (51.2 vs. 23.1%, p < .001).

CONCLUSIONS

Potential safety concerns were especially reported during procedures in which a relatively high percentage of the duration consisted of surgical flow disturbances and during procedures in which a new instrument or device was used. The Surgical Safety Questionnaire can act as a validated tool to evaluate and maintain surgical safety during minimally invasive procedures, especially during the introduction of a new intervention.

Adaptation of a tool to assess non-technical skills of scrub practitioners in Denmark

The aim of this study was to adapt the Scottish tool, Scrub Practitioners List of Intraoperative Non-Technical Skills, to Danish organisation and culture. With an explorative and qualitative approach, four group interviews with scrub practitioners, surgeons and anaesthesia staff were conducted. The main differences found were related to communication and teamwork regarding scrub practitioners focus on the team and speaking up. Differences in the non-technical skills described in the behavioural markers are perhaps explained by cultural differences between Scotland and Denmark. A new tool for scrub practitioners in Denmark was adapted.

Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery

Introduction

Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality.

Objective

The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow.

Methods

A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery.

Results

The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale.

Conclusion

Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

Operating room professionals' attitudes towards patient safety and the influencing factors

OBJECTIVE

To determine operating room professionals'attitudes towards patient safety and the influencing factors.

METHODS

This study was conducted in research hospitals in Izmir, Turkey using descriptive, cross-sectional and correlation research designs. The sample of this study consisted of 477 individuals including nurses, physicians and anesthesia technicians. Data were collected using the Sociodemographic and Working Characteristics Form and the Safety Attitudes Questionnaire. Descriptive statistics method, and Pearson's correlation and the multiple regression models were used for data analysis.

RESULTS

Operating room professionals' attitudes towards patient safety were at moderate levels. Regarding the influencing factors, team cooperation obtained the highest score, whereas stress recognition obtained the lowest score. As a result of the regression analysis, age, male gender and receiving patient safety training explains 15.4% of the professionals' safety attitudes.

CONCLUSIONS

Receiving patient safety training was found to be the most important variable of all.

Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial

OBJECTIVE

Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes.

STUDY DESIGN

A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome.

RESULTS

The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units.

CONCLUSIONS

The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and after the delivery room. (ClinicalTrials.gov ID: NCT02584166).

S-TEAMS: A Truly Multiprofessional Course Focusing on Nontechnical Skills to Improve Patient Safety in the Operating Theater

BACKGROUND

Possessing adequate nontechnical skills (NTS) in operating theaters is of increasing interest to health care professionals, yet these are rarely formally taught. Teams make human errors despite technical expertise and knowledge, compromising patient safety. We designed a 1-day, multiprofessional, multidisciplinary course to teach, practice, and apply these skills through simulation.

METHODS

The course, "S-TEAMS," comprised a morning of lectures, case studies, and interactive teamworking exercises. The afternoon divided the group into multiprofessional teams to rotate around simulated scenarios. During the scenarios, teams were encouraged to focus on NTS, including communication strategies, situational awareness, and prompts such as checklists. A thorough debrief with experienced clinician observers followed. Data was collected through self-assessments, immediate and 6-month feedback to assess whether skills continued to be used and their effect on safety.

FINDINGS

In total, 68 health care professionals have completed the course thus far. All participants felt the course had a clear structure and that learning objectives were explicit. Overall, 95% felt the scenarios had good or excellent relevance to clinical practice. Self-assessments revealed a 55% increase in confidence for "speaking up" in difficult situations. Long-term data revealed 97% of the participants continued to use the skills, with 88% feeling the course had prevented them from making errors. Moreover, 94% felt the course had directly improved patient safety.

CONCLUSIONS

There is a real demand and enthusiasm for developing NTS within the modern theater team. The simple and easily reproducible format of S-TEAMS is sustainable and inclusive, and crucially, the skills taught continue to be used in long term to improve patient safety and teamworking.