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Al Abbas AI, Meier J, Daniel W, Cadeddu JA, Bartolome S, Willett DL, Palter V, Grantcharov T, Odeh J, Dandekar P, Evans K, Wu E, Apraku W, Zeh HJ. Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis. Surg Endosc 2024:10.1007/s00464-024-11064-7. [PMID: 39103662 DOI: 10.1007/s00464-024-11064-7] [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: 03/13/2024] [Accepted: 07/06/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Surgical safety checklists reduce adverse events, but monitoring adherence to checklists is confounded by observation bias. The ORBB platform can monitor checklist compliance and correlate compliance with outcomes. This study aims to evaluate the association between checklist compliance and patient outcomes using the ORBB platform. METHODS This is a retrospective analysis of data from the electronic medical record of cases performed in ORBB-equipped operating rooms at a single quaternary referral center. All patients who did not opt out and underwent surgery at UT Southwestern Medical Center in ORBB-equipped rooms from August 2020 to September 2022 were included. The ORBB platform was set-up in five operating rooms and surgical safety checklist compliance was monitored by way of AI-based video review. RESULTS Overall, 4581 patients were included in this analysis.. Performance on the checklist was associated with lower mortality (OR, 0.96; 95% CI, 0.94-0.98; P < 0.05), and decreased length of stay (estimate [E]: -0.02 days; 95% CI, -0.03 to -0.005; P < 0.05). Performance during "timeouts" was associated with mortality (OR, 0.97; 95% CI, 0.94-0.99; P < 0.05). "Debriefings" were independently associated with mortality (OR, 0.98; 95% CI, 0.96-0.99; P < 0.05), length of stay (Estimate, -0.0009 days; 95% CI, -0.02 to -0.001; P < 0.05), and ICU admission (OR, 0.99; 95% CI, 0.98-0.99; P < 0.05). CONCLUSION Procedures performed by surgical teams who performed better on the surgical safety checklist tended to have better outcomes. This innovative technology could substantially enhance our ability to understand and mitigate threats to patients in real-time.
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Affiliation(s)
- Amr I Al Abbas
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jennie Meier
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - William Daniel
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Sonja Bartolome
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Duwayne L Willett
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Vanessa Palter
- International Center for Surgical Safety, University of Toronto, Toronto, ON, Canada
| | - Teodor Grantcharov
- Department of Surgery, Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Jaafar Odeh
- Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA
| | - Priya Dandekar
- Perioperative Services, University of Texas Southwestern, Dallas, TX, USA
| | - Kim Evans
- Perioperative Services, University of Texas Southwestern, Dallas, TX, USA
| | - Elaine Wu
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Winifred Apraku
- Department of Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Herbert J Zeh
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA.
- Department of Surgery, Hall and Mary Lucile Shannon Distinguished Chair in Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
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Wing R, Goldman MP, Prieto MM, Miller KA, Baluyot M, Tay KY, Bharath A, Patel D, Greenwald E, Larsen EP, Polikoff LA, Kerrey BT, Nishisaki A, Nagler J. Usability Testing Via Simulation: Optimizing the NEAR4PEM Preintubation Checklist With a Human Factors Approach. Pediatr Emerg Care 2024; 40:575-581. [PMID: 39078284 DOI: 10.1097/pec.0000000000003223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
OBJECTIVES To inform development of a preintubation checklist for pediatric emergency departments via multicenter usability testing of a prototype checklist. METHODS This was a prospective, mixed methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative. Pediatric emergency medicine attending physicians and senior fellows at each site were first oriented to a checklist prototype, including content previously identified using a modified Delphi approach. Each site used the checklist in 2 simulated cases: an "easy airway" and a "difficult airway" scenario. Facilitators recorded verbalization, completion, and timing of checklist items. After each simulation, participants completed an anonymous usability survey. Structured debriefings were used to gather additional feedback on checklist usability. Comments from the surveys and debriefing were qualitatively analyzed using a framework approach. Responses informed human factors-based optimization of the checklist. RESULTS Fifty-five pediatric emergency medicine physicians/fellows (4-13 per site) participated. Participants found the prototype checklist to be helpful, easy to use, clear, and of appropriate length. During the simulations, 93% of checklist items were verbalized and more than 80% were completed. Median time to checklist completion was 6.2 minutes (interquartile range, 4.8-7.1) for the first scenario and 4.2 minutes (interquartile range, 2.7-5.8) for the second. Survey and debriefing data identified the following strengths: facilitating a shared mental model, cognitively offloading the team leader, and prompting contingency planning. Suggestions for checklist improvement included clarifying specific items, providing more detailed prompts, and allowing institution-specific customization. Integration of these data with human factors heuristic inspection resulted in a final checklist. CONCLUSIONS Simulation-based, human factors usability testing of the National Emergency Airway Registry for Pediatric Emergency Medicine Preintubation Checklist allowed optimization prior to clinical implementation. Next steps involve integration into real-world settings utilizing rigorous implementation science strategies, with concurrent evaluation of the impact on patient outcomes and safety.
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Affiliation(s)
- Robyn Wing
- From the Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Lifespan Medical Simulation Center, Providence, RI
| | - Michael P Goldman
- Departments of Pediatrics (Section of Pediatric Emergency Medicine) and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Monica M Prieto
- Perelman School of Medicine at the University of Pennsylvania, Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kelsey A Miller
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Pediatric Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Mariju Baluyot
- Departments of Pediatrics and Emergency Medicine, Indiana University School of Medicine, Divisions of Pediatric Emergency Medicine and Simulation, Riley Hospital for Children, Indianapolis, IN
| | - Khoon-Yen Tay
- Perelman School of Medicine at the University of Pennsylvania, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Anita Bharath
- Department of Emergency Medicine, Phoenix Children's, Phoenix, AZ
| | - Deepa Patel
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Division of Pediatric Emergency Medicine, Cohen Children's Medical Center, New Hyde Park, NY
| | - Emily Greenwald
- Department of Pediatrics, Duke Children's Hospital, Duke University Hospital, Durham, NC
| | - Ethan P Larsen
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lee A Polikoff
- Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Benjamin T Kerrey
- University of Cincinnati, College of Medicine and the Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Akira Nishisaki
- Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Joshua Nagler
- Departments of Emergency Medicine and Pediatrics, Harvard Medical School, Division of Pediatric Emergency Medicine, Boston Children's Hospital, Boston, MA
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Clebone Ruskin A, Ahmed F, O'Connor M, Tung A. Why don't clinicians use checklists? Int Anesthesiol Clin 2024; 62:1-8. [PMID: 38410912 DOI: 10.1097/aia.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Anna Clebone Ruskin
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Cai J, Jiang M, Qi H. Evaluating the Effects of a General Anesthesia and Prone Position Nursing Checklist and Training Course on Posterior Lumbar Surgery: A Randomized Controlled Trial. J Patient Saf 2024; 20:22-27. [PMID: 37921750 DOI: 10.1097/pts.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND While general anesthesia in the prone position is one of the most utilized surgical positions, it predisposes to multiple types of complications. Existing studies on this topic are mostly literature reviews or focus on solving one complication, which limits their clinical use. OBJECTIVE The aims of the study were to evaluate the effectiveness of a 22-item general anesthesia and prone position nursing checklist and specific training course at preventing complications related to general anesthesia in the prone position. DESIGN The study used a randomized controlled trial. SETTINGS AND PARTICIPANTS Convenience sampling was used to recruit patients who underwent general anesthesia during posterior lumbar surgery from July 2021 to December 2021 at the Run Run Shaw Hospital, Zhejiang University School of Medicine Hospital. METHODS Patients involved in the study were randomly assigned to the control (standard general anesthesia and prone position care) or experimental group (general anesthesia and prone position nursing checklist combined with specific training course in addition to standard general anesthesia and prone position care). Outcomes were pressure injuries, peripheral nerve injuries, ocular complications, and length of stay (LOS). Patient satisfaction, Numeric Pain Rating Scale (NRS) and the Oswestry Disability Scale were also measured. RESULTS Compared with the control group, pressure injury, brachial plexus injury, and two ocular findings (foreign body sensation and blurry vision) were significantly less common in the intervention group ( P ≤ 0.01). Participants who received standard general anesthesia and prone position care had lower self-reported satisfaction than those managed with the general anesthesia and prone position nursing checklist plus specific training course ( P = 0.002). The checklist-based intervention also significantly reduced LOS ( P = 0.000) and NRS ( P = 0.000). CONCLUSIONS The intervention group had significant fewer general anesthesia in the prone position-related complications, improved satisfaction, reduced LOS, and lower NRS. These findings suggest that a general anesthesia and prone position nursing checklist in addition to a specific training course are beneficial to standardizing prone position nursing care during posterior lumbar surgery.
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Affiliation(s)
- Jianshu Cai
- From the Nursing Department, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ramjaun A, Hammond Mobilio M, Wright N, Masella M, Snyman A, Serrick C, Moulton CA. Beyond the Surgical Safety Checklist: Using Intraoperative Handoff to Facilitate Team Situation Awareness in the OR. Ann Surg 2023; 278:e1142-e1147. [PMID: 36912035 DOI: 10.1097/sla.0000000000005838] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND The surgical safety checklist (SSC) has been credited with improving team situation awareness (SA) in the operating room. Although the SSC may support team SA at the outset of the operative case, intraoperative handoff provides an opportunity for either SA breakdown or, more preferably, SA reinforcement. High-functioning surgical teams demonstrate a high level of continued SA, whereas teams deficient in SA are more likely to be affected by surgical errors and adverse events. To date, no interprofessional intraoperative tools exist to support team SA beyond the SSC. METHODS This study was divided into 2 phases. The first used qualitative methods to (1) characterize intraoperative handoff processes across surgery, nursing, anesthesia, and perfusion, and (2) identify cultural factors that shaped handoff practices. Data for phase one were collected over 38 observation days and 41 brief interviews. Phase 2, informed by phase 1, used a modified Delphi process to create a tool for use during intraoperative handoff. Data were analyzed iteratively. RESULTS Handoff practices were not standardized and rarely involved the entire team. In addition we uncovered cultural factors-specifically assumptions held by participants-that hindered team communication during handoff. Assumptions included: (1) team members are interchangeable, (2) trained individuals are able to determine when it is appropriate to handoff without consulting the OR team. Despite claims of improved teamwork resulting from the SSC, many participants held a fragmented view of the OR team, resulting in communication challenges during handoff. Findings from both phases of our study informed the development of multidisciplinary intraoperative handoff tools to facilitate shared team situation awareness and a shared mental model. CONCLUSIONS Intraoperative handoff occurs frequently, and offers the opportunity for either renewed or fractured team SA beyond the SSC.
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Affiliation(s)
| | | | - Nicole Wright
- The Wilson Centre, Toronto, ON, Canada
- Toronto General Hospital, Toronto, ON, Canada
| | | | - Adam Snyman
- Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | | | - Carol-Anne Moulton
- The Wilson Centre, Toronto, ON, Canada
- Toronto General Hospital, Toronto, ON, Canada
- Department of Surgery, University Health Network, Toronto, ON, Canada
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Lim PJH, Chen L, Siow S, Lim SH. Facilitators and barriers to the implementation of surgical safety checklist: an integrative review. Int J Qual Health Care 2023; 35:mzad086. [PMID: 37847116 DOI: 10.1093/intqhc/mzad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
Surgical procedures pose an immense risk to patients, which can lead to various complications and adverse events. In order to safeguard patients' safety, the World Health Organization initiated the implementation of the Surgical Safety Checklist (SSC) in operating theatres worldwide. The aim of this integrative review was to summarize and evaluate the use and implementation of SSC, focusing on facilitators and barriers at the individual, professional, and organizational levels. This review followed closely the integrative review method by Whittemore and Knafl. An English literature search was conducted across three electronic databases (PubMed, CINAHL, and EMBASE) and other hand search references. Keywords search included: 'acute care', 'surgical', 'adult patients', 'pre-operative', 'intra-operative', and 'post-operative'. A total of 816 articles were screened by two reviewers independently and all articles that met the pre-specified inclusion criteria were retained. Data extracted from the articles were categorized, compared, and further analysed. A total of 34 articles were included with the majority being observational studies in developed and European countries. Checklists had been adopted in various surgical specialities. Findings indicated that safety checklists improved team cohesion and communication, resulting in enhanced patient safety. This resulted in high compliance rates as healthcare workers expressed the benefits of SSC to facilitate safety within operating theatres. Barriers included manpower limitations, hierarchical culture, lack of staff involvement and training, staff resistance, and appropriateness of checklist. Common facilitators and barriers at individual, professional, and organizational levels have been identified. Staff training and education, conducive workplace culture, timely audits, and appropriate checklist adaptations are crucial components for a successful implementation of the SSC. Methods have also been introduced to counter barriers of SSC.
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Affiliation(s)
- Petrina Jia Hui Lim
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Lin Chen
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Serene Siow
- Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
| | - Siew Hoon Lim
- Nurse Clinician, Division of Nursing, Singapore General Hospital, Outram Road 169608, Singapore
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Hull SJ, Massie JS, Holt SL, Bowleg L. Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality-Informed Policymaking Process to Serve Diverse Women, Children, and Families. Health Promot Pract 2023; 24:623-635. [PMID: 36960782 PMCID: PMC10445436 DOI: 10.1177/15248399231160447] [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: 03/25/2023]
Abstract
Health and economic inequities among U.S. racial/ethnic minority women and children are staggering. These inequities underscore a dire need for intersectionality-informed, social-justice-oriented maternal and child (MCH) policies and programs for U.S. women and children. In response, we developed the "Intersectionality Policymaking Toolkit: Key Principles for an Intersectionality Informed Policymaking Process to Serve Diverse Women, Children and Families" to assist U.S. policymakers/aides, practitioners, and other stakeholders in developing more equitable MCH policies/programs. This article describes the Toolkit development process and initial assessments of acceptability and feasibility for use in MCH policymaking. Between 2018 and 2021, we utilized the process that the World Health Organization (WHO) used to develop its WHO Surgical Safety Checklist to develop the content (e.g., case studies) and format (i.e., structure), make strategic decisions (e.g., core items, primary audiences, timing of utilization), test concepts, and receive feedback. We convened a 2-day planning meeting with experts (n = 8) in intersectionality, policymaking, and MCH to draft the Toolkit. Next, we convened half-day workshops with policymaking and program leadership and staff in Washington, DC, New Orleans, LA, and Santa Fe, NM, to refine the Toolkit (n = 37). Then we conducted an initial assessment of the Toolkits' acceptability and feasibility using surveys (n = 21), followed by focus groups (n = 7). The resulting Toolkit distills Critical Race Theory's and intersectionality's most critical elements into a user-friendly modality to promote and enhance equitable MCH policies and programs for diverse U.S. women and families.
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Affiliation(s)
- Shawnika J. Hull
- Corresponding Author: Department of Communication, Rutgers University, 4 Huntington St. New Brunswick, NJ, 08901.
| | | | | | - Lisa Bowleg
- Department of Psychology, The George Washington University
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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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Conroy L, Faught JT, Bowers E, Ecclestone G, Fong de Los Santos LE, Hsu A, Johnson JL, Kim GGY, Schechter N, Schubert LK, Sterling DA. Medical physics practice guideline 4.b: Development, implementation, use and maintenance of safety checklists. J Appl Clin Med Phys 2023; 24:e13895. [PMID: 36739483 PMCID: PMC10018656 DOI: 10.1002/acm2.13895] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 11/20/2022] [Indexed: 02/06/2023] Open
Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the US. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the US. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and must not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning. Should and should not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
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Affiliation(s)
- Leigh Conroy
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | | | | | - Annie Hsu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | | | - Naomi Schechter
- University of Southern California, Los Angeles, California, USA
| | - Leah K Schubert
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - David A Sterling
- University of Minnesota Medical Center, Minneapolis, Minnesota, USA
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McGurk R, Naheedy KW, Kosak T, Hobbs A, Mullins BT, Paradis KC, Kearney M, Roback D, Durney J, Adapa K, Chera BS, Marks LB, Moran JM, Mak RH, Mazur LM. Multi-Institutional Stereotactic Body Radiation Therapy Incident Learning: Evaluation of Safety Barriers Using a Human Factors Analysis and Classification System. J Patient Saf 2023; 19:e18-e24. [PMID: 35948321 PMCID: PMC9771927 DOI: 10.1097/pts.0000000000001071] [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: 02/02/2023]
Abstract
OBJECTIVES Stereotactic body radiation therapy (SBRT) can improve therapeutic ratios and patient convenience, but delivering higher doses per fraction increases the potential for patient harm. Incident learning systems (ILSs) are being increasingly adopted in radiation oncology to analyze reported events. This study used an ILS coupled with a Human Factor Analysis and Classification System (HFACS) and barriers management to investigate the origin and detection of SBRT events and to elucidate how safeguards can fail allowing errors to propagate through the treatment process. METHODS Reported SBRT events were reviewed using an in-house ILS at 4 institutions over 2014-2019. Each institution used a customized care path describing their SBRT processes, including designated safeguards to prevent error propagation. Incidents were assigned a severity score based on the American Association of Physicists in Medicine Task Group Report 275. An HFACS system analyzed failing safeguards. RESULTS One hundred sixty events were analyzed with 106 near misses (66.2%) and 54 incidents (33.8%). Fifty incidents were designated as low severity, with 4 considered medium severity. Incidents most often originated in the treatment planning stage (38.1%) and were caught during the pretreatment review and verification stage (37.5%) and treatment delivery stage (31.2%). An HFACS revealed that safeguard failures were attributed to human error (95.2%), routine violation (4.2%), and exceptional violation (0.5%) and driven by personnel factors 32.1% of the time, and operator condition also 32.1% of the time. CONCLUSIONS Improving communication and documentation, reducing time pressures, distractions, and high workload should guide proposed improvements to safeguards in radiation oncology.
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Affiliation(s)
- Ross McGurk
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Tara Kosak
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Amy Hobbs
- Rex Cancer Center - UNC Rex Healthcare, Raleigh, NC
| | - Brandon T Mullins
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly C Paradis
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Meghan Kearney
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA
| | | | - Jeffrey Durney
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Karthik Adapa
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bhishamjit S Chera
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lawrence B Marks
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jean M Moran
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA
| | - Lukasz M Mazur
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
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Cai J, Huang X, He L. An evidence-based general anaesthesia and prone position nursing checklist: Development and testing. Nurs Open 2022; 10:1340-1349. [PMID: 36168198 PMCID: PMC9912415 DOI: 10.1002/nop2.1382] [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: 11/27/2021] [Revised: 03/02/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
Abstract
AIM Prone positioning during general anaesthesia is one of the most difficult practices for the perioperative nurse. Patients in this position are vulnerable to many preventable complications. However, no studies have developed an evidence-based tool to improve nursing practice during general anaesthesia and prone positioning. This study aimed to develop and test a general anaesthesia and prone position nursing checklist for use by the circulating nurse. DESIGN A prospective pre-post study was performed between October 2020 and March 2021. METHODS The WHO checklist development model and evidence-based methods guided the checklist development process. We prospectively observed circulating nurses that attended to prone general anaesthesia during posterior lumbar spine surgery for 3 months before and after the introduction of the general anaesthesia and prone position nursing risk checklist. The main outcomes were successful delivery of essential prone positional nursing practices during each surgery and the nurse's opinion of the checklist's efficacy and utility. RESULTS A general anaesthesia and prone position nursing checklist comprised of 4 pause points and 22 necessary nursing practices was developed. Seventy-two nurses participated in this study. Use of the checklist significantly increased the average performance of essential practices during each surgery from 72.72%-95.45%. Three measures had a compliance rate of 100%. The delivery rate of 14 measures was significantly improved, 91.7% of nurses considered the checklist easy to use, and 94.4% nurses would want the checklist to be used if they underwent a prone position and general anaesthesia operation.
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Affiliation(s)
- Jianshu Cai
- Operating Room Department, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Xiaoling Huang
- Operating Room Department, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina
| | - Lifang He
- School of NursingXiang Nan UniversityChenzhouChina
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Surgical safety checklists for dental implant surgeries-a scoping review. Clin Oral Investig 2022; 26:6469-6477. [PMID: 36028779 DOI: 10.1007/s00784-022-04698-1] [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: 05/11/2022] [Accepted: 08/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In both elective surgeries and aviation, a reduction of complications can be expected by paying attention to the so-called human factors. Checklists are a well-known way to overcome some of these problems. We aimed to evaluate the current evidence regarding the use of checklists in implant dentistry. METHODS An electronic literature search was conducted in the following databases: CINHAL, Medline, Web of Science, and Cochrane Library until March 2022. Based on the results and additional literature, a preliminary checklist for surgical implant therapy was designed. RESULTS Three publications dealing with dental implants and checklists were identified. One dealt with the use of a checklist in implant dentistry and was described as a quality assessment study. The remaining two studies offered suggestions for checklists based on literature research and expert opinion. CONCLUSIONS Based on our results, the evidence for the use of checklists in dental implantology is extremely low. Considering the great potential, it can be stated that there is a need to catch up. While creating a new implant checklist, we took care of meeting the criteria for high-quality checklists. Future controlled studies will help to place it on a broad foundation. CLINICAL RELEVANCE Checklists are a well-known way to prevent complications. They are especially established in aviation, but many surgical specialties and anesthesia adopt this successful concept. As implantology has become one of the fastest-growing areas of dentistry, it is imperative that checklists become an integral part of it.
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Munthali J, Pittalis C, Bijlmakers L, Kachimba J, Cheelo M, Brugha R, Gajewski J. Barriers and enablers to utilisation of the WHO surgical safety checklist at the university teaching hospital in Lusaka, Zambia: a qualitative study. BMC Health Serv Res 2022; 22:894. [PMID: 35810290 PMCID: PMC9271243 DOI: 10.1186/s12913-022-08257-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia. Methods A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis. Results Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams. Conclusion The SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08257-y.
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Affiliation(s)
- Judith Munthali
- University Teaching Hospital, Nationalist Rd, Lusaka, Zambia.
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Mweene Cheelo
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Ruairi Brugha
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Mejia OAV, Fernandes PMP. Checklists as a central part of surgical safety culture. SAO PAULO MED J 2022; 140:515-517. [PMID: 35946681 PMCID: PMC9491475 DOI: 10.1590/1516-3180.2022.140404052022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Omar Asdrúbal Vilca Mejia
- MD, PhD. Coordinator of the Surgical Quality and Safety Unit, Cardiac Surgery Division, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo Manuel Pêgo Fernandes
- MD, PhD. Titular Professor of the Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, BR; and Director of the Scientific Department, Associação Paulista de Medicina, São Paulo (SP), Brazil
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Reich AJ, Perez S, Fleming J, Gazarian P, Manful A, Ladin K, Tjia J, Semco R, Prigerson H, Weissman JS, Candrian C. Advance Care Planning Experiences Among Sexual and Gender Minority People. JAMA Netw Open 2022; 5:e2222993. [PMID: 35857322 PMCID: PMC9301514 DOI: 10.1001/jamanetworkopen.2022.22993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient's values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cisgender people, but it is unknown whether such discrimination occurs in ACP and how it might affect the ACP experiences of SGM people. OBJECTIVES To increase understanding of barriers and facilitators of ACP facing SGM individuals. DESIGN, SETTING, AND PARTICIPANTS This mixed-methods national study of ACP included a telephone survey of self-identified SGM and non-SGM participants in a nationally representative sample drawn from a larger omnibus national panel by SSRS. Qualitative interviews were conducted with a subset of survey participants who identified as SGM. Data were collected from October 2020 to March 2021. EXPOSURES Self-identified SGM. MAIN OUTCOMES AND MEASURES The survey included 4 items from the validated ACP Engagement Survey, adapted to capture experiences of discrimination. Interviews asked about participants' experiences with ACP, including the appointment of medical decision-makers, sharing preferences, and experiences within the health care system more broadly. RESULTS A total of 603 adults participated in the survey, with 201 SGM individuals (mean [SD] age, 45.7 [18.7] years; 101 [50.2%] female; 22 [10.9%] Black, 37 [18.4%] Hispanic, and 140 [69.7%] White individuals) and 402 non-SGM individuals (mean [SD] age, 53.7 [19.2] years; 199 [49.5%] female; 35 [8.7%] Black, 41 [10.2%] Hispanic, and 324 [80.6%] White individuals). Regarding reasons for not completing ACP, SGM respondents, compared with non-SGM respondents, were more likely to say "I don't see the need" (72 [73.5%] vs 131 [57.2%], P = .006) and "I feel discriminated against by others" (12 [12.2%] vs 6 [2.6%], P < .001). Of 25 completed interviews among SGM participants, 3 main themes were identified: how fear and experiences of discrimination affect selection of clinicians and whether to disclose SGM identity; concerns about whether EOL preferences and medical decision-makers would be supported; and a preference to discuss EOL decisions and values outside of clinical settings. CONCLUSIONS AND RELEVANCE This study found that fear of disclosing sexual orientation or gender identity information and discrimination are important barriers to ACP for SGM in clinical settings, but discussions of preferences and values still occur between many SGM people and medical decision-makers. More SGM-specific patient-centered care might better support these discussions within the health care system. Furthermore, health systems can facilitate improved engagement by supporting clinician sensitivity training, including guidance on documentation and requirements.
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Affiliation(s)
- Amanda Jane Reich
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen Perez
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | | | | | | | - Keren Ladin
- Department of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts
| | - Jennifer Tjia
- University of Massachusetts School of Medicine, Worcester
| | | | - Holly Prigerson
- Center for Research on End-of-Life Care, Weill Cornell School of Medicine, New York City, New York
| | - Joel S. Weissman
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Carey Candrian
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
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Hoz SS, Arkawazi AH, Al-Sharshahi ZF, Al-Rawi MA, Al-Taweel MM, Sadik H, Salih HR. A customized checklist for microsurgical clipping of intracranial aneurysms. Surg Neurol Int 2022; 13:226. [PMID: 35673673 PMCID: PMC9168363 DOI: 10.25259/sni_1118_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/12/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Samer S. Hoz
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
| | - Alaa H. Arkawazi
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | | | | | | | - Hatem Sadik
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Hayder R. Salih
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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Mejia OAV, de Mendonça FCC, Sampaio LABN, Galas FRBG, Pontes MF, Caneo LF, Dallan LRP, Lisboa LAF, Ferreira JFM, Dallan LADO, Jatene FB. Adherence to the cardiac surgery checklist decreased mortality at a teaching hospital: A retrospective cohort study. Clinics (Sao Paulo) 2022; 77:100048. [PMID: 35594622 PMCID: PMC9123198 DOI: 10.1016/j.clinsp.2022.100048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital. METHODS A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist "Five steps to safe cardiac surgery" in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson's coefficient was calculated using R software. RESULTS Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%). CONCLUSION In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist "Five steps to safe cardiac surgery" was associated with decreased mortality after cardiac surgery.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejia
- Quality and Safety Surgical Unit, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Frederico Carlos Cordeiro de Mendonça
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Filomena Regina Barbosa Gomes Galas
- Anesthesiology Unit, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mauricio Franklin Pontes
- InnovaSpace UK, Space & Extreme Environment Research Center, Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | - Luiz Fernando Caneo
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luís Roberto Palma Dallan
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - João Fernando Monteiro Ferreira
- Patient Safety Subcommittee, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Luís Alberto de Oliveira Dallan
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Department of Cardiopneumology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Vega EA, Salehi O, Loewenthal JV, Kutlu OC, Vellayappan U, Freeman R, Pomposelli F, Asbun HJ, Gayet B, Conrad C. Strategic response to bleeding in laparoscopic hepato-pancreato-biliary surgery: an intraoperative checklist. HPB (Oxford) 2022; 24:452-460. [PMID: 34598880 DOI: 10.1016/j.hpb.2021.08.944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim is to develop and test the utility of an event-initiated, team-based check list to optimize the response to bleeding during laparoscopic HPB surgery. METHODS To build a checklist for managing bleeding events, we conducted a systematic review. Using nominal group technique (NGT), a checklist consisting of four domains was developed. Following team-based training of anesthesia and surgical staff, the checklist was implemented. HPB cases before and after implementation of the checklist were compared for adverse outcomes, bleeding complications, and transfusions. RESULTS NGT identified four domains: Communicate Control, Expose, and Repair under which the checklist was organized. Supplemental Video for a detailed review of how each domain was applied to a specific case example. We compared 169 HPB cases before to 53 cases after implementation. We found a significant decrease in mean EBL (from 518 ± 852.8 to 151.5 ± 221.7 ml (P = 0.001)) for cases performed after implementation of the checklist and a trends toward less volume of pRBC transfused (2.7 ± 2.5 vs 2.3 ± 1.7 units/per patient, P = 0.611) and transfusion rates (22% vs 11%, P = 0.703). CONCLUSION An event-initiated, team-based response to an adverse bleeding event during laparoscopic HPB surgery correlates with positive effects on bleeding management, and transfusion rates.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Julia V Loewenthal
- Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Onur C Kutlu
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Usha Vellayappan
- Department of Anesthesia, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Frank Pomposelli
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States
| | - Horacio J Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, United States
| | - Brice Gayet
- Department of Digestive Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, United States.
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Kim SH, Song H, Valentine MA. Learning in Temporary Teams: The Varying Effects of Partner Exposure by Team Member Role. ORGANIZATION SCIENCE 2022. [DOI: 10.1287/orsc.2022.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In many workplaces, temporary teams convene to coordinate complex work, despite team members having not worked together before. Most related research has found consistent performance benefits when members of temporary teams work together multiple times (team familiarity). Recent work in this area broke new conceptual ground by instead exploring the learning and performance benefits that team members gain by being exposed to many new partners (partner exposure). In contrast to that new work that examined partner exposure between team members who are peers, in this paper, we extend this research by developing and testing theory about the performance effects of partner exposure for team members whose roles are differentiated by authority and skill. We use visit-level data from a hospital emergency department and leverage the ad hoc assignment of attendings, nurses, and residents to teams and the round-robin assignment of patients to these teams as our identification strategy. We find a negative performance effect of both nurses’ and resident trainees’ partner exposure to more attendings and of attendings’ and nurses’ exposure to more residents. In contrast, both attendings and residents experience a positive impact on performance from working with more nurses. The respective effects of residents working with more attendings and with more nurses is attenuated on patient cases with more structured workflows. Our results suggest that interactions with team members in decision-executing roles, as opposed to decision-initiating roles, is an important but often unrecognized part of disciplinary training and team learning.
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Affiliation(s)
- Song-Hee Kim
- SNU Business School, Seoul National University, Seoul 08826, South Korea
| | - Hummy Song
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Melissa A. Valentine
- Department of Management Science and Engineering, Stanford University, Stanford, California 94305
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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Development and validation of patients' surgical safety checklist. BMC Health Serv Res 2022; 22:259. [PMID: 35216592 PMCID: PMC8873354 DOI: 10.1186/s12913-022-07470-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Poor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients. Method This was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients’ PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients. Results Initial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs’ user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage. Conclusion Multidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07470-z.
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Galeano Castañeda CA, Hoyos Redondo JV, Gómez Salgado JC. The Surgical Safety Checklist from the resident's perspective. Observational study. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.5554/22562087.e1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The Surgical Safety Checklist implemented by the World Health Organization has proven to decrease perioperative morbidity and mortality; however, the barriers and limitations to its implementation are consistently reported in the literature.
Objective: To establish the level of appropriation of the surgical safety checklist in the training of human resources in anesthesiology, in addition to identifying the perception and the level of implementation of such checklist at the national scale.
Methods: Descriptive cross-sectional study conducted through a survey administered to the residents of anesthesiology in Colombia. Likert-type questions were included, distributed into three domains: appropriation, perception and implementation.
Results: 215 answers corresponding to 54.5 % of the population were analyzed, comprising participants from all of the anesthesiology programs in the country. 20% of the residents have never been subject to formal academic reviews about checklists, and this trend did not change throughout the residency; 97.2 % considers that the implementation of the lists improves the safety of surgical procedures and 40 % have seen rejection or indifference by surgeons. 80.5 % of the residents have seen the frequent use of the checklist, while only 13.5% have seen the use of the checklist during the three surgical moments – before the induction of anesthesia, before the surgical incision, and before the patient leaves the operating room -; 88 % have observed that the form is completed without actually doing the verification.
Conclusions: There is limited exposure to education about the surgical safety checklist in anesthesiology postgraduate programs in the country. The residents have a favorable perception about the value of the list, however, there are some shortcomings in its administration.
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Vishwanathan K, Kambhampati SBS, Maini L. Reviewer's Checklists for Evaluating Scientific Manuscripts. Indian J Orthop 2022; 56:175-182. [PMID: 35140849 PMCID: PMC8789980 DOI: 10.1007/s43465-022-00602-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Karthik Vishwanathan
- Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Limda, Waghodia, Vadodara, Gujarat 391760 India
| | - Srinivas B. S. Kambhampati
- Sri Dhaatri Orthopaedic, Maternity and Gynaecology Center, SKDGOC, Vijayawada, Andhra Pradesh 531127 India
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Emond YEJJM, Calsbeek H, Peters YAS, Bloo GJA, Teerenstra S, Westert GP, Damen J, Wollersheim HC, Wolff AP. Increased adherence to perioperative safety guidelines associated with improved patient safety outcomes: a stepped-wedge, cluster-randomised multicentre trial. Br J Anaesth 2022; 128:562-573. [PMID: 35039174 DOI: 10.1016/j.bja.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND National Dutch guidelines have been introduced to improve suboptimal perioperative care. A multifaceted implementation programme (IMPlementatie Richtlijnen Operatieve VEiligheid [IMPROVE]) has been developed to support hospitals in applying these guidelines. This study evaluated the effectiveness of IMPROVE on guideline adherence and the association between guideline adherence and patient safety. METHODS Nine hospitals participated in this unblinded, superiority, stepped-wedge, cluster RCT in patients with major noncardiac surgery (mortality risk ≥1%). IMPROVE consisted of educational activities, audit and feedback, reminders, organisational, team-directed, and patient-mediated activities. The primary outcome of the study was guideline adherence measured by nine patient safety indicators on the process (stop moments from the composite STOP bundle, and timely administration of antibiotics) and on the structure of perioperative care. Secondary safety outcomes included in-hospital complications, postoperative wound infections, mortality, length of hospital stay, and unplanned care. RESULTS Data were analysed for 1934 patients. The IMPROVE programme improved one stop moment: 'discharge from recovery room' (+16%; 95% confidence interval [CI], 9-23%). This stop moment was related to decreased mortality (-3%; 95% CI, -4% to -1%), fewer complications (-8%; 95% CI, -13% to -3%), and fewer unscheduled transfers to the ICU (-6%; 95% CI, -9% to -3%). IMPROVE negatively affected one other stop moment - 'discharge from the hospital' - possibly because of the limited resources of hospitals to improve all stop moments together. CONCLUSIONS Mixed implementation effects of IMPROVE were found. We found some positive associations between guideline adherence and patient safety (i.e. mortality, complications, and unscheduled transfers to the ICU) except for the timely administration of antibiotics. CLINICAL TRIAL REGISTRATION NTR3568 (Dutch Trial Registry).
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Affiliation(s)
- Yvette E J J M Emond
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands.
| | - Hiske Calsbeek
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Yvonne A S Peters
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Gerrit J A Bloo
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department for Health Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Gert P Westert
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Johan Damen
- Department of Anesthesiology, Pain and Palliative Care, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - Hub C Wollersheim
- IQ Healthcare, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - André P Wolff
- Department of Anesthesiology, Pain Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Knoche BB, Busche C, Grodd M, Busch HJ, Lienkamp SS. A simulation-based pilot study of crisis checklists in the emergency department. Intern Emerg Med 2021; 16:2269-2276. [PMID: 33687692 PMCID: PMC8563565 DOI: 10.1007/s11739-021-02670-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
Abstract
Checklists can improve adherence to standardized procedures and minimize human error. We aimed to test if implementation of a checklist was feasible and effective in enhancing patient care in an emergency department handling internal medicine cases. We developed four critical event checklists and confronted volunteer teams with a series of four simulated emergency scenarios. In two scenarios, the teams were provided access to the crisis checklists in a randomized cross-over design. Simulated patient outcome plus statement of the underlying diagnosis defined the primary endpoint and adherence to key processes such as time to commence CPR represented the secondary endpoints. A questionnaire was used to capture participants' perception of clinical relevance and manageability of the checklists. Six teams of four volunteers completed a total of 24 crisis sequences. The primary endpoint was reached in 8 out of 12 sequences with and in 2 out of 12 sequences without a checklist (Odds ratio, 10; CI 1.11, 123.43; p = 0.03607, Fisher's exact test). Adherence to critical steps was significantly higher in all scenarios for which a checklist was available (performance score of 56.3% without checklist, 81.9% with checklist, p = 0.00284, linear regression model). All participants rated the checklist as useful and 22 of 24 participants would use the checklist in real life. Checklist use had no influence on CPR quality. The use of context-specific checklists showed a statistically significant influence on team performance and simulated patient outcome and contributed to adherence to standard clinical practices in emergency situations.
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Affiliation(s)
- Beatrice Billur Knoche
- Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Gynaecology and Obstetrics, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Caroline Busche
- Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Internal Medicine, Renal Division, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marlon Grodd
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center-University of Freiburg, Freiburg, Germany
| | - Hans-Jörg Busch
- Department of Emergency Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Soeren Sten Lienkamp
- Department of Internal Medicine, Renal Division, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute of Anatomy, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
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The role of surface-guided radiation therapy for improving patient safety. Radiother Oncol 2021; 163:229-236. [PMID: 34453955 DOI: 10.1016/j.radonc.2021.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/20/2022]
Abstract
Emerging data indicates SGRT could improve safety and quality by preventing errors in its capacity as an independent system in the treatment room. The aim of this work is to investigate the utility of SGRT in the context of safety and quality. Three incident learning systems (ILS) were reviewed to categorize and quantify errors that could have been prevented with SGRT: SAFRON (International Atomic Energy Agency), UW-ILS (University of Washington) and AvIC (Skåne University Hospital). A total of 849/9737 events occurred during the pre-treatment review/verification and treatment stages. Of these, 179 (21%) events were predicted to have been preventable with SGRT. The most common preventable events were wrong isocentre (43%) and incorrect accessories (34%), which appeared at comparable rates among SAFRON and UW-ILS. The proportion of events due to wrong accessories was much smaller in the AvIC ILS, which may be attributable to the mandatory use of SGRT in Sweden. Several case scenarios are presented to demonstrate that SGRT operates as a valuable complement to other quality-improvement tools routinely used in radiotherapy. Cases are noted in which SGRT itself caused incidents. These were mostly related to workflow issues and were of low severity. Severity data indicated that events with the potential to be mitigated by SGRT were of higher severity for all categories except wrong accessories. Improved vendor integration of SGRT systems within the overall workflow could further enhance its clinical utility. SGRT is a valuable tool with the potential to increase patient safety and treatment quality in radiotherapy.
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Bickley SJ, Torgler B. A systematic approach to public health - Novel application of the human factors analysis and classification system to public health and COVID-19. SAFETY SCIENCE 2021; 140:105312. [PMID: 33897105 PMCID: PMC8053242 DOI: 10.1016/j.ssci.2021.105312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 03/16/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
In this article, we argue for a novel adaptation of the Human Factors Analysis and Classification System (HFACS) to proactive incidence prevention in the public health and in particular, during and in response to COVID-19. HFACS is a framework of causal categories of human errors typically applied for systematic retrospective incident analysis in high-risk domains. By leveraging this approach proactively, appropriate, and targeted measures can be quickly identified and established to mitigate potential errors at different levels within the public health system (from tertiary and secondary healthcare workers to primary public health officials, regulators, and policymakers).
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Affiliation(s)
- Steve J Bickley
- School of Economics and Finance, Queensland University of Technology, 2 George St, Brisbane, QLD 4000, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), 2 George St, Brisbane, QLD 4000, Australia
| | - Benno Torgler
- School of Economics and Finance, Queensland University of Technology, 2 George St, Brisbane, QLD 4000, Australia
- Centre for Behavioural Economics, Society and Technology (BEST), 2 George St, Brisbane, QLD 4000, Australia
- CREMA - Centre for Research in Economics, Management, and the Arts, Südstrasse 11, CH-8008 Zürich, Switzerland
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Hock SM, Martin JJ, Stanfield SC, Alcorn TR, Binstadt ES. Novel cricothyrotomy assessment tool for attending physicians: A multicenter study of an error avoidance checklist. AEM EDUCATION AND TRAINING 2021; 5:e10687. [PMID: 34589660 PMCID: PMC8457693 DOI: 10.1002/aet2.10687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study used existing literature and expert feedback to develop and pilot a novel error-avoidance checklist tool for cricothyrotomy in attending physicians. Prior literature has not focused on expert cricothyrotomy performance. While published checklists teach a specific procedural method, ideal for novice learners, this may hinder expert learners. OBJECTIVES We endeavored to create a succinct error-avoidance checklist for cricothyrotomy. We hypothesized that such a checklist would prove feasible and acceptable to attending physicians. METHODS This is a multicenter prospective checklist creation, evaluation, and feasibility study. Multiple experts pursued an iterative process to reach consensus on a 7-item error-avoidance checklist. The checklist was trialed for feasibility in pilot sessions at two sites by 45 attending emergency physicians who used the checklist for peer performance assessment and provided feedback. RESULTS During the pilot implementation, 94% of respondents completed the procedure within the allotted 120 s. Greater than 85% of respondents agreed that four of the five procedural errors on the checklist were very or somewhat critical to avoid, including cutting >2 cm from midline, creating a false passage, failing to continuously maintain an object in the trachea, and injuring oneself during the procedure. Only 66% of participants felt severing the cricoid cartilage was critical. Successful breath administration and time under 120 s were critical for 100% and 95% of participants, respectively. The checklist was rated "easy" or "very easy" to use by 93% of participants, and 95% found this checklist reasonable for evaluating attending physicians. CONCLUSIONS We present the multicenter development and implementation of a novel error-avoidance checklist tool for use in expert cricothyrotomy performance. Attending emergency medicine (EM) physicians rated our tool easy to use and agreed that most of the proposed errors were critical. Participants overwhelmingly agreed this tool would be reasonable for evaluation of cricothyrotomy performance among attending EM physicians.
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Affiliation(s)
- Sara M. Hock
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | - Jerome J. Martin
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | | | - Thomas R. Alcorn
- Emergency DepartmentRush University Medical CenterChicagoIllinoisUSA
| | - Emily S. Binstadt
- Emergency DepartmentRegions HospitalHealth PartnersSt PaulMinnesotaUSA
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Bitar V, Martel M, Restellini S, Barkun A, Kherad O. Checklist feasibility and impact in gastrointestinal endoscopy: a systematic review and narrative synthesis. Endosc Int Open 2021; 9:E453-E460. [PMID: 33655049 PMCID: PMC7895652 DOI: 10.1055/a-1336-3464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background and study aim Checklists prevent errors and have a positive impact on patient morbidity and mortality in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy units across many countries, a summary of cumulated experience is lacking. The aim of this study was to identify and evaluate the feasibility of successful checklist implementation in gastrointestinal endoscopy units and summarise the evidence of its impact on the commitment in safety culture. Methods A comprehensive literature search was performed identifying the use of a checklist or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy. We summarised overall adherence to checklists from included studies through a narrative synthesis, characterizing barriers and facilitators according to nurse and physician perspectives, while also summarizing safety endpoints. Results The seven studies selected from 673 screened citations were highly heterogeneous in terms of methodology, context, and outcomes. Across five of these, checklist adherence rates post-intervention varied for both nurses (84 % to 96 %) and physicians (66 % to 95 %). Various facilitators (education, continued reassessment) and barriers (lack of safety culture, checklist completion time) were identified. Most studies did not report associations between checklist implementation and clinical outcomes, except for better team communication. Conclusion Implementation of a gastrointestinal endoscopy checklist is feasible, with an understanding of relevant barriers and facilitators. Apart from a significant increase in the perception of team communication, evidence for a measurable impact attributable to gastrointestinal checklist implementation on endoscopic processes and safety outcomes is limited and warrants further study.
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Affiliation(s)
- Véronique Bitar
- Division of Internal Medicine, Université de Montréal, Montreal, Canada
| | - Myriam Martel
- Division of Gastroenterology, McGill University, Montreal, Canada
| | - Sophie Restellini
- Division of Gastroenterology, McGill University, Montreal, Canada,Division of Gastroenterology, Geneva University Hospital and University of Geneva, Geneva, Switzerland
| | - Alan Barkun
- Division of Gastroenterology, McGill University, Montreal, Canada
| | - Omar Kherad
- Department of Internal Medicine, La Tour Hospital and University of Geneva, Geneva, Switzerland
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Read J, Perry W, Rossaak JI. Ward round checklist improves patient perception of care. ANZ J Surg 2021; 91:854-859. [PMID: 33459481 DOI: 10.1111/ans.16543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/12/2020] [Accepted: 12/15/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Checklists have been shown to reduce morbidity and mortality in medicine by improving documentation and reducing errors. In the modern era of care, where patients are the centre of decision-making, this study examines patient perception of care and error prevention with the use of ward round checklist. METHODS We conducted a prospective stepped-wedge cluster randomized controlled checklist intervention study using a standardized questionnaire to investigate patients' perception of ward rounds before and after implementation of a ward round checklist. RESULTS A total of 124 patients completed the questionnaire. The overall percentage of items endorsed increased significantly by 5.1% from 64.8% to 70.0% (P = 0.014). Statistically significant improvements were seen in patients knowing their diagnosis (P = 0.027), the day's plan (P = 0.038), observing a medication chart (P < 0.001) and observation chart review (P = 0.008). CONCLUSION Our study indicates that the use of a ward round checklist leads to patient-perceived improvements in aspects of quality of care.
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Affiliation(s)
- Joshua Read
- Department of Surgery, The University of Otago, Dunedin, New Zealand
| | - William Perry
- Department of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy I Rossaak
- Department of Surgery, Tauranga Hospital, Tauranga, New Zealand.,Department of Health Sciences, The University of Auckland, Auckland Hospital, Auckland, New Zealand
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Hawker WTG, Singh A, Gibson TWG, Giuffrida MA, Weese JS. Use of a surgical safety checklist after implementation in an academic veterinary hospital. Vet Surg 2020; 50:393-401. [PMID: 33378549 DOI: 10.1111/vsu.13561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/06/2020] [Accepted: 11/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the use and barriers to uptake of a surgical safety checklist (SSC) after implementation in a veterinary teaching hospital. STUDY DESIGN Voluntary online survey and retrospective study. SAMPLE POPULATION All personnel actively involved in the Ontario Veterinary College Health Sciences Centre small animal surgery service between October 2, 2018 and June 28, 2019. METHODS Surgical case logs and electronically initiated SSC were reviewed to calculate checklist use. The sample population was surveyed to identify factors and barriers associated with use of the SSC. Participants were allowed 1 month to respond, and five reminder emails were sent. RESULTS Forth-one of 50 (82%) participants completed the survey. The SSC was used in 374 of 784 (47.7%) surgeries. Use rates declined over sequential three-month intervals (P < .0001). Twenty-six of 41 (63%) respondents overestimated checklist use. Staff attitudes were largely supportive of the SSC, with 29 of 41 respondents suggesting mandatory application. Forgetfulness, hierarchal concerns, timing issues, perceived delays in care, lack of clarity regarding roles, and inadequate training were identified as obstacles to use of the SSC. CONCLUSION The SCC tested in this study was used in approximately half of the surgical procedures performed after its implementation. Hospital personnel were supportive of the SSC; forgetting to use the SSC was the most common barrier identified by respondents (24/41 [59%]). CLINICAL SIGNIFICANCE The SSC implementation experience and user feedback described here should be taken into consideration to improve design and implementation of future SSC.
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Affiliation(s)
- William T G Hawker
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas W G Gibson
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | | | - J Scott Weese
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Abstract
Critical events are rare and stressful. These properties make reliance on memory for clinical management highly susceptible to failure. In the past 10 to 20 years, health care has begun to accept the experience of aviation and other high-reliability organizations in addressing failure to rescue from these events through a combination of practice through simulation and the introduction of cognitive aids, known as checklists or emergency manuals. Cognitive aids have a persuasive body of evidence from simulation studies to establish their value in improving clinician performance. However, their introduction to practice is more complex than distribution of the tools.
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Affiliation(s)
- Alexander A Hannenberg
- Ariadne Labs, 401 Park Drive 3-West, Boston, MA 02215, USA; Tufts University School of Medicine, Boston, MA, USA.
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Sheth S, Mudge B, Fishman EK. The pre-CT checklist: A simple tool to improve workflow and patient safety in an outpatient CT setting. Clin Imaging 2020; 66:101-105. [DOI: 10.1016/j.clinimag.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
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Hansen K. Cognitive bias in emergency medicine. Emerg Med Australas 2020; 32:852-855. [DOI: 10.1111/1742-6723.13622] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Kim Hansen
- Emergency Department St Andrew's War Memorial Hospital Brisbane Queensland Australia
- Emergency Department The Prince Charles Hospital Brisbane Queensland Australia
- Faculty of Medicine The University of Queensland Brisbane Queensland Australia
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Development of a combat surgical safety checklist. J Trauma Acute Care Surg 2020; 89:e182-e186. [PMID: 32890347 DOI: 10.1097/ta.0000000000002921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Murray RM, Allen JA, Davis AL, Taylor JA. Meeting science meets public health: Results from the "Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC 3). JOURNAL OF SAFETY RESEARCH 2020; 74:249-261. [PMID: 32951789 PMCID: PMC8509107 DOI: 10.1016/j.jsr.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/17/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION In order to implement a systems-level Emergency Medical Services (EMS) workplace violence intervention, input from end users was critically needed. We convened the two-day Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3) using methods from meeting science (i.e., ThinkLets) to comprehensively and efficiently gather feedback from stakeholders on the completeness and utility of the draft checklist that would comprise the intervention. METHODS ThinkLets, a codified facilitation technique was used to aid brainstorming, convergence, organization, evaluation, and consensus building activities on the SAVER Systems Checklist among 41 national stakeholders during a two-day conference. A qualitative and quantitative process evaluation was conducted to measure the effectiveness of conference procedures. To verify checklist feasibility results from the conference, a second feasibility assessment was conducted with the four implementation sites. CONCLUSIONS The quantitative conference evaluation results indicated most participants viewed the conference process favorably. Emergent themes reflecting on conference effectiveness and suggestions for improvements are described. The re-evaluation of the checklist's feasibility completed by the SAVER study sites confirmed prior feasibility findings. SAVER study sites cast 45.5% of votes on checklist items to be most feasible, 34.9% as less feasible, and 19.6% as extremely difficult. Practical Applications: Multidisciplinary collaboration between public health, occupational health psychology, and meeting science led to the development of the SAVER Systems Checklist. The checklist underscores important needs for EMS policy and training development critical to responder safety as identified and supported by over 41 diverse subject matter experts. The incorporation of a widely used meeting science method, ThinkLets, into public health intervention design proved an effective and well-received approach to bring assessment, evaluation, and consensus to the SAVER Systems Checklist. These methods may hold benefit for other industries and disciplines that may not be familiar with such facilitation and consensus-building techniques.
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Affiliation(s)
- Regan M Murray
- Drexel University Dornsife School of Public Health, Department of Environmental and Occupational Health Philadelphia, PA, USA
| | - Joseph A Allen
- University of Utah Health, Rocky Mountain Center for Occupational & Environmental Health, Salt Lake City, UT, USA
| | - Andrea L Davis
- Drexel University Dornsife School of Public Health, Department of Environmental and Occupational Health Philadelphia, PA, USA
| | - Jennifer A Taylor
- Drexel University Dornsife School of Public Health, Department of Environmental and Occupational Health Philadelphia, PA, USA.
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Dekker-van Doorn C, Wauben L, van Wijngaarden J, Lange J, Huijsman R. Adaptive design: adaptation and adoption of patient safety practices in daily routines, a multi-site study. BMC Health Serv Res 2020; 20:426. [PMID: 32410618 PMCID: PMC7227082 DOI: 10.1186/s12913-020-05306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals’ needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. Methods Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital’s OT. Results 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. Conclusions Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness.
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Affiliation(s)
- Connie Dekker-van Doorn
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands. .,Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Linda Wauben
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rochussenstraat 198, 3015, EK, Rotterdam, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Faculty of Mechanical Engineering, Mekelweg 2, 2628, CD, Delft, The Netherlands
| | - Jeroen van Wijngaarden
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
| | - Johan Lange
- Erasmus University Medical Center, Department of Surgery, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Robbert Huijsman
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, P.O. Box 738, 3000, DR, Rotterdam, The Netherlands
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Goodman D, Zagaria AB, Flanagan V, Deselle FS, Hitchings AR, Maloney R, Small TA, Vergo AV, Bruce ML. Feasibility and Acceptability of a Checklist and Learning Collaborative to Promote Quality and Safety in the Perinatal Care of Women with Opioid Use Disorders. J Midwifery Womens Health 2020; 64:104-111. [PMID: 30695159 DOI: 10.1111/jmwh.12943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Perinatal opioid use disorder (OUD) represents a maternal-child health crisis in the United States. Untreated, OUD is associated with maternal and neonatal morbidity due to infectious disease, polysubstance use, co-occurring mental health conditions, prematurity, neonatal opioid withdrawal, and maternal mortality from overdose. Although national guidelines exist to optimize perinatal care for women with OUD, wide variation persists in health care providers' experience caring for this population and in the quality of care delivered. PROCESS We conducted a pilot study to determine whether the use of a checklist summarizing best practice could improve perinatal care for women with OUD. Implementation was supported by a learning collaborative of maternity care providers at 8 diverse sites across Vermont, New Hampshire, and Maine. Outcomes before and after implementation were compared to determine whether practice change occurred. OUTCOMES Data were collected from the records of 223 women with OUD who received prenatal care at pilot sites. All sites endorsed use of the checklist as a practice guide, and it was integrated in 78% of records reviewed. Across sites, significant improvement occurred in key elements of care, including increasing the proportion of women with access to the lifesaving drug naloxone (10.9% vs 36.3%, P < .001), receiving counseling about the benefits of breastfeeding (50.9% vs 72.0%, P < .01), and treating with nicotine replacement when indicated (9.1% vs 26.8%, P = .01). No significant change occurred in rates of prematurity, low birth weight, or breastfeeding at hospital discharge. DISCUSSION Implementation of a checklist to facilitate best practice in the care of pregnant women with OUD is feasible, acceptable to maternity care providers, and represents a promising approach to improving quality of care for this vulnerable population. Additional research is needed to determine whether improvement in quality can transform perinatal outcomes.
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Jelacic S, Togashi K, Bussey L, Nair BG, Wu T, Boorman DJ, Bowdle A. Development of an aviation-style computerized checklist displayed on a tablet computer for improving handoff communication in the post-anesthesia care unit. J Clin Monit Comput 2020; 35:607-616. [PMID: 32405801 DOI: 10.1007/s10877-020-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
Critical patient care information is often omitted or misunderstood during handoffs, which can lead to inefficiencies, delays, and sometimes patient harm. We implemented an aviation-style post-anesthesia care unit (PACU) handoff checklist displayed on a tablet computer to improve PACU handoff communication. We developed an aviation-style computerized checklist system for use in procedural rooms and adapted it for tablet computers to facilitate the performance of PACU handoffs. We then compared the proportion of PACU handoff items communicated before and after the implementation of the PACU handoff checklist on a tablet computer. A trained observer recorded the proportion of PACU handoff information items communicated, any resistance during the performance of the checklist, the type of provider participating in the handoff, and the time required to perform the handoff. We also obtained these patient outcomes: PACU length of stay, respiratory events, post-operative nausea and vomiting, and pain. A total of 209 PACU handoffs were observed before and 210 after the implementation of the tablet-based PACU handoff checklist. The average proportion of PACU handoff items communicated increased from 49.3% (95% CI 47.7-51.0%) before checklist implementation to 72.0% (95% CI 69.2-74.9%) after checklist implementation (p < 0.001). A tablet-based aviation-style handoff checklist resulted in an increase in PACU handoff items communicated, but did not have an effect on patient outcomes.
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Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA.
| | - Kei Togashi
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Logan Bussey
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Tim Wu
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Daniel J Boorman
- The Boeing Company, Boeing Test and Evaluation, Seattle, WA, USA
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
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Dharmarajan H, Snyderman CH. Tracheostomy time-out: New safety tool in the setting of COVID-19. Head Neck 2020; 42:1397-1402. [PMID: 32383532 PMCID: PMC7267311 DOI: 10.1002/hed.26253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time‐out applicable to all patients including those suspected of having COVID‐19. The aim of the tracheostomy time‐out is to reduce preventable errors that may increase the risk of transmission of SARS‐CoV‐2.
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Affiliation(s)
- Harish Dharmarajan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Almufleh B, Ducret M, Malixi J, Myers J, Nader SA, Franco Echevarria M, Adamczyk J, Chisholm A, Pollock N, Emami E, Tamimi F. Development of a Checklist to Prevent Reconstructive Errors Made By Undergraduate Dental Students. J Prosthodont 2020; 29:573-578. [PMID: 32282105 DOI: 10.1111/jopr.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/22/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To design a checklist in order to reduce the frequency of reconstructive preventable errors (PE) performed by undergraduate dental students at McGill University. MATERIALS AND METHODS The most common PE occurring at a university dental clinic were identified by three reviewers analyzing the refunded cases, and used to create a preliminary checklist. This checklist was then validated by a panel of dental educators to produce a finalized 20-item checklist. The 20-question checklist was then submitted to students in a cross-sectional survey-based study to evaluate its relevance to undergraduate clinical education needs. RESULTS As many as 81% of students reported to have forgotten at least one item of the checklist during care of their last patient, and the most forgotten checklist items corresponded to the pretreatment stage. The students also reported that 17 of the 20 items in the checklist were relevant to a considerable extent or highly relevant. CONCLUSION Common PE identified in the undergraduate clinic could be used to create a checklist of relevant items designed to reduce errors made by students and practitioners performing prosthodontic and reconstructive treatments. However, further studies are required to evaluate the implementation and efficiency of the checklist.
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Affiliation(s)
- Balqees Almufleh
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,King Saud University, Riyadh, Saudi Arabia
| | - Maxime Ducret
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Faculty of Dentistry, Lyon 1 University, Lyon, France.,Odontology Center, Lyon Civils Hospices, Lyon, France
| | - Jodeci Malixi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Jeffrey Myers
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Samer Abi Nader
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | | | - Jessica Adamczyk
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Alicia Chisholm
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Natalie Pollock
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Faleh Tamimi
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,College of Dental Medicine, Qatar University, Doha, Qatar
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Huang J, Rickard MJFX, Keshava A, Suen MKL. Impact of post-haemorrhoidectomy pain relief checklists on pain outcomes: a randomized controlled trial. ANZ J Surg 2020; 90:580-584. [PMID: 32062860 DOI: 10.1111/ans.15732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/09/2020] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Haemorrhoidectomy is associated with significant post-operative pain which is primarily managed pharmacologically. Whether a non-pharmacological adjunct such as a checklist can improve pain outcomes after an open haemorrhoidectomy has yet to be studied. The purpose of this study was to determine if a patient-completed checklist of prescribed post-haemorrhoidectomy pain medications would improve pain management after surgery. METHODS We conducted a dual-centre randomized controlled trial of patients undergoing a Milligan-Morgan haemorrhoidectomy for symptomatic third or fourth degree haemorrhoids. Thirty-five patients were randomized into either a control group which received post-operative pain medication plus a visual analogue scale (VAS) form, or an intervention group which received a post-operative medication checklist in addition to the items the control group received. Both groups recorded their pain levels on the VAS forms at 10.00, 14.00 and 20.00 hours each day for 14 days post-operatively. RESULTS Patients in the checklist group reported a significantly greater reduction in mean VAS pain score of 2.51 (95% confidence interval (CI) 1.34-3.68; P < 0.001) between day 1 post-op and day 14 post-op compared to 1.86 (95% CI 0.77-2.95; P = 0.001) for the control group. There was no significant difference between mean pain experienced by patients in either group over each of the 14 days individually or overall (P = 0.07). CONCLUSION The pain medication checklist lead to a greater reduction in pain between day 1 and 14 after an open haemorrhoidectomy compared to standard care but did not significantly reduce mean pain across any individual days or overall.
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Affiliation(s)
- Johnny Huang
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew J F X Rickard
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia.,Discipline of Colorectal Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anil Keshava
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia.,Discipline of Colorectal Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Michael K L Suen
- Discipline of Surgery, School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Repatriation General Hospital, The University of Sydney, Concord Clinical School, Sydney, New South Wales, Australia
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Compliance With Preoperative Elements of the American Society of Colon and Rectal Surgeons Rectal Cancer Surgery Checklist Improves Pathologic and Postoperative Outcomes. Dis Colon Rectum 2020; 63:30-38. [PMID: 31804269 DOI: 10.1097/dcr.0000000000001511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2016, the American Society of Colon and Rectal Surgeons published a rectal cancer surgery checklist composed of the essential elements of preoperative, intraoperative, and postoperative care for patients undergoing rectal cancer surgery. OBJECTIVE The purpose of this study was to assess whether compliance with preoperative checklist elements was associated with improved pathologic and 30-day postoperative outcomes after rectal cancer surgery. DESIGN This was a retrospective cohort study. SETTINGS The study involved North American hospitals contributing to the American College of Surgeons National Surgical Quality Improvement Program. PATIENTS Adult patients who underwent elective rectal cancer surgery from 2016 to 2017 were included. INTERVENTION The study encompassed checklist compliance with 6 preoperative elements from the checklist. MAIN OUTCOME MEASURES Pathologic outcomes (circumferential resection margin status, distal resection margin status, and adequate lymph node harvest ≥12), 30-day surgical morbidity, and length of stay were measured. RESULTS In total, 2217 patients were included in the analysis. Individual compliance with the 6 available preoperative checklist items was variable, including 91.3% for pretreatment documentation of tumor location within the rectum, 86.8% for complete colonoscopy, 84.0% for appropriate preoperative stoma marking, 79.8% for appropriate use of neoadjuvant radiotherapy, 76.6% for locoregional staging, and 70.8% for distant staging. Only 836 patients (37.7%) had all 6 checklist elements complete, whereas 1381 (62.3%) did not. Compared with patients without checklist compliance, patients with checklist compliance were younger (60.0 vs 63.0 y; p < 0.001) but otherwise had similar demographic characteristics. On multivariate regression, checklist compliance was associated with lower odds of circumferential resection margin positivity (OR = 0.47 (95% CI, 0.31-0.71); p < 0.001), higher odds of an adequate lymph node harvest ≥12 (OR = 1.60 (95% CI, 1.29-2.00); p < 0.001), reduced surgical morbidity (OR = 0.78 (95% CI, 0.65-0.95); p = 0.01), and shorter length of stay (β = -0.87 (95% CI, -1.51 to -0.24); p = 0.007). The association between checklist compliance and reduced odds of circumferential resection margin positivity remained on sensitivity analysis (OR = 0.61 (95% CI, 0.42-0.88); p = 0.009) when adjusting for neoadjuvant radiation. LIMITATIONS This study was limited by its absence of long-term oncologic data and missing variables. CONCLUSIONS Compliance with 6 preoperative elements of the American Society of Colon and Rectal Surgeons rectal cancer surgery checklist was associated with significantly improved pathologic outcomes and reduced postoperative morbidity. See Video Abstract at http://links.lww.com/DCR/B80. EL CUMPLIMIENTO CON LOS ELEMENTOS PREOPERATORIOS DE LA LISTA DE VERIFICACIÓN DE CIRUGÍA PARA CÁNCER RECTAL DE LA SOCIEDAD AMERICANA DE CIRUJANOS DE COLON Y RECTO MEJORA LOS RESULTADOS HISTOPATOLÓGICOS Y POSTOPERATORIOS: En 2016, la Sociedad Americana de Cirujanos de Colon y Recto publicó una lista de verificación de cirugía de cáncer de recto que comprende los elementos esenciales de la atención pre, intra y postoperatoria para pacientes sometidos a cirugía de cáncer de recto.Evaluar si el cumplimiento con los elementos preoperatorios de la lista de verificación se asoció con mejores resultados histopatológicos y postoperatorios a 30 días después de la cirugía de cáncer rectal.Estudio de cohorte retrospectiva.Hospitales norteamericanos que contribuyen al Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos.Pacientes adultos que se sometieron a cirugía electiva de cáncer rectal entre 2016 y 2017.Cumplimiento de la lista de verificación con seis elementos preoperatorios de la lista de verificación.Resultados histopatológicos (estado del margen de resección circunferencial, estado del margen de resección distal, cosecha adecuada de ganglios linfáticos ≥12), morbilidad quirúrgica a 30 días y duración de la estadía.En total, 2,217 pacientes fueron incluidos en el análisis. El cumplimiento individual de los seis ítems disponibles de la lista de verificación preoperatoria fue variable: 91.3% para la documentación previa al tratamiento de la localización del tumor dentro del recto, 86.8% para colonoscopía completa, 84.0% para el marcado preoperatorio apropiado del sitio de estoma, 79.8% para el uso apropiado de radioterapia neoadyuvante, 76.6 % para estadificación locorregional y 70.8% para estadificación distante. Solo 836 (37.7%) pacientes tenían los seis elementos de la lista de verificación completos, mientras que 1,381 (62.3%) no. En comparación con los pacientes sin cumplimiento de la lista de verificación, los pacientes con cumplimiento de la lista de verificación eran más jóvenes (60.0 vs. 63.0 años, p <0.001), pero por lo demás tenían características demográficas similares. En la regresión multivariada, el cumplimiento de la lista de verificación se asoció con menores probabilidades de positividad en el margen de resección circunferencial (OR = 0.47; IC del 95%: 0.31-0.71, p <0.001), mayores probabilidades de una cosecha adecuada de ganglios linfáticos ≥12 (OR = 1.60, IC 95% 1.29-2.00, p <0.001), menor morbilidad quirúrgica (OR = 0.78, IC 95% 0.65-0.95, p = 0.01) y menor duración de estadía (β = -0.87, IC 95% -1.51 - - 0.24, p = 0.007). La asociación entre el cumplimiento de la lista de verificación y las probabilidades reducidas de positividad del margen de resección circunferencial se mantuvo en el análisis de sensibilidad (OR = 0.61; IC del 95%: 0.42-0.88, p = 0.009) al ser ajustado con radiación neoadyuvante.Ausencia de datos oncológicos a largo plazo y variables faltantes.El cumplimiento de seis elementos preoperatorios de la lista de verificación de cirugía de cáncer rectal de la Sociedad Americana de Cirujanos de Colon y Recto se asoció con resultados histopatológicos significativamente mejores y una menor morbilidad postoperatoria. Vea el resumen en video en http://links.lww.com/DCR/B80.
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Abstract
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.
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Abstract
Cognitive bias is increasingly recognised as an important source of medical error, and is both ubiquitous across clinical practice yet incompletely understood. This increasing awareness of bias has resulted in a surge in clinical and psychological research in the area and development of various 'debiasing strategies'. This paper describes the potential origins of bias based on 'dual process thinking', discusses and illustrates a number of the important biases that occur in clinical practice, and considers potential strategies that might be used to mitigate their effect.
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Affiliation(s)
- E D O'Sullivan
- Department of Renal Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK,
| | - S J Schofield
- Centre for Medical Education, University of Dundee, UK
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Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway. Ann Surg 2019; 269:283-290. [PMID: 29112512 PMCID: PMC6326038 DOI: 10.1097/sla.0000000000002584] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text Objective: We hypothesize that high-quality implementation of the World Health Organization's Surgical Safety Checklist (SSC) will lead to improved care processes and subsequently reduction of peri- and postoperative complications. Background: Implementation of the SSC was associated with robust reduction in morbidity and length of in-hospital stay in a stepped wedge cluster randomized controlled trial conducted in 2 Norwegian hospitals. Further investigation of precisely how the SSC improves care processes and subsequently patient outcomes is needed to understand the causal mechanisms of improvement. Methods: Care process metrics are reported from one of our earlier trial hospitals. Primary outcomes were in-hospital complications and care process metrics, e.g., patient warming and antibiotics. Secondary outcome was quality of SSC implementation. Analyses include Pearson's exact χ2 test and binary logistic regression. Results: A total of 3702 procedures (1398 control vs. 2304 intervention procedures) were analyzed. High-quality SSC implementation (all 3 checklist parts) improved processes and outcomes of care. Use of forced air warming blankets increased from 35.3% to 42.4% (P < 0.001). Antibiotic administration postincision decreased from 12.5% to 9.8%, antibiotic administration preincision increased from 54.5% to 63.1%, and nonadministration of antibiotics decreased from 33.0% to 27.1%. Surgical infections decreased from 7.4% (104/1398) to 3.6% (P < 0.001). Adjusted SSC effect on surgical infections resulted in an odds ratio (OR) of 0.52 (95% confidence interval (CI): 0.38–0.72) for intervention procedures, 0.54 (95% CI: 0.37–0.79) for antibiotics provided before incision, and 0.24 (95% CI: 0.11–0.52) when using forced air warming blankets. Blood transfusion costs were reduced by 40% with the use of the SSC. Conclusions: When implemented well, the SSC improved operating room care processes; subsequently, high-quality SSC implementation and improved care processes led to better patient outcomes.
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Khurana VG, Vats P. Awake craniotomy versus piloting an aircraft: What medicine and aviation can learn from one another? Surg Neurol Int 2019; 10:93. [PMID: 31528431 PMCID: PMC6744727 DOI: 10.25259/sni-215-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/07/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Praveen Vats
- Royal Australian Air Force Reserves, Mount Waverley, Victoria, Australia
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Paladino J, Kilpatrick L, O'Connor N, Prabhakar R, Kennedy A, Neal BJ, Kavanagh J, Sanders J, Block S, Fromme E. Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems. J Palliat Med 2019; 23:337-345. [PMID: 31503520 DOI: 10.1089/jpm.2019.0334] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.
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Affiliation(s)
- Joanna Paladino
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurel Kilpatrick
- Baylor Scott & White Health, Texas A&M University College of Medicine, Bryan, Texas
| | - Nina O'Connor
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anna Kennedy
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Brandon J Neal
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Jane Kavanagh
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Justin Sanders
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan Block
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik Fromme
- Ariadne Labs, Brigham and Women's Hospital, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
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