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Keller S, Jelsma JGM, Tschan F, Sevdalis N, Löllgen RM, Creutzfeldt J, Kennedy-Metz LR, Eppich W, Semmer NK, Van Herzeele I, Härenstam KP, de Bruijne MC. Behavioral sciences applied to acute care teams: a research agenda for the years ahead by a European research network. BMC Health Serv Res 2024; 24:71. [PMID: 38218788 PMCID: PMC10788034 DOI: 10.1186/s12913-024-10555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Multi-disciplinary behavioral research on acute care teams has focused on understanding how teams work and on identifying behaviors characteristic of efficient and effective team performance. We aimed to define important knowledge gaps and establish a research agenda for the years ahead of prioritized research questions in this field of applied health research. METHODS In the first step, high-priority research questions were generated by a small highly specialized group of 29 experts in the field, recruited from the multinational and multidisciplinary "Behavioral Sciences applied to Acute care teams and Surgery (BSAS)" research network - a cross-European, interdisciplinary network of researchers from social sciences as well as from the medical field committed to understanding the role of behavioral sciences in the context of acute care teams. A consolidated list of 59 research questions was established. In the second step, 19 experts attending the 2020 BSAS annual conference quantitatively rated the importance of each research question based on four criteria - usefulness, answerability, effectiveness, and translation into practice. In the third step, during half a day of the BSAS conference, the same group of 19 experts discussed the prioritization of the research questions in three online focus group meetings and established recommendations. RESULTS Research priorities identified were categorized into six topics: (1) interventions to improve team process; (2) dealing with and implementing new technologies; (3) understanding and measuring team processes; (4) organizational aspects impacting teamwork; (5) training and health professions education; and (6) organizational and patient safety culture in the healthcare domain. Experts rated the first three topics as particularly relevant in terms of research priorities; the focus groups identified specific research needs within each topic. CONCLUSIONS Based on research priorities within the BSAS community and the broader field of applied health sciences identified through this work, we advocate for the prioritization for funding in these areas.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
- Department for BioMedical Research (DBMR), Bern University, Bern, Switzerland.
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, KCL, London, UK
| | - Ruth M Löllgen
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Johan Creutzfeldt
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training, (CAMST), Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Lauren R Kennedy-Metz
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
- Psychology Department, Roanoke College, Salem, VA, USA
| | - Walter Eppich
- Department of Medical Education & Collaborative Practice Centre, University of Melbourne, Melbourne, Australia
| | - Norbert K Semmer
- Department of Work Psychology, University of Bern, Bern, Switzerland
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Karin Pukk Härenstam
- Pediatric Emergency Department, Astrid Lindgrens Children's Hospital; Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Alexandrino H, Martinho B, Ferreira L, Baptista S. Non-technical skills and teamwork in trauma: from the emergency department to the operating room. Front Med (Lausanne) 2023; 10:1319990. [PMID: 38116034 PMCID: PMC10728672 DOI: 10.3389/fmed.2023.1319990] [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] [Received: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 12/21/2023] Open
Abstract
Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.
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Affiliation(s)
- Henrique Alexandrino
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Surgery, Coimbra University Hospital Center, Coimbra, Portugal
- Lusitanian Association for Trauma and Emergency Surgery, Coimbra, Portugal
| | - Bárbara Martinho
- Department of Surgery, Coimbra University Hospital Center, Coimbra, Portugal
| | - Luís Ferreira
- Lusitanian Association for Trauma and Emergency Surgery, Coimbra, Portugal
- Hospital Dr. Nélio Mendonça, Funchal, Madeira, Portugal
| | - Sérgio Baptista
- Lusitanian Association for Trauma and Emergency Surgery, Coimbra, Portugal
- Medio Tejo Hospital Center, Tomar, Portugal
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Mathis MR, Janda AM, Yule SJ, Dias RD, Likosky DS, Pagani FD, Stakich-Alpirez K, Kerray FM, Schultz ML, Fitzgerald D, Sturmer D, Manojlovich M, Krein SL, Caldwell MD. Nontechnical Skills for Intraoperative Team Members. Anesthesiol Clin 2023; 41:803-818. [PMID: 37838385 PMCID: PMC10703542 DOI: 10.1016/j.anclin.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nontechnical skills, defined as the set of cognitive and social skills used by individuals and teams to reduce error and improve performance in complex systems, have become increasingly recognized as a key contributor to patient safety. Efforts to characterize, quantify, and teach nontechnical skills in the context of perioperative care continue to evolve. This review article summarizes the essential behaviors for safety, described in taxonomies for nontechnical skills assessments developed for intraoperative clinical team members (eg, surgeons, anesthesiologists, scrub practitioners, perfusionists). Furthermore, the authors describe emerging methods to advance understanding of the impact of nontechnical skills on perioperative outcomes.
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Affiliation(s)
- Michael R Mathis
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Allison M Janda
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Steven J Yule
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Roger D Dias
- Department of Emergency Medicine, Brigham & Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Donald S Likosky
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Francis D Pagani
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Korana Stakich-Alpirez
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Fiona M Kerray
- Department of Clinical Surgery, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, Scotland
| | - Megan L Schultz
- Department of Cardiac Surgery, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - David Fitzgerald
- Department of Clinical Sciences, Medical University of South Carolina College of Health Professions, A 151 Rutledge Avenue, Charleston, SC 29403, USA
| | - David Sturmer
- Department of Perfusion, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Milisa Manojlovich
- School of Nursing, University of Michigan, 426 N Ingalls Street, Ann Arbor, MI 48104, USA
| | - Sarah L Krein
- Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, USA
| | - Matthew D Caldwell
- Department of Anesthesiology, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Huber T, Boedecker C, Borchardt T, Vradelis L, Wachter N, Grimminger PP, Musholt TJ, Mädge S, Griemert EV, Heinrich S, Huettl F, Lang H. Education Team Time Out in Oncologic Visceral Surgery Optimizes Surgical Resident Training and Team Communication-Results of a Prospective Trial. JOURNAL OF SURGICAL EDUCATION 2023; 80:1215-1220. [PMID: 37455191 DOI: 10.1016/j.jsurg.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Surgical education is highly dependent on intraoperative communication. Trainers must know the trainee's training level to ensure high-quality surgical training. A systematic preoperative dialogue (Educational Team Time Out, ETO) was established to discuss the steps of each surgical procedure. METHODS Over 6 months, ETO was performed within a time limit of 3 minutes. Digital surveys on the utility of ETO and its impact on performance were conducted immediately after surgery and at the end of the study period among the staff of the participating disciplines (trainer, trainee, surgical nursing staff, anaesthesiologists, and medical students). The number of surgical substeps performed was recorded and compared with the equivalent period one year earlier. RESULTS ETO was performed in 64 of the 103 eligible operations (62%). Liver resection (n = 37) was the most frequent procedure, followed by left-sided colorectal surgery (n = 12), partial pancreaticoduodenectomy (n = 6), right-sided hemicolectomies (n = 5), and thyroidectomies (n = 4). Anaesthesiologists most frequently reported that ETO had a direct impact on their work during surgery (90.9%). The influence scores were 46.8% for trainees, 8.8% for trainers, 53.3% for surgical nursing staff and 66.6% for medical students. During the implementation of ETO, a trend towards more assisted substeps in oncologic visceral surgery was seen compared to the corresponding period one year earlier (51% vs.40%; p = 0.11). CONCLUSION ETO leads to improved intraoperative communication and more performed substeps during complex procedures, which increases motivation and practical training. This concept can easily be implemented in all surgical specialties to improve surgical education.
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Affiliation(s)
- T Huber
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
| | - C Boedecker
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - T Borchardt
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - L Vradelis
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - N Wachter
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - P P Grimminger
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - T J Musholt
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - S Mädge
- Central OR Management, University Medical Center Mainz, Mainz, Germany
| | - E V Griemert
- Department of Anaesthesiology University Medical Center Mainz, Mainz, Germany
| | - S Heinrich
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - F Huettl
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - H Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
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Timm-Holzer E, Tschan F, Keller S, Semmer NK, Zimmermann J, Huber SA, Hübner M, Candinas D, Demartines N, Weber M, Beldi G. No signs of check-list fatigue - introducing the StOP? intra-operative briefing enhances the quality of an established pre-operative briefing in a pre-post intervention study. Front Psychol 2023; 14:1195024. [PMID: 37457099 PMCID: PMC10338924 DOI: 10.3389/fpsyg.2023.1195024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
Background The team timeout (TTO) is a safety checklist to be performed by the surgical team prior to incision. Exchange of critical information is, however, important not only before but also during an operation and members of surgical teams frequently feel insufficiently informed by the operating surgeon about the ongoing procedure. To improve the exchange of critical information during surgery, the StOP?-protocol was developed: At appropriate moments during the procedure, the leading surgeon briefly interrupts the operation and informs the team about the current Status (St) and next steps/objectives (O) of the operation, as well as possible Problems (P), and encourages questions of other team members (?). The StOP?-protocol draws attention to the team. Anticipating the occurrence of StOP?-protocols may support awareness of team processes and quality issues from the beginning and thus support other interventions such as the TTO; however, it also may signal an additional demand and contribute to a phenomenon akin to "checklist fatigue." We investigated if, and how, the introduction of the StOP?-protocol influenced TTO quality. Methods This was a prospective intervention study employing a pre-post design. In the visceral surgical departments of two university hospitals and one urban hospital the quality of 356 timeouts (out of 371 included operation) was assessed by external observers before (154) and after (202) the introduction of the StOP?-briefing. Timeout quality was rated in terms of timeout completeness (number of checklist items mentioned) and timeout quality (engagement, pace, social atmosphere, noise). Results As compared to the baseline, after the implementation of the StOP?-protocol, observed timeouts had higher completeness ratings (F = 8.69, p = 0.003) and were rated by observers as higher in engagement (F = 13.48, p < 0.001), less rushed (F = 14.85, p < 0.001), in a better social atmosphere (F = 5.83, p < 0.016) and less noisy (F = 5.35, p < 0.022). Conclusion Aspects of TTO are affected by the anticipation of StOP?-protocols. However, rather than harming the timeout goals by inducing "checklist fatigue," it increases completeness and quality of the team timeout.
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Affiliation(s)
- Eliane Timm-Holzer
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sandra Keller
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | | | - Jasmin Zimmermann
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon A. Huber
- Department of Psychology, University of Berne, Berne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
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Koch A, Schlenker B, Becker A, Weigl M. Operating room team strategies to reduce flow disruptions in high-risk task episodes: resilience in robot-assisted surgery. ERGONOMICS 2022:1-14. [PMID: 36285451 DOI: 10.1080/00140139.2022.2136406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
In healthcare work settings, flow disruptions (FDs) pose a potential threat to patient safety. Resilience research suggests that adaptive behavioural strategies contribute to preventing cognitive overload through FDs at crucial moments. We aimed to explore the nature and efficacy of operating room (OR) team strategies to prevent FDs in robot-assisted surgery. Within a mixed-methods design, we first asked surgical professionals, which strategies they apply, and secondly, identified behavioural strategies through direct observations. Findings were analysed using content analysis. Additionally, FDs were assessed through live observations in the OR. The sample included four interviewed experts and 15 observed surgical cases. Sixty originally received strategies were synthesised into 17 final OR team strategies. Overall, 658 FDs were observed with external FDs being the most frequent. During high-risk episodes, FDs were significantly reduced (p < 0.0001). The identified strategies reveal how OR teams deliberatively and dynamically manage and mitigate FDs during critical tasks. Our findings contribute to a nuanced understanding of adaptive strategies to safeguard performance in robot surgery services. Practitioner Summary: Flow disruptions (FDs) in surgical work may become a severe safety threat during high-risk situations. With interviews and observations, we explored team strategies applied to prevent FDs in critical moments. We obtained a comprehensive list of behavioural strategies and found that FDs were significantly reduced during a specific high-risk surgical task. Our findings emphasise the role of providers' and teams' adaptive capabilities to manage workflow in high-technology care environments.
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Affiliation(s)
- Amelie Koch
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital, LMU, Munich, Germany
| | - Matthias Weigl
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany
- Institute for Patient Safety, University Hospital, University of Bonn, Bonn, Germany
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Keller S, Tschan F, Semmer NK, Trelle S, Manser T, Beldi G. StOP? II trial: cluster randomized clinical trial to test the implementation of a toolbox for structured communication in the operating room-study protocol. Trials 2022; 23:878. [PMID: 36258223 PMCID: PMC9580155 DOI: 10.1186/s13063-022-06775-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Surgical care, which is performed by intensely interacting multidisciplinary teams of surgeons, anesthetists, and nurses, remains associated with significant morbidity and mortality. Intraoperative communication has been shown to be associated with surgical outcomes, but tools ensuring efficient intraoperative communication are lacking. In a previous study, we developed the StOP?-protocol that fosters structured intraoperative communication. Before the critical phases of the operation, the responsible surgeon initiates and leads one or several StOP?s. During a StOP?, the surgeon informs about the progress of the operation (status), next steps and proximal goals (objectives), and possible problems (problems) and encourages all team members to voice their observations and ask questions (?). In a before-after study performed mainly in visceral surgery, we found effects of the StOP?-protocol on mortality, length of hospital stay, and reoperation. We intend to assess the impact of the StOP?-protocol in a cluster randomized trial, in a wider variety of surgical specialties (i.e., general, visceral, thoracic, vascular surgery, surgical urology, and gynecology). The primary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces patient mortality within 30 days after the operation. The secondary hypothesis is that the consistent use of the StOP?-protocol by the main surgeon reduces unplanned reoperations, length of hospital stay, and unplanned hospital readmissions. Methods This study is designed as a multicenter, cluster-randomized parallel-group trial. Board-certified surgeons of participating clinical departments will be randomized 1:1 to the StOP? intervention group or to the standard of care (control) group. The intervention group will undergo a training to use the StOP?-protocol and receive regular feedback on their compliance with the protocol. The surgeons in the control group will communicate as usual during their operations. The unit of observation will be operations performed by cluster surgeons. Consecutive patients will be enrolled over 4 months per cluster. A total of 400 surgeons will be recruited, and we expect to collect patient outcome data for 14,000 surgical procedures. Discussion The StOP?-protocol was designed as a tool to structure communication during surgical procedures. Testing its effects on patient outcomes will contribute to implementing evidenced-based interventions to reduce surgical complications. Trial registration ClinicalTrials.gov NCT05356962. Registered on May 2, 2022 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06775-y.
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Affiliation(s)
- Sandra Keller
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Sven Trelle
- CTU Bern, University of Bern, Bern, Switzerland
| | - Tanja Manser
- FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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No impact of sex on surgical site infections in abdominal surgery: a multi-center study. Langenbecks Arch Surg 2022; 407:3763-3769. [PMID: 36214869 DOI: 10.1007/s00423-022-02691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/15/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Male sex is controversially discussed as a risk factor for surgical site infections (SSI). The aim of the present study was to evaluate the impact of sex on SSI in abdominal surgery under elimination of relevant confounders. METHODS Clinicopathological data of 6603 patients undergoing abdominal surgery from a multi-center prospective database of four Swiss hospitals including patients between 2015 and 2018 were assessed. Patients were stratified according to postoperative SSI and risk factors for SSI were identified using univariate and multivariate analysis. RESULTS In 649 of 6603 patients, SSI was reported (9.8%). SSI was significantly associated with reoperation (22.7% vs. 3.4%, p < 0.001), increased mortality rate (4.6% vs. 0.9%, p < 0.001), and increased rate of length of hospital stay > 75th percentile (57.0% vs. 17.9%, p < 0.001). In univariate analysis, male sex was a significant risk factor for SSI (p = 0.01). In multivariate analysis including multiple confounders' such as comorbidities and perioperative factors, there was no association between male sex and risk of SSI (odds ratio (OR) 1.1 [CI 0.8-1.4]). Independent risk factors for SSI in multivariate analysis were BMI ≥ 30 kg/m2 (OR 1.8 [CI 1.3-2.3]), duration of surgery > 75th percentile (OR 2.3 [1.8-2.9]), high contamination level (OR 1.3 [1.0-1.6]), laparotomy (OR 1.3 [1.0-1.7]), previous laparotomy (OR 1.4 [1.1-1.7]), blood transfusion (OR 1.7 [1.2-2.4]), cancer (OR 1.3 [1.0-1.8] and malnutrition (OR 2.5 [1.8-3.4]). CONCLUSION Under elimination of relevant confounders, there is no significant correlation between sex and risk of SSI after abdominal surgery.
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Mohamadipanah H, Perumalla CA, Kearse LE, Yang S, Wise BJ, Goll CK, Witt AK, Korndorffer JR, Pugh CM. Do Individual Surgeon Preferences Affect Procedural Outcomes? Ann Surg 2022; 276:701-710. [PMID: 35861074 PMCID: PMC10254571 DOI: 10.1097/sla.0000000000005595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Surgeon preferences such as instrument and suture selection and idiosyncratic approaches to individual procedure steps have been largely viewed as minor differences in the surgical workflow. We hypothesized that idiosyncratic approaches could be quantified and shown to have measurable effects on procedural outcomes. METHODS At the American College of Surgeons (ACS) Clinical Congress, experienced surgeons volunteered to wear motion tracking sensors and be videotaped while evaluating a loop of porcine intestines to identify and repair 2 preconfigured, standardized enterotomies. Video annotation was used to identify individual surgeon preferences and motion data was used to quantify surgical actions. χ 2 analysis was used to determine whether surgical preferences were associated with procedure outcomes (bowel leak). RESULTS Surgeons' (N=255) preferences were categorized into 4 technical decisions. Three out of the 4 technical decisions (repaired injuries together, double-layer closure, corner-stitches vs no corner-stitches) played a significant role in outcomes, P <0.05. Running versus interrupted did not affect outcomes. Motion analysis revealed significant differences in average operative times (leak: 6.67 min vs no leak: 8.88 min, P =0.0004) and work effort (leak-path length=36.86 cm vs no leak-path length=49.99 cm, P =0.001). Surgeons who took the riskiest path but did not leak had better bimanual dexterity (leak=0.21/1.0 vs no leak=0.33/1.0, P =0.047) and placed more sutures during the repair (leak=4.69 sutures vs no leak=6.09 sutures, P =0.03). CONCLUSIONS Our results show that individual preferences affect technical decisions and play a significant role in procedural outcomes. Future analysis in more complex procedures may make major contributions to our understanding of contributors to procedure outcomes.
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Standardizing The Intraoperative Adverse Events Assessment to Create a Positive Culture of Reporting Errors in Surgery and Anesthesiology. Ann Surg 2022; 276:e75-e76. [DOI: 10.1097/sla.0000000000005464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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11
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Fridrich A, Imhof A, Staender S, Brenni M, Schwappach D. A Quality Improvement Initiative Using Peer Audit and Feedback to Improve Compliance with the Surgical Safety Checklist. Int J Qual Health Care 2022; 34:6622008. [PMID: 35770658 PMCID: PMC9290878 DOI: 10.1093/intqhc/mzac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/11/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Surgical Safety Checklist (SSC) published by the WHO in 2009 is used as standard in surgery worldwide to reduce perioperative patient mortality. However, compliance with the SSC and quality of its application are often not satisfactory. Internal audits and feedbacks seem promising for improving SSC application. Objective The purpose of this study is to investigate whether an intervention consisting of peer observation and immediate peer feedback can be implemented with high fidelity and acceptance. Method Data were obtained from a national pilot programme that was initiated in Switzerland in 2018 to measure and improve compliance with the SSC using peer audit and feedback. A total of 11 hospitals with 14 sites implemented the full intervention. Each hospital formed an interprofessional project team that should perform at least 30 observations with feedback on SSC application documented in an observation tool developed specifically for this programme. Since the SSCs of the study hospitals differ greatly regarding checklist items, for each of the three SSC sections standard items were defined: four at Sign In, five at Team Time Out and two at Sign Out. Frequency analyses were performed for initiation characteristics, SSC application at item level, feedback characteristics and programme evaluation. Results The 11 hospitals documented 715 valid observations, and feedback on SSC application was provided for 79% of the observations. In 61%, all team members stopped their work for the SSC application, and in 71%, the items were read off from the checklist (instead of recalled from memory). On average, 86% of the standard items were read out by the checklist coordinator, whilst the two items at Sign Out were read out only in 60% and 74%. Additional visual checks with another source (e.g. patient wristband) took place in only 41%, and verbal confirmation of the items (by someone else other than the checklist coordinator) was obtained on an average of 76% across all three checklist sections. The surgical teams reacted positively in 64% to the peer feedback. Conclusion Both implementation fidelity and acceptability of the intervention were high—the present intervention seems suitable for regular monitoring of the quality of SSC application with internal resources. Peer observation facilitated identifying weaknesses regarding the SSC process and application at item level. Across all hospitals, the Sign Out section in general, visual control for item checks and lack of work interruption of all team members during SSC application showed up as the main areas of improvement.
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Affiliation(s)
| | - Anita Imhof
- Swiss Patient Safety Foundation, Zurich, Switzerland
| | - Sven Staender
- Department of Anaesthesia & Intensive Care Medicine, Regional Hospital Maennedorf, Maennedorf, Switzerland
| | - Mirko Brenni
- Institute of Anesthesiology, Intensive Care Medicine, Emergency and Rescue Medicine, See-Spital, Horgen, Switzerland
| | - David Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Bottet B, Rivera C, Dahan M, Falcoz PE, Jaillard S, Baste JM, Seguin-Givelet A, de la Tour RB, Bellenot F, Rind A, Gossot D, Thomas PA, D’Journo XB. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6584014. [PMID: 35543477 PMCID: PMC9419675 DOI: 10.1093/icvts/ivac129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/10/2022] [Accepted: 05/04/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Benjamin Bottet
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Caroline Rivera
- Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France
| | - Marcel Dahan
- Department of Thoracic Surgery, Larrey Hospital, CHU Toulouse, Toulouse, France
| | | | - Sophie Jaillard
- Department of Thoracic surgery, Hopital Privé le Bois, Lille, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, Rouen University Hospital, Rouen, France
| | - Agathe Seguin-Givelet
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
- Paris 13 University, Sorbonne Paris Cité, Faculty of Medecine SMBH, Bobigny, France
| | | | | | - Alain Rind
- Organisme d’Accréditation (OA)-CTCV, SFCTCV, Paris, France
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thorax Institute, Institut Mutualiste Montsouris, Paris, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Marseille, France
| | - Xavier Benoit D’Journo
- Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Marseille, France
- Corresponding author. Department of Thoracic Surgery, Hopital Nord-APHM, Aix-Marseille University, Chemin des Bourrely, 13015 Marseille, France. Tel: +33-4-91-96-60-01; fax: +33-4-91-96-60-04; e-mail: (X.B. D’Journo)
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