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Facey M, Baxter N, Hammond Mobilio M, Moulton CA, Paradis E. The ritualisation of the surgical safety checklist and its decoupling from patient safety goals. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:1100-1118. [PMID: 38300726 DOI: 10.1111/1467-9566.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/08/2023] [Indexed: 02/03/2024]
Abstract
Patient harm, patient safety and their governance have been ongoing concerns for policymakers, care providers and the public. In response to high rates of adverse events/medical errors, the World Health Organisation (WHO) advocated the use of surgical safety checklists (SSC) to improve safety in surgical care. Canadian health authorities subsequently made SSC use a mandatory organisational practice, with public reporting of safety indicators for compliance tied to pre-existing legislation and to reimbursements for surgical procedures. Perceived as the antidote for socio-technical issues in operating rooms (ORs), much of the SSC-related research has focused on assessing clinical and economic effectiveness, worker perceptions, attitudes and barriers to implementation. Suboptimal outcomes are attributed to implementations that ignored contexts. Using ethnographic data from a study of SSC at an urban teaching hospital (C&C), a critical lens and the concepts of ritual and ceremony, we examine how it is used, and theorise the nature and implications of that use. Two rituals, one improvised and one scripted, comprised C&C's SSC ceremony. Improvised performances produced dislocations that were ameliorated by scripted verification practices. This ceremony produced causally opaque links to patient safety goals and reproduced OR/medical culture. We discuss the theoretical contributions of the study and the implications for patient safety.
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Affiliation(s)
- Marcia Facey
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Nancy Baxter
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Hammond Mobilio
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Carol-Anne Moulton
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
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González Mariño MA. Safety of surgery: quality assessment of meta-analyses on the WHO checklist. Ann Med Surg (Lond) 2024; 86:2684-2687. [PMID: 38694363 PMCID: PMC11060208 DOI: 10.1097/ms9.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/16/2024] [Indexed: 05/04/2024] Open
Abstract
Objectives To assess the quality of the meta-analyses that review the WHO surgical safety checklist. Methods A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. Results In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. Conclusions The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.
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Affiliation(s)
- Mario Arturo González Mariño
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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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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Hart JWH', Takken R, Hogewoning CRC, Biter LU, Apers JA, Zengerink H, Dunkelgrün M, Verhoef C. Markers for Major Complications at Day-One Postoperative in Fast-Track Metabolic Surgery: Updated Metabolic Checklist. Obes Surg 2023; 33:3008-3016. [PMID: 37610699 PMCID: PMC10514089 DOI: 10.1007/s11695-023-06782-1] [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: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION In fast-track metabolic surgery, the window to identify complications is narrow. Postoperative checklists can be useful tools in the decision-making of safe early discharge. The aim of this study was to evaluate the predictive value of a checklist used in metabolic surgery. METHODS Retrospective data from June 2018 to January 2021 was collected on all patients that underwent metabolic surgery in a high-volume bariatric hospital in the Netherlands. Patients without an available checklist were excluded. The primary outcome was major complications and the secondary outcomes were minor complications, readmission, and unplanned hospital visits within 30 days postoperatively. RESULTS Major complications within 30 days postoperatively occurred in 62/1589 (3.9%) of the total included patients. An advise against early discharge was significantly more seen in patients with major complications compared to those without major complications (90.3% versus 48.1%, P < 0.001, respectively), and a negative checklist (advice for discharge) had a negative predictive value of 99.2%. The area under the curve for the total checklist was 0.80 (P < 0.001). Using a cut-off value of ≥3 positive points, the sensitivity and specificity were 65% and 82%, respectively. Individual parameters from the checklist: oral intake, mobilization, calf pain, willingness for discharge, heart rate, drain (>30 ml/24 h), hemoglobin, and leukocytes count were also significantly different between groups. CONCLUSION This checklist is a valuable tool to decide whether patients can be safely discharged early. Heart rate appeared to be the most predictive parameter for the development of major complications. Future studies should conduct prediction models to identify patients at risk for major complications.
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Affiliation(s)
- J W H 't Hart
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands.
| | - R Takken
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C R C Hogewoning
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - L U Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - H Zengerink
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - M Dunkelgrün
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Testori T, Tavelli L, Scaini R, Saibene AM, Felisati G, Barootchi S, Decker AM, Deflorian MA, Rosano G, Wallace SS, Zucchelli G, Francetti L, Wang HL. How to avoid intraoperative and postoperative complications in maxillary sinus elevation. Periodontol 2000 2023; 92:299-328. [PMID: 37345386 DOI: 10.1111/prd.12480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/01/2022] [Accepted: 11/13/2022] [Indexed: 06/23/2023]
Abstract
Maxillary sinus floor elevation, via the lateral approach, is one of the most predictable bone augmentation procedures performed in implant dentistry. but both intra- and postoperative complications can occur, and some of them are severe. Our aim is as follows: To review the pertinent literature on the topic, especially assessing the risk factors related to complications. To give clinical recommendations to minimize intra- and postoperative complications with the ultimate scope of improving the standard of clinical care and patient safety.
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Affiliation(s)
- Tiziano Testori
- IRCCS Galeazzi -Sant'Ambrogio Hospital, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Lorenzo Tavelli
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Riccardo Scaini
- IRCCS Galeazzi -Sant'Ambrogio Hospital, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, Santi Paolo e Carlo Hospital, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Ann Marie Decker
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Matteo Antonio Deflorian
- IRCCS Galeazzi -Sant'Ambrogio Hospital, Dental Clinic, Section of Implant Dentistry and Oral Rehabilitation, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Gabriele Rosano
- Academy of Craniofacial Anatomy, Como, Italy
- Lake Como Institute Implant Advanced Training Center, Como, Italy
| | - Stephen S Wallace
- Department of Periodontics, Columbia University College of Dental Medicine, New York City, New York, USA
- Private Practice, Waterbury, Connecticut, USA
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS Galeazzi -Sant'Ambrogio Hospital, Dental Clinic, Dean of the Dental Clinic, Milan, Italy
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Do HTT, Edwards H, Finlayson K. Surgical wound assessment tool: Construct validity and inter-rater reliability of a tool designed for nurses. J Clin Nurs 2023; 32:83-95. [PMID: 36494871 DOI: 10.1111/jocn.16476] [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: 03/21/2022] [Revised: 06/17/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To validate construct validity and inter-rater reliability of a surgical wound assessment tool. BACKGROUND Wound assessment is central to appropriate wound management. However, limited standard surgical wound assessment tools are available to assist nurses in assessing and recording progress in the healing of surgical wounds. DESIGN A prospective observational study was utilised to test the validity and reliability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline was used. METHODS Convenience sampling was used to recruit 260 patients who underwent elective or emergency surgery at a hospital in Vietnam. Exploratory factor analysis was used to examine the construct validity of the surgical wound assessment tool. Inter-rater reliability was calculated using the intraclass correlation coefficient and Cohen's kappa to determine reliability of the overall scale and identified items. RESULTS The results of the exploratory factor analysis supported a three-component structure of the surgical wound assessment tool. The intraclass correlation coefficient value of the overall scale was 0.79 (95% CI 0.67-0.89), p < .001, confirming excellent inter-rater reliability. Cohen's kappa value ranged from 0.5 to 1, demonstrating moderate to almost perfect level of agreement for individual items, except for one item on pain. CONCLUSION The surgical wound assessment tool was deemed to be acceptable, valid and reliable for monitoring the status of surgical wound healing. However, further modification and testing are needed to strengthen the tool and to determine the applicability of the tool in other populations. RELEVANCE TO CLINICAL PRACTICE The application of the SWAT would improve the assessment of surgical wounds in daily nursing practice which will promote improved postoperative wound management. It is an easy and practical tool for enhancing inter-disciplinary communication and care outcomes for all patients with surgical wounds.
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Affiliation(s)
- Hien Thi Thu Do
- Nursing Faculty, Haiduong Medical Technical University, Haiduong, Vietnam.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Helen Edwards
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kathleen Finlayson
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Mortality rates among surgical patients in Africa are double those of surgical patients in high-income countries. Internationally, there is a call to improve access to and safety of surgical and perioperative care. Perioperative research needs to be coordinated across Africa to positively impact perioperative mortality. METHODS The aim of this study was to determine the top 10 perioperative research priorities for perioperative nurses in Africa, using a research priority-setting process. A Delphi technique with 4 rounds was used to establish consensus on the top 10 perioperative research priorities. In the first round, respondents submitted research priorities. Similar research priorities were amalgamated into single priorities when possible. In round 2, respondents ranked the priorities using a scale from 1 to 10 (of which 1 is the first/highest priority, and 10 is the last/lowest priority). The top 20 (of 31) were determined after round 2. In round 3, respondents ranked their top 10 priorities. The final round was an online discussion to reach consensus on the top 10 perioperative research priorities. RESULTS A total of 17 perioperative nurses representing 12 African countries determined the top research priorities, which were: (1) strategies to translate and implement perioperative research into clinical practice in Africa, (2) creating a perioperative research culture and the tools, resources, and funding needed to conduct perioperative nursing research in Africa, (3) optimizing nurse-led postoperative pain management, (4) survey of operating theater and critical care resources, (5) perception of, and adherence to sterile field and aseptic techniques among surgeons in Africa (6) surgical staff burnout, (7) broad principles of infection control in surgical wards, (8) the role of interprofessional communication to promote clinical teamwork when caring for surgical patients, (9) effective implementation of the surgical safety checklist and measures of its impact, and (10) constituents of quality nursing care. CONCLUSIONS These research priorities provide the structure for an intermediate-term research agenda for perioperative research in Africa.
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GÜRKAN A, KIRTIL İ, DİKMEN Y. Surgical Teams’ Attitudes and Views Concerning the Surgical Safety ChecklistTR. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.937745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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9
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da Silva LM, Lima HDO, Ferrer R, Ho AMH, Silveira SQ, Abib ADCV, Bellicieri FN, Camire D, Mittermayer O, Botelho KK, Pla Gil AM, Mizubuti GB. Comparison of strategies for adherence to venous thromboembolism prophylaxis in high-risk surgical patients: a before and after intervention study. BMJ Open Qual 2021; 10:bmjoq-2021-001583. [PMID: 34663589 PMCID: PMC8524289 DOI: 10.1136/bmjoq-2021-001583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major cause of perioperative morbimortality. Despite significant efforts to advance evidence-based practice, prevention rates remain inadequate in many centres. OBJECTIVE To evaluate the effectiveness of different strategies aimed at improving adherence to adequate VTE prophylaxis in surgical patients at high risk of VTE. METHOD Before and after intervention study conducted at a tertiary hospital. Adherence to adequate VTE prophylaxis was compared according to three strategies consecutively implemented from January 2019 to December 2020. A dedicated hospitalist physician alone (strategy A) or in conjunction with a nurse (strategy B) overlooked the postoperative period to ensure adherence and correct inadequacies. Finally, a multidisciplinary team approach (strategy C) focused on promoting adequate VTE prophylaxis across multiple stages of care-from the operating room (ie, preoperative team-based checklist) to collaboration with clinical pharmacists in the postoperative period-was implemented. RESULTS We analysed 2074 surgical patients: 783 from January to June 2019 (strategy A), 669 from July 2019 to May 2020 (strategy B), and 622 from June to December 2020 (strategy C). VTE prophylaxis adherence rates for strategies (A), (B) and (C) were (median (25th-75th percentile)) 43.29% (31.82-51.69), 50% (42.57-55.80) and 92.31% (91.38-93.51), respectively (p<0.001; C>A=B). There was a significant reduction in non-compliance on all analysed criteria (risk stratification (A (25.5%), B (22%), C (6%)), medical documentation (A (68%), B (55.2%) C (9%)) and medical prescription (A (51.85%), B (48%), C (6.10%)) after implementation of strategy C (p<0.05). Additionally, a significant increase in compliance with adequate dosage, dosing interval and scheduling of the prophylactic regimen was observed. CONCLUSION Perioperative VTE prophylaxis strategies that relied exclusively on physicians and/or nurses were associated with suboptimal execution and prevention. A multidisciplinary team-based approach that covers multiple stages of patient care significantly increased adherence to adequate VTE prophylaxis in surgical patients at high risk of developing perioperative VTE.
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Affiliation(s)
| | | | - Ricardo Ferrer
- Nursing, São Luiz Hospital-ITAIM/Rede D'Or-CMA, São Paulo, Brazil
| | - Anthony M-H Ho
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | | | | | | | - Daenis Camire
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Otto Mittermayer
- Anesthesiology, São Luiz Hospital-ITAIM/Rede D'Or-CMA Anaesthesia Team, São Paulo, Brazil
| | | | - Andre Mortari Pla Gil
- Anesthesiology, São Luiz Hospital-ITAIM/Rede D'Or-CMA Anaesthesia Team, São Paulo, Brazil
| | - Glenio B Mizubuti
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
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Sotto KT, Burian BK, Brindle ME. Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis. J Am Coll Surg 2021; 233:794-809.e8. [PMID: 34592406 DOI: 10.1016/j.jamcollsurg.2021.08.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. STUDY DESIGN We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. CONCLUSIONS The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Affiliation(s)
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA
| | - Mary E Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB; Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
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Gillespie BM, Harbeck E, Kang E, Steel C, Fairweather N, Panuwatwanich K, Chaboyer W. Effects of a Brief Team Training Program on Surgical Teams' Nontechnical Skills: An Interrupted Time-Series Study. J Patient Saf 2021; 17:e448-e454. [PMID: 28452912 DOI: 10.1097/pts.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Up to 60% of adverse events in surgery are the result of poor communication and teamwork. Nontechnical skills in surgery (NOTSS) are critical to the success of surgery and patient safety. The study aim was to evaluate the effect of a brief team training intervention on teams' observed NOTSS. METHODS Pretest-posttest interrupted time-series design with statistical process control analysis was used to detect longitudinal changes in teams' NOTSS. We evaluated NOTSS using the revised NOTECHS weekly for 20 to 25 weeks before and after implementation of a team training program. RESULTS We observed 179 surgical procedures with cardiac, vascular, upper gastrointestinal, and hepatobiliary teams. Mean posttest NOTECHS scores increased across teams, showing special cause variation. There were also significant before and after improvements in NOTECHS scores in respect to professional role and in the use of the Surgical Safety Checklist. CONCLUSIONS Our results suggest associated improvements in teams' NOTSS after implementation of the team training program.
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Affiliation(s)
| | - Emma Harbeck
- School of Applied Psychology, Griffith University, Gold Coast Campus, Gold Coast
| | - Evelyn Kang
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland
| | - Catherine Steel
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane
| | - Nicole Fairweather
- Division of Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane
| | - Kriengsak Panuwatwanich
- School of Engineering, Griffith University, Gold Coast Campus, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland
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12
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Dellefield ME, Verkaaik CA. Using the Observational Teamwork Assessment in Surgery Instrument to Measure RN Teamwork During Cardiac Surgery: Lessons Learned. J Nurs Care Qual 2021; 36:162-168. [PMID: 32568965 DOI: 10.1097/ncq.0000000000000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical teams aspire to be safe and avoid preventable deaths. A lack of teamwork has been associated with safety failures, including adverse events and errors. PURPOSE The purpose of the pilot study was to: (1) modify the Observational Teamwork Assessment in Surgery (OTAS) and the original data collection method to measure registered nurse (RN) teamwork during the intraoperative phase of 5 open heart surgical procedures and (2) recommend strategies to further test the reliability and validity of the modified OTAS. METHODS This was a pilot study of the OTAS using direct observation. RESULTS Although characterized as psychometrically rigorous in prior systematic reviews, using the OTAS to measure RN teamwork in the intraoperative phase of cardiac surgery revealed deficits in its content validity and reliability. The OTAS and its original data collection method were modified. CONCLUSION Recommendations for further use of the modified OTAS to increase its reliability and validity are given.
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Fridrich A, Imhof A, Schwappach DLB. How Much and What Local Adaptation Is Acceptable? A Comparison of 24 Surgical Safety Checklists in Switzerland. J Patient Saf 2021; 17:217-222. [PMID: 33323892 PMCID: PMC7984757 DOI: 10.1097/pts.0000000000000802] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In 2009, the World Health Organization (WHO) published the WHO Surgical Safety Checklist, and 3 years later, the Swiss Patient Safety Foundation adapted it for Switzerland. Several meta-analyses and systematic reviews showed ambiguous results on the effectiveness of surgical checklists. Most of them assume that the study checklists are almost identical, but in fact they are quite heterogeneous due to adaptations to local settings. This study aims to investigate the extent to which the checklists currently used in Switzerland differ and to discuss the consequences of local adaptations. METHODS For the analysis, 24 checklists used in 18 Swiss hospitals are analyzed. First, general checklist characteristics are examined. Second, the checklist items are compared with the checklist items of the WHO and the Swiss Patient Safety Foundation. RESULTS The checklists contain a median of 34.5 items (range, 15-76). Compared with the checklists of WHO and Patient Safety Switzerland, which contain 12 and 21 process checks and 10 and 9 conversation prompts, respectively, the study checklists contain a median of 15.5 process checks (range, 3-25) and a median of 4 conversation prompts (range, 0-10). CONCLUSIONS There are major differences between the study checklists and the reference checklists that raise doubts about the comparability of checklists. More resources must be invested in proper checklist adaptions and better guidance on how to adapt safety tools such as the surgical safety checklist needed to local conditions. In any case, details of the checklists used need to be clearly described in studies on checklist effectiveness.
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Affiliation(s)
| | - Anita Imhof
- From the Swiss Patient Safety Foundation, Zurich
| | - David L. B. Schwappach
- From the Swiss Patient Safety Foundation, Zurich
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Alidina S, Chatterjee P, Zanial N, Alreja SS, Balira R, Barash D, Ernest E, Giiti GC, Maina E, Mazhiqi A, Mushi R, Reynolds C, Sydlowski M, Tinuga F, Maongezi S, Meara JG, Kapologwe NA, Barringer E, Cainer M, Citron I, DiMeo A, Fitzgerald L, Ghandour H, Gruendl M, Hellar A, Jumbam DT, Katoto A, Kelly L, Kisakye S, Kuchukhidze S, Lama TN, Menon G, Mshana S, Reynolds C, Segirinya H, Simba D, Smith V, Staffa SJ, Strader C, Tibyehabwa L, Troxel A, Varallo J, Wurdeman T, Zurakowski D. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others? BMJ Qual Saf 2021; 30:937-949. [PMID: 33547219 PMCID: PMC8606467 DOI: 10.1136/bmjqs-2020-011795] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 01/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Evidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings. METHODS We identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers. RESULTS Performance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum. CONCLUSION Future interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Pritha Chatterjee
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rebecca Balira
- Department of Epidemiology, National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania
| | | | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | | | | | - Adelina Mazhiqi
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Rahma Mushi
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cheri Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Florian Tinuga
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | - Erin Barringer
- Dalberg Advisors, Dalberg Group, New York, New York, USA
| | - Monica Cainer
- Department of Global Health, Assist International, Ripon, California, USA
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Amanda DiMeo
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Hiba Ghandour
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Magdalena Gruendl
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Desmond T Jumbam
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Adam Katoto
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Lauren Kelly
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Steve Kisakye
- Dalberg Implement, Dalberg Group, Dar es Salaam, Tanzania
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - Stella Mshana
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Chase Reynolds
- Department of Global Health, Assist International, Ripon, California, USA
| | | | - Dorcas Simba
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania
| | - Victoria Smith
- Department of Global Health, Assist International, Ripon, California, USA
| | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Christopher Strader
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | | | - Alena Troxel
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Arriaga AF, Szyld D, Pian-Smith MCM. Real-Time Debriefing After Critical Events: Exploring the Gap Between Principle and Reality. Anesthesiol Clin 2020; 38:801-820. [PMID: 33127029 PMCID: PMC7552980 DOI: 10.1016/j.anclin.2020.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alexander F Arriaga
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Ariadne Labs, Boston, MA, USA; Center for Surgery and Public Health, Boston, MA, USA.
| | - Demian Szyld
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Medical Simulation, Boston, MA, USA. https://twitter.com/debriefmentor
| | - May C M Pian-Smith
- Center for Medical Simulation, Boston, MA, USA; Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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16
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Concha-Torre A, Alonso YD, Blanco SÁ, Allende AV, Mayordomo-Colunga J, Barrio BF. The checklists: A help or a hassle? An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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18
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[The checklists: A help or a hassle?]. An Pediatr (Barc) 2020; 93:135.e1-135.e10. [PMID: 32591318 DOI: 10.1016/j.anpedi.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022] Open
Abstract
Patient safety has become a central component of quality of care. One of the best known and most widely used security tool in all work settings is the checklist. The checklist is a tool that helps to not forget any step during the performance of a procedure, to do tasks with an established order, to control the fulfilment of a series of requirements or to collect data in a systematic way for its subsequent analysis. It is an aid to improve the efficiency of teamwork, promote communication, decrease variability, standardize care and improve patient safety. Main barriers to implementation are reviewed: staff attitudes, hierarchies, poor design, inadequate training, duplication with other work lists, work overload, cultural barriers, lack of replication or checklist closing time. Finally, its applications in Pediatrics are reviewed starting from the most widespread, the safety checklist of pediatric surgery, checklists in neonatal critical units, for safe delivery, for risk procedures, in pediatric intensive care and for pathology time-dependent emergent, e.g. pediatric trauma. It is necessary to highlight the role of leadership in the implantation of a checklist in any area of Pediatrics. There must be one or more people from the team with the support of the Heads of Service and Managers who lead the training of the personnel, direct the implementation of the LV, evaluate the results, inform the rest of the team and can modify the processes depending on the problems found.
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Spanjersberg AJ, Ottervanger JP, Nierich AP, Speekenbrink RG, Stooker W, Hoogendoorn M, van Veghel D, Houterman S, Brandon Bravo Bruinsma GJ. Implementation of a specific safety check is associated with lower postoperative mortality in cardiac surgery. J Thorac Cardiovasc Surg 2020; 159:1882-1890.e2. [DOI: 10.1016/j.jtcvs.2019.07.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
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20
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Biccard BM. Priorities for peri-operative research in Africa. Anaesthesia 2020; 75 Suppl 1:e28-e33. [PMID: 31903576 DOI: 10.1111/anae.14934] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2019] [Indexed: 11/30/2022]
Abstract
Deaths following surgery are the third largest contributor to deaths globally, and in Africa are twice the global average. There is a need for a peri-operative research agenda to ensure co-ordinated, collaborative research efforts across Africa in order to decrease peri-operative mortality. The objective was to determine the top 10 research priorities for peri-operative research in Africa. A Delphi technique was used to establish consensus on the top research priorities. The top 10 research priorities identified were (1) Develop training standards for peri-operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (2) Develop minimum provision of care standards for peri-operative healthcare providers (surgical, anaesthesia and nursing) in Africa; (3) Early identification and management of mothers at risk from peripartum haemorrhage in the peri-operative period; (4) The role of communication and teamwork between surgical, anaesthetic, nursing and other teams involved in peri-operative care; (5) A facility audit/African World Health Organization situational analysis tool audit to assess emergency and essential surgical care, which includes anaesthetic equipment available and level of training and knowledge of peri-operative healthcare providers (surgeons, anaesthetists and nurses); (6) Establishing evidence-based practice guidelines for peri-operative physicians in Africa; (7) Economic analysis of strategies to finance access to surgery in Africa; (8) Establishment of a minimum dataset surgical registry; (9) A quality improvement programme to improve implementation of the surgical safety checklist; and (10) Peri-operative outcomes associated with emergency surgery. These peri-operative research priorities provide the structure for an intermediate-term research agenda to improve peri-operative outcomes across Africa.
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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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22
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[76-year-old [male] total hip arthroplasty : Preparation for the medical specialist examination: part 32]. Anaesthesist 2019; 68:230-235. [PMID: 31758213 DOI: 10.1007/s00101-019-00696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The aim of this review is to highlight the latest movements surrounding Emergency Manual (EM) implementation nationally and abroad within perioperative medicine with a focus on studies linking EM to patient safety. This is a comprehensive literature review which includes a brief introduction to the definition and history of EM as well as an overview of a successful implementation strategy, international influence and correlations to patient safety. The recent changes in healthcare and healthcare reimbursement have directed the focus throughout healthcare to quality improvement and patient safety. The potential of EMs' application to improve patient outcomes has influential implications both on patient outcomes as well as reimbursements. This study includes relevant citations with the large majority published in the last five years. EM implementation in healthcare has grown within the US and internationally over the last decade. Prominent organizations have created EMs containing principles of evidence-based medicine and widely accepted protocols that have been endorsed by major entities in the medical field. Successful implementation strategies primarily focus on different forms of simulation training and have been found to increase adherence to protocols through EM use. An increasing amount of educational institutions and healthcare facilities worldwide are perpetuating such implementation and a growing number of successful cases are being published.
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Affiliation(s)
- Wayne R Simmons
- Anesthesiology, Hospital Corporation of America West Florida Graduate Medical Education Consortium / Oak Hill Hospital, Brooksville, USA
| | - Jeff Huang
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
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24
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Jelacic S, Bowdle A, Nair BG, Togashi K, Wu C, Boorman DJ, Cain KC, Lang JD, Dellinger EP. The effects of an aviation-style computerised pre-induction anaesthesia checklist on pre-anaesthetic set-up and non-routine events. Anaesthesia 2019; 74:1138-1146. [PMID: 31155704 DOI: 10.1111/anae.14707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
This prospective, observational study compared the proportion of cases with missing critical pre-induction items before and after the implementation of an aviation-style computerised pre-induction anaesthesia checklist. Trained observers recorded the availability of critical pre-induction items and evaluated the characteristics of the pre-induction anaesthesia checklist performance including provider participation and distraction level, resistance to the use of the checklist and the time required for completion. Surgical cases that met the criteria for inclusion in the National Surgical Quality Improvement Program at a single academic hospital were selected for observation. A total of 853 cases were observed before and 717 after implementation of the checklist. The proportion of cases with failure to perform all pre-induction steps decreased from 10.0% to 6.4% (p = 0.012). There was also a significant decrease in the proportion of cases with non-routine events from 1.2% cases before to none after checklist implementation (p = 0.003). In 17 cases, the checklist alerted the anaesthesia provider to correct a mistake in pre-induction preparation.
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Affiliation(s)
- S Jelacic
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - A Bowdle
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - B G Nair
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - K Togashi
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - C Wu
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - D J Boorman
- Boeing Test and Evaluation, The Boeing Company, Seattle, WA, USA
| | - K C Cain
- Office of Nursing Research and Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - J D Lang
- Department of Anaesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - E P Dellinger
- Department of Surgery, University of Washington, Seattle, WA, USA
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25
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Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care 2019; 23:98. [PMID: 30917843 PMCID: PMC6436241 DOI: 10.1186/s13054-019-2347-3] [Citation(s) in RCA: 688] [Impact Index Per Article: 137.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources. METHODS The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. RESULTS Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms. CONCLUSIONS A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.
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Affiliation(s)
- Donat R. Spahn
- Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
| | - Bertil Bouillon
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Vladimir Cerny
- Department of Anaesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital, Usti nad Labem, Socialni pece 3316/12A, CZ-40113 Usti nad Labem, Czech Republic
- Centre for Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic, Sokolska 581, CZ-50005 Hradec Kralove, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, CZ-50003 Hradec Kralove, Czech Republic
- Department of Anaesthesia, Pain Management and Perioperative Medicine, QE II Health Sciences Centre, Dalhousie University, Halifax, 10 West Victoria, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Jacques Duranteau
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires Paris Sud, University of Paris XI, Faculté de Médecine Paris-Sud, 78 rue du Général Leclerc, F-94275 Le Kremlin-Bicêtre Cedex, France
| | - Daniela Filipescu
- Department of Cardiac Anaesthesia and Intensive Care, C. C. Iliescu Emergency Institute of Cardiovascular Diseases, Sos Fundeni 256-258, RO-022328 Bucharest, Romania
| | - Beverley J. Hunt
- King’s College and Departments of Haematology and Pathology, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH UK
| | - Radko Komadina
- Department of Traumatology, General and Teaching Hospital Celje, Medical Faculty Ljubljana University, SI-3000 Celje, Slovenia
| | - Marc Maegele
- Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109 Cologne, Germany
| | - Giuseppe Nardi
- Department of Anaesthesia and ICU, AUSL della Romagna, Infermi Hospital Rimini, Viale Settembrini, 2, I-47924 Rimini, Italy
| | - Louis Riddez
- Department of Surgery and Trauma, Karolinska University Hospital, S-171 76 Solna, Sweden
| | - Charles-Marc Samama
- Hotel-Dieu University Hospital, 1, place du Parvis de Notre-Dame, F-75181 Paris Cedex 04, France
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium
| | - Rolf Rossaint
- Department of Anaesthesiology, University Hospital Aachen, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany
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El Raichani L, Du Q, Mathieu A, Almassy S, Lalonde L, Berbiche D, Gélinas‐Lemay E, Boudreau N, Cardinal H. Development and validation of PART (Pharmacotherapy Assessment in Renal Transplant Patients) criteria to assess drug-related problems in an outpatient renal transplant population: A cross-sectional study. Pharmacol Res Perspect 2019; 7:e00453. [PMID: 30675363 PMCID: PMC6333916 DOI: 10.1002/prp2.453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022] Open
Abstract
Kidney transplant recipients are at risk of pharmacological interactions and adverse drug reactions. Community pharmacists are uniquely poised to detect and intervene in cases of drug-related problems. The aims of this study were to develop and validate a list of explicit criteria to be used by community pharmacists to assess drug-related problems in kidney transplant patients, and to assess their frequency and their determinants. First, we used a modified RAND method where a panel of experts established the PART (Pharmacotherapy Assessment in Renal Transplant Patient) criteria. Then, we performed a cross-sectional study in which we applied the PART criteria to 97 prevalent kidney transplant recipients followed at a single university-affiliated center. The final list of PART criteria included 70 drug-related problems and was reliable (kappa: 0.88). An average of 1.2 drug-related problems per patient was detected when the PART criteria were applied, with 68% of patients having at least 1 problem. This figure was 1.4 per patient using the expert judgment of renal transplant pharmacists who had no access to the PART list. The total number of medications taken was the only factor associated with the number of drug-related problems (β: 0.27 for an increase of five medications, 95% CI 0.005, 0.547). The PART criteria provide a novel tool for community pharmacists to systematically detect drug-related problems in kidney transplant recipients.
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Affiliation(s)
- Layal El Raichani
- Department of PharmacyCentre intégré de santé et de services sociaux CISSS de la Montérégie CentreLongueuilQuebecCanada
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
| | - Qian Du
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
- Department of PharmacyCentre intégré universitaire de santé et de services sociaux du Centre‐Sud‐de‐l’île‐MontréalMontrealQuebecCanada
| | - Alexandre Mathieu
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
- Department of PharmacyCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - Sabrina Almassy
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
- Department of PharmacyCentre intégré universitaire de santé et de services sociaux de l'EstrieSherbrookeQuebecCanada
| | - Lyne Lalonde
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
| | - Djamal Berbiche
- Faculty of Medicine and Health SciencesUniversité de SherbrookeSherbrookeQuebecCanada
| | - Elisabeth Gélinas‐Lemay
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
- Department of PharmacyCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - Nathalie Boudreau
- Faculty of PharmacyUniversity of MontrealMontrealQuebecCanada
- Department of PharmacyCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
- Research centerCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
| | - Héloïse Cardinal
- Research centerCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
- Nephrology DivisionCentre Hospitalier de l'Université de MontréalMontrealQuebecCanada
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When Checklists Fail: Human Factors Learning from Aviation and Safety by Design. Anesthesiology 2018; 129:1192-1193. [PMID: 30422860 DOI: 10.1097/aln.0000000000002470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgical Safety Checklists in Children's Surgery: Surgeons' Attitudes and Review of the Literature. Pediatr Qual Saf 2018; 3:e108. [PMID: 30584635 PMCID: PMC6221594 DOI: 10.1097/pq9.0000000000000108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Surgical safety checklists (SSCs) aim to create a safe operating room environment for surgical patients. Provider attitudes toward checklists affect their ability to prevent harm. Pediatric surgeons’ perceptions surrounding SSCs, and their role in improving patient safety, are unknown. Methods: American Pediatric Surgical Association members conducted an online survey to evaluate the use of and attitudes toward SSCs. The survey measured surgeons’ perceptions of checklists, including the components that make them effective and barriers to participation. To better evaluate the available data on SSCs, the authors performed a systematic literature review on the use of SSCs with a focus on pediatric studies. Results: Of the 353 survey respondents, 93.6% use SSCs and 62.6% would want one used in their own child’s operation, but only 54.7% felt that checklists improve patient safety. Reasons for checklist skepticism included the length of the checklist process, a distraction from thoughtful patient care, and lack of data supporting use. Literature review shows that checklists improve communication, promote teamwork, and identify errors, but do not necessarily decrease morbidity. Staff perception is a major barrier to implementation. Conclusions: Almost all pediatric surgeons participate in SSCs at their institutions, but many question their benefit. Better pediatric surgeon engagement in checklist use is needed to change the safety culture, improve operating room communication, and prevent harm.
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Steelman VM, Thenuwara K, Shaw C, Shine L. Unintentionally Retained Guidewires: A Descriptive Study of 73 Sentinel Events. Jt Comm J Qual Patient Saf 2018; 45:81-90. [PMID: 30262391 DOI: 10.1016/j.jcjq.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Unintentionally retained foreign objects remain the sentinel events most frequently reported to The Joint Commission. Many of these objects are guidewires used to facilitate placement of catheters, tubes, and other devices. The purpose of this study was to describe reports of unintentionally retained guidewires in order to make recommendations to improve patient safety. METHODS A retrospective review was undertaken of unintentionally retained guidewires voluntarily reported to The Joint Commission from October 2012 through March 2018. Reports included the type of catheter or device, location of insertion, department, contributing factors, discovery period, patient harm, and a narrative description of the event. RESULTS A total of 73 reports of retained guidewires or parts of guidewires were reviewed. Retention occurred during insertion of vascular catheters, devices used during surgery, and drainage tubes. A total of 285 contributing factors were identified, most frequently within the categories of human factors, leadership, and communication. In the cases in which the discovery period was known, 39.3% were identified after hospital discharge. In 76.7% of reports, the harm was categorized as unexpected additional care or extended stay. Four patients died as a result of the retained guidewire. CONCLUSION Unintentionally retained guidewires remain a significant patient safety issue. This study describes retained guidewires used to insert a variety of vascular catheters and devices, in different departments within hospitals. The large number of contributing factors demonstrates the complexity of care and provides new knowledge that can be used for designing interventions for prevention.
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Bergs J, Lambrechts F, Desmedt M, Hellings J, Schrooten W, Vlayen A, Vandijck D. Seen through the patients' eyes: surgical safety and checklists. Int J Qual Health Care 2018; 30:118-123. [PMID: 29340625 DOI: 10.1093/intqhc/mzx180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/06/2017] [Indexed: 11/15/2022] Open
Abstract
Objective We sought to explore the views patients have towards surgical safety and checklists. As a secondary aim, we explored if previous experience of error or other patient characteristics influence these views. Design A cross-sectional survey study design was applied. Participants The Flemish Patients' Platform network and social media were used to recruit participants. Main outcome measure(s) An 11-item questionnaire was designed to assess the following constructs: perception of surgical safety, attitudes towards the WHO surgical safety checklist and attitudes regarding checklist usage. Results Respondents' view (N = 444) on the risk of an adverse event showed considerable variation. Respondents were positive towards the checklist, strongly agreeing that it would impact positively on their safety. However, this positive perception did not translate into an attitude where patients will actively inform themselves whether a checklist is used. The majority of respondents have no difficulty with repetitive verification of identity, procedure and location of the surgery. Respondents with a clinical background were the least anxious. Views were divided regarding hearing discussions around blood loss or airway problems. Conclusions Patients perceive the checklist as a reliable safety tool. They do not mind repetitive verification of identity and procedure. However, hearing staff discussing specific, explicit, risks could cause anxiousness in some patients. Building a supportive and collaborative environment is needed to involve and empower patients to contribute in the realization of a safe hospital environment.
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Affiliation(s)
- Jochen Bergs
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Frank Lambrechts
- Faculty of Busines Economics, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Melissa Desmedt
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Johan Hellings
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,AZ Delta Hospital, General Management, Rode-kruisstraat 20, 8800 Roeselare, Belgium
| | - Ward Schrooten
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Annemie Vlayen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000 Gent, Belgium
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Rodella S, Mall S, Marino M, Turci G, Gambale G, Montella MT, Bonilauri S, Gelmini R, Zuin P. Effects on Clinical Outcomes of a 5-Year Surgical Safety Checklist Implementation Experience: A Large-scale Population-Based Difference-in-Differences Study. Health Serv Insights 2018; 11:1178632918785127. [PMID: 30046243 PMCID: PMC6056784 DOI: 10.1177/1178632918785127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 05/24/2018] [Indexed: 11/17/2022] Open
Abstract
The adoption of a surgical checklist is strongly recommended worldwide as an effective
practice to improve patient safety; however, several studies have reported mixed results
and a number of issues are still unresolved. The main objective of this study was to
explore the impact of the first 5-year period of a surgical checklist-based intervention
in a large regional health care system in Italy (4 500 000 inhabitants). We conducted a
retrospective longitudinal study on 1 166 424 patients who underwent surgery in 48 public
hospitals between 2006 and 2014. The adherence to the checklist was measured between 2011
and 2013 through a computerized database. The effects of the intervention were explored
through multivariable logistic regression and difference-in-differences (DID) approaches,
based on current administrative data sources. In-hospital and 30-days mortality, 30-days
readmissions and length-of-stay (LOS) ⩾8 days were the observed outcomes. Adherence to the
checklist showed marked variations across hospitals (0%-93.3%). A pre/post analysis
detected statistically significant differences between surgical interventions performed in
hospitals with higher adherence to the checklist (⩾75% of the surgeries) and those
performed in other hospitals, as for the 30-days readmissions rate (odds
ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98) and LOS ⩾ 8 days rate (OR:
0.88; 95% CI: 0.87-0.89). These findings were confirmed after risk adjustment and DID
analysis. No association was observed with mortality outcomes. On the whole, our study
attained mixed results. Although a protective effect of the surgical
checklist use could not be proved over the first 5 years of this regional implementation
experience, our research offers some methodological insights for practical use in the
evaluation process of large-scale implementation projects.
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Affiliation(s)
- Stefania Rodella
- Agenzia Sanitaria e Sociale Regionale-Emilia-Romagna, Bologna, Italy
| | - Sabine Mall
- Public Health Department, Azienda USL Bologna-Emilia-Romagna, Bologna, Italy
| | - Massimiliano Marino
- Clinical governance, Azienda USL Reggio Emilia- IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | | | - Giorgio Gambale
- ‡Anesthesia and Intensive Care, Azienda USL Romagna-Emilia-Romagna, Cesena, Italy
| | - Maria Teresa Montella
- Operation Management Unit, Azienda USL Reggio Emilia-IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | - Stefano Bonilauri
- Department of General Surgery, General and Emergency Surgery, Azienda USL Reggio Emilia- IRCCS-Emilia-Romagna, Reggio Emilia, Italy
| | - Roberta Gelmini
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, Policlinico of Modena, University of Modena and Reggio Emilia-Emilia-Romagna, Modena, Italy
| | - Piera Zuin
- Azienda Ospedaliera - Universitaria Policlinico of Modena-Emilia-Romagna, Modena, Italy
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Gillespie BM, Harbeck EL, Lavin J, Hamilton K, Gardiner T, Withers TK, Marshall AP. Evaluation of a patient safety programme on Surgical Safety Checklist Compliance: a prospective longitudinal study. BMJ Open Qual 2018; 7:e000362. [PMID: 30057963 PMCID: PMC6059267 DOI: 10.1136/bmjoq-2018-000362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/02/2018] [Accepted: 06/14/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Surgical Safety Checklists (SSC) have been implemented widely across 132 countries since 2008. Yet, despite associated reductions in postoperative complications and death rates, implementation of checklists in surgery remains a challenge. The aim of this study was to assess the impact of a patient safety programme over time on SSC use and incidence of clinical errors. DESIGN A prospective longitudinal design over three time points and a retrospective secondary analysis of clinical incident data was undertaken. METHODS We implemented a patient safety programme over 4 weeks to improve surgical teams' use of the SSC. We undertook structured observations to assess surgical teams' checklist use before and after programme implementation and conducted a retrospective audit of clinical incident data 12 months before and 12 months following implementation of the programme. RESULTS There were significant improvements in the observed use of the SSC across all phases, particularly in sign-out where completion rates ranged from 79.3% to 94.5% (p<0.0001) following programme implementation. Across clinical incident audit periods, 33 019 surgical procedures were performed. Based on a subsample of 64 cases, clinical incidents occurred in 22/16 264 (0.13%) before implementation and 42/16 755 (0.25%) cases after implementation. The most predominant incident after programme implementation was inadequate tissue specimen labelling (23/42, 54.8%). Clinical incidents resulted in minimal or no harm to the patient. CONCLUSIONS The benefit in using a surgical checklist lies in the potential to enhance team communications and the promotion of a team culture in which safety is the priority.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Research & Education Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
| | - Emma L Harbeck
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
| | - Joanne Lavin
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Mt Gravatt Campus, Mount Gravatt, Queensland, Australia
| | - Therese Gardiner
- Nursing and Midwifery Education and Research Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Teresa K Withers
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Research & Education Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
- National Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia
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Abstract
PURPOSE OF REVIEW Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced. RECENT FINDINGS Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use. Postoperatively, the concept of 'failure to rescue' in the surgical patients has been explored. SUMMARY A clear vision of what postoperative recovery should mean for practitioner and patients; careful risk stratification and prophylactic measures to avoid postoperative complications; the judicious use of checklists and other cognitive aids to complement clinical expertise in promoting safety within each local context; and the prompt recognition and rescue of postoperative problems when they occur are all important aspects of a safe perioperative care.
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de Jager E, Gunnarsson R, Ho YH. Implementation of the World Health Organization Surgical Safety Checklist Correlates with Reduced Surgical Mortality and Length of Hospital Admission in a High-Income Country. World J Surg 2018; 43:117-124. [DOI: 10.1007/s00268-018-4703-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anderson KT, Appelbaum R, Bartz-Kurycki MA, Tsao K, Browne M. Advances in perioperative quality and safety. Semin Pediatr Surg 2018; 27:92-101. [PMID: 29548358 DOI: 10.1053/j.sempedsurg.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
For decades, safe surgery focused on intraoperative technique and decision-making. The traditional hierarchy placed the surgeon as the leader with ultimate authority and responsibility. Despite the advances in surgical technique and equipment, too many patients have suffered unnecessary complications and suboptimal care. Today, we understand that the conduct of safe and effective surgery requires evidence-based decision-making, multifaceted treatment approaches to prevent complications, and effective communication in and out of the operating room. In this manuscript, we describe three significant advances in quality and safety that have changed the approach to surgical care: the National Surgical Quality Improvement Program, evidence-based bundled prevention of surgical site infections, and the Surgical Safety Checklist.
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Affiliation(s)
- Kathryn T Anderson
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rachel Appelbaum
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marisa A Bartz-Kurycki
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - KuoJen Tsao
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marybeth Browne
- USF Morsani College of Medicine, Division of Pediatric Surgical Specialties, Lehigh Valley Children's Hospital, Department of Surgery, Lehigh Valley Health Network, 1210 S Cedar Crest Blvd, Allentown, PA 18103-6241, USA.
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Gillespie BM, Harbeck E, Lavin J, Gardiner T, Withers TK, Marshall AP. Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical safety checklist. BMC Health Serv Res 2018; 18:170. [PMID: 29523148 PMCID: PMC5845378 DOI: 10.1186/s12913-018-2973-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Although mandated in many health care institutions around the world, challenges in implementation of the SSC continue. To use Normalisation Process Theory (NPT) to help understand how/why implementation of a complex intervention coined Pass The Baton (PTB) could help explain what facets of the Surgical Safety Checklist use led to its' integration in practice, while others were not. METHODS A longitudinal multi-method study using survey and interviews was undertaken. Implementation of PTB involved; change champions, audit and feedback, education and prompts. Following implementation, surgical teams were surveyed using the NOrmalization MeAsure Development (NoMAD) and subsequently interviewed to explore the impact of PTB on their use of the checklist at 6 and 12 months respectively. Respondents' self-reported perceptions of implementation of PTB was explained using the four NPT constructs; coherence, cognitive participation, collective action, and reflexive monitoring. Survey data were analysed using descriptive statistics. Interview data were coded inductively and content analysed using a framework derived from NPT. RESULTS The NoMAD survey response rate was 59/150 (39.3%). Many (45/59, 77.6%) survey respondents saw the value in PTB, while 50/59 (86.2%) would continue to use it; 45/59 (77.6%) believed that PTB could easily be integrated into existing workflows, and 48/59 (82.8%) thought that feedback could improve PTB in the future. A total of 8 interviews were completed with 26 surgical team members. Nurses and physicians held mixed views towards coherence while buy-in and participation relied on individuals' investment in the implementation process and the ability to modify PTB. Participants generally recognised the benefit and value of using PTB in the ongoing implementation the checklist. CONCLUSIONS Workarounds and flexible co-construction in implementation designed to improve team communications in surgery may facilitate their normalisation in practice.
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Affiliation(s)
- Brigid M. Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
| | - Emma Harbeck
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
| | - Joanne Lavin
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Therese Gardiner
- Nursing & Midwifery Education & Research Unit, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Teresa K. Withers
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Andrea P. Marshall
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
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Arriaga AF, Hepner DL, Bader AM. "However Beautiful the Strategy, You Should Occasionally Look at the Results": Sir Winston Churchill and Medical Checklists. Anesth Analg 2018; 126:16-18. [PMID: 29252477 DOI: 10.1213/ane.0000000000002492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alexander F Arriaga
- From the Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Ariadne Labs, Boston, Massachusetts
| | - Angela M Bader
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts
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de Jager E, McKenna C, Bartlett L, Gunnarsson R, Ho YH. Postoperative Adverse Events Inconsistently Improved by the World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies. World J Surg 2017; 40:1842-58. [PMID: 27125680 PMCID: PMC4943979 DOI: 10.1007/s00268-016-3519-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events. METHOD This systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased. RESULTS The quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations. CONCLUSIONS The checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.
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Affiliation(s)
- Elzerie de Jager
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia.
| | - Chloe McKenna
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia
| | - Lynne Bartlett
- College of Public Health, Medical & Veterinary Sciences, The Townsville Hospital, Townsville, QLD, 4814, Australia
| | - Ronny Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Research and Development Unit, Primary Health Care and Dental Care Narhalsan, Southern Älvsborg County, Region Västra Götaland, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yik-Hong Ho
- International College of Surgeons, Chicago, IL, USA.,Department of Surgery, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Abstract
Crisis checklists and emergency manuals are cognitive aids that help team performance and adherence to evidence-based practices during operating room crises. Resources to enable local implementation and training (key for effective use) are linked at http://www.emergencymanuals.org.
Supplemental Digital Content is available in the text.
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Boyd J, Wu G, Stelfox H. The Impact of Checklists on Inpatient Safety Outcomes: A Systematic Review of Randomized Controlled Trials. J Hosp Med 2017; 12:675-682. [PMID: 28786436 DOI: 10.12788/jhm.2788] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Systematic reviews of non-randomized controlled trials (RCTs) suggest that using a checklist results in fewer medical errors and adverse events, but these evaluations are at risk of bias. OBJECTIVE To conduct a systematic review of RCTs of checklists to determine their effectiveness in improving patient safety outcomes in hospitalized patients. METHODS Ovid EMBASE, Ovid MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials were searched from inception until December 8, 2016. The search was restricted to RCTs. Included studies reported patient safety outcomes of a checklist intervention. Data extracted included the study characteristics, setting, population, intervention, outcomes measures, and sample size. MEASUREMENTS AND MAIN RESULTS 11,225 citations were identified, of which 9 (16,987 patients) satisfied the inclusion criteria. Citations reported evaluations of checklists designed to improve surgical safety, prescription of medications, heart failure management, pain control, infection control precautions, and physician handover. Studies reported significant reductions in postoperative complications and medication-related problems and improved compliance with evidence-based prescribing of medications, infection control precautions, and patient handover procedures. 30-day mortality was reported in 3 studies and was significantly lower among patients allocated to the checklist group (odds ratio 0.60, 95% confidence interval, 0.41-0.89, 𝑃 = 0.01, I² = 0.0%, 𝑃 = 0.573). Methodological quality of the studies was moderate. CONCLUSION A small number of citations report RCT evaluations of the impact of checklists on patient safety. There is an urgent need for high-quality evaluations of the effectiveness of patient safety checklists in inpatient healthcare settings to substantiate their perceived benefits.
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Affiliation(s)
- Jamie Boyd
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guosong Wu
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Alberta, Canada
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Alpendre FT, Cruz EDDA, Dyniewicz AM, Mantovani MDF, Silva AEBDCE, Santos GDSD. Safe surgery: validation of pre and postoperative checklists. Rev Lat Am Enfermagem 2017; 25:e2907. [PMID: 28699994 PMCID: PMC5511001 DOI: 10.1590/1518-8345.1854.2907] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/06/2017] [Indexed: 11/24/2022] Open
Abstract
Objective: to develop, evaluate and validate a surgical safety checklist for
patients in the pre and postoperative periods in surgical hospitalization units.
Method: methodological research carried out in a large public teaching hospital in the
South of Brazil, with application of the principles of the Safe Surgery Saves
Lives Programme of the World Health Organization. The checklist was applied to 16
nurses of 8 surgical units and submitted for validation by a group of eight
experts using the Delphi method online. Results: the instrument was validated and it was achieved a mean score ≥1, level of
agreement ≥75% and Cronbach’s alpha >0.90. The final version included 97 safety
indicators organized into six categories: identification, preoperative, immediate
postoperative, immediate postoperative, other surgical complications, and hospital
discharge. Conclusion: the Surgical Safety Checklist in the Pre and Postoperative periods is another
strategy to promote patient safety, as it allows the monitoring of predictive
signs and symptoms of surgical complications and the early detection of adverse
events.
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Affiliation(s)
- Francine Taporosky Alpendre
- Doctoral student, Universidade Federal do Paraná, Curitiba, PR, Brazil. RN, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | | | | | - Gabriela de Souza Dos Santos
- Master's student, Universidade Federal do Paraná, Curitiba, PR, Brazil. RN, Instituto De Neurologia de Curitiba, Curitiba, PR, Brazil
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Burbano-Paredes CC, Amaya-Guio J, Rubiano-Pinzón AM, Hernández-Caicedo ÁC, Grillo-Ardila CF. Clinical practice guideline for the management of sedation outside of operating room in patients over 12 years. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Clinical practice guideline for the management of sedation outside of operating room in patients over 12 years☆,☆☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Burbano-Paredes CC, Amaya-Guio J, Rubiano-Pinzón AM, Hernández-Caicedo ÁC, Grillo-Ardila CF. Guía de práctica clínica para la administración de sedación fuera del quirófano en pacientes mayores de 12 años. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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van Mil SR, Duinhouwer LE, Mannaerts GHH, Biter LU, Dunkelgrun M, Apers JA. The Standardized Postoperative Checklist for Bariatric Surgery; a Tool for Safe Early Discharge? Obes Surg 2017. [DOI: 10.1007/s11695-017-2746-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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46
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Gillespie BM, Hamilton K, Ball D, Lavin J, Gardiner T, Withers TK, Marshall AP. Unlocking the "black box" of practice improvement strategies to implement surgical safety checklists: a process evaluation. J Multidiscip Healthc 2017; 10:157-166. [PMID: 28435283 PMCID: PMC5388350 DOI: 10.2147/jmdh.s124298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Compliance with surgical safety checklists (SSCs) has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve. Objectives The objective of this study was to undertake a process evaluation of four knowledge translation (KT) strategies used to implement the Pass the Baton (PTB) intervention which was designed to improve utilization of the SSC. Methods As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well) in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Results Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently implemented. Of the 220 staff working in the department, that is, nurses, anesthetists, and surgeons, 160 (72.7%) knew about the PTB strategies. Qualitative analysis revealed that implementation was generally feasible and acceptable. A barrier to feasibility was physician engagement. An impediment to acceptability was participants’ skepticism about the ability of the KT strategies to effect behavioral change. Conclusion Overall, results of this evaluation suggest that success of implementation was moderate. Given the probable impact of contextual factors, that is, team culture and the characteristics of participants, the KT strategies may need modification prior to widespread implementation.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast.,Gold Coast University Hospital and Health Service, Southport.,Nursing & Midwifery Education & Research Unit (NMERU), National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Mt Gravatt
| | | | | | | | - Teresa K Withers
- Surgical and Procedural Services, Gold Coast University Hospital and Health Service, Southport, Australia
| | - Andrea P Marshall
- School of Nursing & Midwifery, Griffith University, Gold Coast.,Gold Coast University Hospital and Health Service, Southport.,Nursing & Midwifery Education & Research Unit (NMERU), National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast
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Yu X, Huang Y, Guo Q, Wang Y, Ma H, Zhao Y, Wang Y, Yu X, Tan G, Ma S, Wu X, Xu M, Zhang S, Shang H, Xin S, Zhang X, Wang J, Li L, Wu S, Zhao S, Yang J, Wen H, Sun H, Xiong Y, Wang Y, He J, Liu Q, Li J, Jiang J, Xue F, Han W, Wang Z, Wang Y, Hu Y, Wang L. Clinical motivation and the surgical safety checklist. Br J Surg 2017; 104:472-479. [PMID: 28158915 DOI: 10.1002/bjs.10446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/09/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Although the surgical safety checklist (SSC) has been adopted worldwide, its efficacy can be diminished by poor clinical motivation. Systematic methods for improving implementation are lacking.
Methods
A multicentre prospective study was conducted in 2015 in four academic/teaching hospitals to investigate changes during revision of the SSC for content, staffing and workflow. All modifications were based on feedback from medical staff. Questionnaires were used to monitor dynamic changes in surgeons', nurses' and anaesthetists' perceptions.
Results
Complete information was obtained from 30 654 operations in which the newly developed SSC system was used. Implementation quality was evaluated in 1852 operations before, and 1822 after the changes. The revised SSC content was simplified from 34 to 22 items. Anaesthetists achieved widespread recommendation as SSC coordinators. Completion rates of all stages reached over 80·0 per cent at all sites (compared with 10·2–59·5 per cent at the sign-out stage in the baseline survey). There was a significant change in doctors who participated (for example, surgeon: from 24·6 to 64·5 per cent at one site). The rates of hasty (15·1–33·7 per cent) or casual (0·4–4·4 per cent) checking decreased to less than 6·0 per cent overall. Perceptions about the SSC were studied from 2211 forms. They improved, with a converging trend among the three different professions, to a uniform 80·0 per cent agreeing on the need for its regular use.
Conclusion
Medical staff members are both the users and owners of the SSC. High-quality SSC implementation can be achieved by clinically motivated adaptation.
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Affiliation(s)
- X Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Y Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Q Guo
- Xiangya Hospital, Central South University, Changsha, China
| | - Y Wang
- Qinghai Provincial People's Hospital, Xining, China
| | - H Ma
- First Hospital of China Medical University, Shenyang, China
| | - Y Zhao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Y Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - X Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - G Tan
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - S Ma
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - X Wu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - M Xu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - S Zhang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - H Shang
- First Hospital of ChinaMedical University, Shenyang, China
| | - S Xin
- First Hospital of ChinaMedical University, Shenyang, China
| | - X Zhang
- First Hospital of ChinaMedical University, Shenyang, China
| | - J Wang
- First Hospital of ChinaMedical University, Shenyang, China
| | - L Li
- First Hospital of ChinaMedical University, Shenyang, China
| | - S Wu
- Qinghai Provincial People's Hospital, Xining, China
| | - S Zhao
- Qinghai Provincial People's Hospital, Xining, China
| | - J Yang
- Qinghai Provincial People's Hospital, Xining, China
| | - H Wen
- Qinghai Provincial People's Hospital, Xining, China
| | - H Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Y Xiong
- Xiangya Hospital, Central South University, Changsha, China
| | - Y Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - J He
- Xiangya Hospital, Central South University, Changsha, China
| | - Q Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - J Li
- Xiangya Hospital, Central South University, Changsha, China
| | - J Jiang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - F Xue
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - W Han
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Z Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Y Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Y Hu
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - L Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
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Implementation of the surgical safety checklist at a tertiary academic center: Impact on safety culture and patient outcomes. Am J Surg 2016; 214:193-197. [PMID: 28215964 DOI: 10.1016/j.amjsurg.2016.10.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/29/2016] [Accepted: 10/31/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact and efficacy of the World Health Organization Surgery Safety Checklist (SSC) is uncertain. We sought to determine if the SSC decreases complications and examined the attitudes of the surgical team members following implementation of the SSC. METHODS A 28-question survey was developed to assess perspectives of surgical team members at the University of Vermont Medical Center (UVMC). The University Health System Consortium database was examined to compare the rates of nine complications before and after SSC implementation using Chi square analysis and Fisher's exact test. RESULTS There was no significant decrease in any of the nine complications 2 years after SSC implementation. There was overall agreement that the SSC improved communication, safety, and prevented errors in the operating room. However, there was disagreement between nursing and surgeons over whether all three parts of the SSC were always completed. CONCLUSIONS Implementation of the SSC did not result in a significant decrease in perioperative morbidity or mortality. However, it did improve the perception of safety culture by operating room staff.
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Anesthesia related mortality? A national and international overview. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2016. [DOI: 10.1016/j.tacc.2016.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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