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Arredondo Montero J, Bardají Pascual C. From Aviation to Pediatric Surgery. Clin Pediatr (Phila) 2024; 63:557-559. [PMID: 37246755 DOI: 10.1177/00099228231176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.
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Affiliation(s)
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Melo AVDOG, Nascimento MADL. DEVELOPMENT AND VALIDATION OF A CHECKLIST FOR THE SAFETY OF HOSPITALIZED CHILDREN. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to develop and validate a checklist of safety actions for hospitalized children. Method: a methodological research study carried out from March 2017 to March 2020 in two phases: 1) Identification of the themes and elaboration of the checklist through the literature review; 2) Content validation with expert judges by means of the Delphi technique, applying the Content Validity Index (CVI), accepting values >0.8 for the CVI per item and >0.9 for the checklist. The data collection instrument was organized using an ordinal progressive valuation scale, of the Likert type. The content validation stage was performed in three rounds using a Google Forms® electronic form. Fifteen experts participated in the survey in the first round and 14 in the second and third rounds. The statistical analysis of the data was performed with the aid of Google Forms® and of the Excel® software, and the results were presented descriptively and in a table. Results: the final version of the checklist consisted of 6 categories and 23 check items, validated with a Content Validity Index of 0.98. The checklist was also validated in relation to the objectives (0.95) and to the structure and presentation (0.98). Conclusion: validation of the content, objectives, structure and presentation of the checklist allows this tool to be implemented in any pediatric hospitalization unit, contributing to the care practice aimed at the safety of hospitalized children.
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Urban D, Burian BK, Patel K, Turley NW, Elam M, MacRobie AG, Merry AF, Kumar M, Hannenberg A, Haynes AB, Brindle ME. Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey. ANNALS OF SURGERY OPEN 2021; 2:e075. [PMID: 36590849 PMCID: PMC9770110 DOI: 10.1097/as9.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
To assess health care professionals' attitudes on the Surgical Safety Checklist ("the Checklist") in resource-rich health systems and provide insights on strategies for optimizing Checklist use. Background In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. Methods An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. Results A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). Conclusions While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.
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Affiliation(s)
- Denisa Urban
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Kripa Patel
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan W. Turley
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Meagan Elam
- School of Public Health, Boston University, Boston, MA
| | - Ali G. MacRobie
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alan F. Merry
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Manoj Kumar
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Alexander Hannenberg
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
| | | | - Mary E. Brindle
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
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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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Lagoo J, Lopushinsky SR, Haynes AB, Bain P, Flageole H, Skarsgard ED, Brindle ME. Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis. BMJ Open 2017; 7:e016298. [PMID: 29042377 PMCID: PMC5652514 DOI: 10.1136/bmjopen-2017-016298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. SUMMARY BACKGROUND DATA Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. METHODS A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing. RESULTS 1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety. CONCLUSIONS A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs' role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.
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Affiliation(s)
- Janaka Lagoo
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Alex B Haynes
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Helene Flageole
- Section of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E Brindle
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada
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Skarsgard ED. Recommendations for surgical safety checklist use in Canadian children's hospitals. Can J Surg 2017; 59:161-6. [PMID: 27240284 DOI: 10.1503/cjs.016715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is ample evidence that avoidable harm occurs in patients, including children, who undergo surgical procedures. Among a number of harm mitigation strategies, the use of surgical safety checklists (SSC) is now a required organizational practice for accreditation in all North American hospitals. Although much has been written about the effects of SSC on outcomes of adult surgical patients, there is a paucity of literature on the use and role of the SSC as an enabler of safe surgery for children. METHODS The Pediatric Surgical Chiefs of Canada (PSCC) advocates on behalf of all Canadian children undergoing surgical procedures. We undertook a survey of the use of SSC in Canadian children's hospitals to understand the variability of implementation of the SSC and understand its role as both a measure and driver of patient safety and to make specific recommendations (based on survey results and evidence) for standardized use of the SSC in Canadian children's hospitals. RESULTS Survey responses were received from all 15 children's hospitals and demonstrated significant variability in how the checklist is executed, how compliance is measured and reported, and whether or not use of the checklist resulted in specific instances of error prevention over a 12-month observation period. There was near unanimous agreement that use of the SSC contributed positively to the safety culture of the operating room. CONCLUSION Based on the survey results, the PSCC have made 5 recommendations regarding the use of the SSC in Canadian children's hospitals.
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Abstract
PURPOSE OF REVIEW The goal of this review is to provide updates on the evolution of conceptual definitions as they relate to quality in healthcare, existing measurement platforms for performance benchmarking in pediatric surgery, and available tools for quality improvement that are relevant to care of the pediatric surgical patient. RECENT FINDINGS The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric has continued to evolve, now providing risk-adjusted safety outcomes data to over 70 hospitals and broadening its scope of quality measurement to include resource utilization and value-based metrics. Increasing use of checklists and other team-based communication tools show potential for making surgical care safer for children, and thoughtful application of quality improvement methods such as Lean methodology, six-sigma and others are helping to improve efficiency and increase healthcare value. Finally, efforts to define minimal resource standards for pediatric surgical care holds promise to improve outcomes for neonates and other children with complex surgical needs. SUMMARY Over the past decade, significant progress has been made in our ability to measure, benchmark and improve quality in pediatric surgery. Future efforts will need to facilitate broader participation in benchmarking programs and knowledge-sharing collaboratives, and to develop multidisciplinary, 'disease-specific' longitudinal care models where quality measurement extends before and beyond the 'traditional' 30-day perioperative period.
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Borgmann H, Helbig S, Reiter MA, Hüsch T, Schilling D, Tsaur I, Haferkamp A. Utilization of surgical safety checklists by urological surgeons in Germany: a nationwide prospective survey. Patient Saf Surg 2015; 9:37. [PMID: 26561502 PMCID: PMC4641404 DOI: 10.1186/s13037-015-0082-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives We aimed to investigate the contemporary usage rate and habits of the WHO Surgical Safety Checklist (SSC) in German urological departments. Methods We designed a 26-item questionnaire that was sent to all urological departments in Germany. The primary aim of this study was to evaluate the usage rate of the SSC. Secondary aims were to compare perioperative characteristics of users vs. non-users of the SSC and to assess circumstances of the SSC application. Results A total of 213 of 234 (91 %) urological departments were users of the SSC, and 21 (9 %) were non-users. SSC users had more often a standard protocol, took less time and had fewer people involved for checking perioperative patient data compared to non-users. Financial budgeting for the SSC existed in 55 (24 %) departments and for patient safety in 73 (32 %) departments. Conclusions The usage rate of the SSC in urological departments in Germany is high despite restricted financial budgeting. Users of the SSC profit by saving time and manpower for checking perioperative patient data. Electronic supplementary material The online version of this article (doi:10.1186/s13037-015-0082-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik Borgmann
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Sarah Helbig
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Michael A Reiter
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - David Schilling
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Hospital Frankfurt, Germany, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
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Wilson J, Topley K, Stott D, Neachell J, Gallagher R. The OneTogether collaborative approach to reduce the risk of surgical site infection: identifying the challenges to assuring best practice. J Infect Prev 2015; 16:118-125. [PMID: 28989414 PMCID: PMC5074110 DOI: 10.1177/1757177414564204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/23/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) account for 16% of healthcare associated infections, and are associated with considerable morbidity, mortality and increased costs of care. Ensuring evidence-based practice to prevent SSI is incorporated across the patient's surgical journey is complex. OneTogether is a quality improvement collaborative of infection prevention and operating department specialists, formed to support the spread and adoption of best practice to prevent SSI. This paper describes the findings of an expert workshop on infection prevention in operating departments. METHODS A total of 84 delegates from 75 hospitals attended the workshop, comprising 46 (55%) theatre nurses/operating department practitioners; 16 (19%) infection control practitioners and 22 (26%) other healthcare practitioners. Discussion focused on evidence, policy implementation and barriers to best practice. Responses were synthesised into a narrative review. RESULTS Delegates reported significant problems in translating evidence-based guidance into everyday practice, lack of local polices and poor compliance. Major barriers were lack of leadership, poorly defined responsibilities, and lack of knowledge/training. CONCLUSIONS This workshop has provided important insights into major challenges in assuring compliance with best practice in relation to the prevention of SSI. The OneTogether partnership aims to support healthcare practitioners to improve the outcomes of patients undergoing surgery by reducing the risk of SSI.
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Affiliation(s)
- Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | | | - Dawn Stott
- Association of Perioperative Practitioners, Harrogate, UK
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