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Lawday S, Mattick K, Bethune R. Does randomised evidence alter clinical practise? The react qualitative study. BMC Health Serv Res 2024; 24:862. [PMID: 39075560 PMCID: PMC11287829 DOI: 10.1186/s12913-024-11305-4] [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: 05/01/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND In 2015, the results of the 'Small bites versus large bites for closure of abdominal midline incisions (STITCH) Trial' were published in The Lancet. This demonstrated the superiority of small bite laparotomy closure over mass closure for the reduction of incisional hernias; despite this most surgeons have not changed their practice. Previous research has shown the time taken for the implementation of evidenced based practise within medicine takes an average of 17 years. This study aims to understand the reasons why surgeons have and have not changed their practice with regards to closure of midline laparotomy. METHODS Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise. RESULTS Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; 'Trusting the Evidence & Critical Appraisal', 'Surgical Attitude to Risk' and 'Adopting Evidence in Practise', that reflected barriers to the introduction of evidenced based practise to clinical work. CONCLUSION Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.
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Affiliation(s)
- Samuel Lawday
- HeSRU, Royal Devon & Exeter Hospital, Exeter, UK
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Centre for Surgical Research, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Karen Mattick
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Rob Bethune
- HeSRU, Royal Devon & Exeter Hospital, Exeter, UK.
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
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Levine DM, Syrowatka A, Salmasian H, Shahian DM, Lipsitz S, Zebrowski JP, Myers LC, Logan MS, Roy CG, Iannaccone C, Frits ML, Volk LA, Dulgarian S, Amato MG, Edrees HH, Sato L, Folcarelli P, Einbinder JS, Reynolds ME, Mort E, Bates DW. The Safety of Outpatient Health Care : Review of Electronic Health Records. Ann Intern Med 2024; 177:738-748. [PMID: 38710086 DOI: 10.7326/m23-2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. OBJECTIVE To measure AEs in the outpatient setting. DESIGN Retrospective review of the electronic health record (EHR). SETTING 11 outpatient sites in Massachusetts in 2018. PATIENTS 3103 patients who received outpatient care. MEASUREMENTS Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. RESULTS The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. LIMITATION Retrospective EHR review may miss AEs. CONCLUSION Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. PRIMARY FUNDING SOURCE Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.
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Affiliation(s)
- David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (D.M.L., A.S., H.S., S.L., H.H.E.)
| | - Ania Syrowatka
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (D.M.L., A.S., H.S., S.L., H.H.E.)
| | - Hojjat Salmasian
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (D.M.L., A.S., H.S., S.L., H.H.E.)
| | - David M Shahian
- Harvard Medical School; Lawrence Center for Quality and Safety, Massachusetts General Hospital; and Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts (D.M.S.)
| | - Stuart Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (D.M.L., A.S., H.S., S.L., H.H.E.)
| | - Jonathan P Zebrowski
- Harvard Medical School; Lawrence Center for Quality and Safety, Massachusetts General Hospital; and Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts (J.P.Z.)
| | - Laura C Myers
- Kaiser Permanente Northern California Division of Research, Oakland, California (L.C.M.)
| | - Merranda S Logan
- Harvard Medical School and Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts (M.S.L.)
| | | | - Christine Iannaccone
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts (C.I., M.L.F., S.D., M.G.A.)
| | - Michelle L Frits
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts (C.I., M.L.F., S.D., M.G.A.)
| | - Lynn A Volk
- Mass General Brigham, Somerville, Massachusetts (L.A.V.)
| | - Sevan Dulgarian
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts (C.I., M.L.F., S.D., M.G.A.)
| | - Mary G Amato
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts (C.I., M.L.F., S.D., M.G.A.)
| | - Heba H Edrees
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (D.M.L., A.S., H.S., S.L., H.H.E.)
| | - Luke Sato
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Harvard Medical School; and CRICO and the Risk Management Foundation of the Harvard Medical Institutions, Boston, Massachusetts (L.S.)
| | - Patricia Folcarelli
- CRICO and the Risk Management Foundation of the Harvard Medical Institutions, Boston, Massachusetts (P.F., J.S.E., M.E.R.)
| | - Jonathan S Einbinder
- CRICO and the Risk Management Foundation of the Harvard Medical Institutions, Boston, Massachusetts (P.F., J.S.E., M.E.R.)
| | - Mark E Reynolds
- CRICO and the Risk Management Foundation of the Harvard Medical Institutions, Boston, Massachusetts (P.F., J.S.E., M.E.R.)
| | - Elizabeth Mort
- Harvard Medical School; Lawrence Center for Quality and Safety, Massachusetts General Hospital; Division of General Internal Medicine, Massachusetts General Hospital; and Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts (E.M.)
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital; Harvard Medical School; and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (D.W.B.)
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Provvidenza CF, Bonder R, McPherson AC. Putting weight-related conversations into practice: Lessons learned from implementing a knowledge translation casebook in a disability context. Child Care Health Dev 2024; 50:e13257. [PMID: 38587273 DOI: 10.1111/cch.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Due to reported challenges experienced by healthcare providers (HCPs) when having weight-related conversations with children with disabilities and their families, a knowledge translation (KT) casebook was developed, providing key communication principles with supportive resources. Our aim was to explore how the KT casebook could be implemented into a disability context. Study objectives were to develop and integrate needs-based implementation supports to help foster the uptake of the KT casebook communication principles. METHODS A sample of nurses, physicians, occupational therapists and physical therapists were recruited from a Canadian paediatric rehabilitation hospital. Informed by the Theoretical Domains Framework, group interviews were conducted with participants to understand barriers to having weight-related conversations in their context. Implementation strategies were developed to deliver the KT casebook content that addressed these identified barriers, which included an education workshop, simulations, printed materials, and a huddle and email strategy. Participant experiences with the implementation supports were captured through workshop evaluations, pre-post surveys and qualitative interviews. Post-implementation interviews were analysed using descriptive content analysis. RESULTS Ten HCPs implemented the KT casebook principles over 6 months. Participants reported that the workshop provided a clear understanding of the KT casebook content. While HCPs appreciated the breadth of the KT casebook, they found the abbreviated printed educational materials more convenient. Strategies developed to address participants' need for a sense of community and opportunities to learn from each other did not achieve their aim. Increased confidence in integrating the KT casebook principles into practice was not demonstrated, due, in part, to having few opportunities to practice. This was partly because of the increase in competing clinical demands at the onset of the COVID-19 pandemic. CONCLUSIONS Despite positive feedback on the product itself, changes in the organisational and environmental context limited the success of the implementation plan. Monitoring and adapting implementation processes in response to unanticipated changes is critical to the success of implementation efforts.
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Affiliation(s)
- Christine F Provvidenza
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Revi Bonder
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
| | - Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Smart N. From evidence to practice - What do surgeons want? Colorectal Dis 2024; 26:595-596. [PMID: 38689407 DOI: 10.1111/codi.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
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Mensah GA, Fuster V, Roth GA. A Heart-Healthy and Stroke-Free World: Using Data to Inform Global Action. J Am Coll Cardiol 2023; 82:2343-2349. [PMID: 38092508 DOI: 10.1016/j.jacc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Gregory A Roth
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, Washington, USA; Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Riad AM, Barry A, Knight SR, Arbaugh CJ, Haque PD, Weiser TG, Harrison EM. Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS). J Glob Health 2023; 13:04114. [PMID: 37787105 PMCID: PMC10546475 DOI: 10.7189/jogh.13.04114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS). Methods We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO. Results We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I2 = 94%). Conclusions Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation. Registration PROSPERO: CRD42021279053.
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Affiliation(s)
- Aya M Riad
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Aisling Barry
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Carlie J Arbaugh
- Department of Surgery, Stanford Health Care and Stanford University, Stanford, California, USA
| | - Parvez D Haque
- Department of General Surgery, Christian Medical College and Hospital, Punjab, India
| | - Thomas G Weiser
- Department of Surgery, Stanford Health Care and Stanford University, Stanford, California, USA
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute Edinburgh, UK
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Yuan CT, Liu TM, Eidman B, Lin DM, Wick EC, Rosen MA. Critical Behaviors for Perioperative Improvement Teams. ANNALS OF SURGERY OPEN 2023; 4:e300. [PMID: 37746603 PMCID: PMC10513186 DOI: 10.1097/as9.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/31/2023] [Indexed: 09/26/2023] Open
Abstract
Effectively leading perioperative safety and quality improvement requires a multidisciplinary team approach. However, leaders are often left without clear guidance on how to assemble and manage teams in these settings. We employ a Delphi process to prioritize specific behavioral strategies surgical safety and quality leaders can use to improve their chances of success implementing improvement efforts. We present the panel's consensus practical guidance on designing, managing, sustaining, training their teams as well as managing team boundaries and the organizational context.
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Affiliation(s)
- Christina T. Yuan
- From the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tasnuva M. Liu
- From the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Benjamin Eidman
- From the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Della M. Lin
- From the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Surgery, John A. Burns School of Medicine, Honolulu, HI
| | - Elizabeth C. Wick
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Michael A. Rosen
- From the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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White MC, Ahuja S, Peven K, McLean SR, Hadi D, Okonkwo I, Clancy O, Turner M, Henry JCA, Sevdalis N. Scaling up of safety and quality improvement interventions in perioperative care: a systematic scoping review of implementation strategies and effectiveness. BMJ Glob Health 2022; 7:bmjgh-2022-010649. [PMID: 36288819 PMCID: PMC9615995 DOI: 10.1136/bmjgh-2022-010649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Globally, 5 billion people lack access to safe surgical care with more deaths due to lack of quality care rather than lack of access. While many proven quality improvement (QI) interventions exist in high-income countries, implementing them in low/middle-income countries (LMICs) faces further challenges. Currently, theory-driven, systematically articulated knowledge of the factors that support successful scale-up of QI in perioperative care in these settings is lacking. We aimed to identify all perioperative safety and QI interventions applied at scale in LMICs and evaluate their implementation mechanisms using implementation theory. METHODS Systematic scoping review of perioperative QI interventions in LMICs from 1960 to 2020. Studies were identified through Medline, EMBASE and Google Scholar. Data were extracted in two phases: (1) abstract review to identify the range of QI interventions; (2) studies describing scale-up (three or more sites), had full texts retrieved and analysed for; implementation strategies and scale-up frameworks used; and implementation outcomes reported. RESULTS We screened 45 128 articles, identifying 137 studies describing perioperative QI interventions across 47 countries. Only 31 of 137 (23%) articles reported scale-up with the most common intervention being the WHO Surgical Safety Checklist. The most common implementation strategies were training and educating stakeholders, developing stakeholder relationships, and using evaluative and iterative strategies. Reporting of implementation mechanisms was generally poor; and although the components of scale-up frameworks were reported, relevant frameworks were rarely referenced. CONCLUSION Many studies report implementation of QI interventions, but few report successful scale-up from single to multiple-site implementation. Greater use of implementation science methodology may help determine what works, where and why, thereby aiding more widespread scale-up and dissemination of perioperative QI interventions.
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Affiliation(s)
- Michelle C White
- Department of Anaesthesia, Manchester Children’s Hospital, Manchester, UK
| | - Shalini Ahuja
- Methodologies Research Division, Faculty of Nursing Midwifery and Pallative Care, London, UK,Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Kimberly Peven
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Susanna Ritchie McLean
- Department of Anesthesia, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Dina Hadi
- Department of Anesthesia, Whittington Hospital, London, UK
| | - Ijeoma Okonkwo
- Department of Anaesthesia, Alder Hey Children’s Hospital, London, UK
| | - Olivia Clancy
- Department of Anaesthesia, Manchester Children’s Hospital, Manchester, UK
| | - Maryann Turner
- Department of Anaesthesia, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Elam ME, Louis CJ, Brindle ME, Woodson J, Greece JA. Using i-PARIHS to assess implementation of the Surgical Safety Checklist: an international qualitative study. BMC Health Serv Res 2022; 22:1284. [PMID: 36284293 PMCID: PMC9597976 DOI: 10.1186/s12913-022-08680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/16/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Strategies selected to implement the WHO's Surgical Safety Checklist (SSC) are key factors in its ability to improve patient safety. Underutilization of implementation frameworks for informing implementation processes hinders our understanding of the checklists' varying effectiveness in different contexts. This study explored the extent to which SSC implementation practices could be assessed through the i-PARIHS framework and examined how it could support development of targeted recommendations to improve SSC implementation in high-income settings. METHODS This qualitative study utilized interviews with surgical team members and health administrators from five high-income countries to understand the key elements necessary for successful implementation of the SSC. Using thematic analysis, we identified within and across-case themes that were mapped to the i-PARIHS framework constructs. Gaps in current implementation strategies were identified, and the utility of i-PARIHS to guide future efforts was assessed. RESULTS Fifty-one multi-disciplinary clinicians and health administrators completed interviews. We identified themes that impacted SSC implementation in each of the four i-PARIHS constructs and several that spanned multiple constructs. Within innovation, a disconnect between the clinical outcomes-focused evidence in the literature and interviewees' patient-safety focus on observable results reduced the SSC's perceived relevance. Within recipients, existing surgical team hierarchies impacted checklist engagement, but this could be addressed through a shared leadership model. Within context, organizational priorities resulting in time pressures on surgical teams were at odds with SSC patient safety goals and reduced fidelity. At a health system level, employing surgical team members through the state or health region resulted in significant challenges in enforcing checklist use in private vs public hospitals. Within its facilitation construct, i-PARIHS includes limited definitions of facilitation processes. We identified using multiple interdisciplinary champions; establishing checklist performance feedback mechanisms; and modifying checklist processes, such as implementing a full-team huddle, as facilitators of successful SSC implementation. CONCLUSION The i-PARIHS framework enabled a comprehensive assessment of current implementation strategies, identifying key gaps and allowed for recommending targeted improvements. i-PARIHS could serve as a guide for planning future SSC implementation efforts, however, further clarification of facilitation processes would improve the framework's utility. TRIAL REGISTRATION No health care intervention was performed.
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Affiliation(s)
- Meagan E Elam
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
- Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA, 02215, USA.
| | - Christopher J Louis
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Mary E Brindle
- Ariadne Labs, 401 Park Dr 3rd Floor, Boston, MA, 02215, USA
- University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Jonathan Woodson
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
- Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - Jacey A Greece
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
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Ring D. CORR Insights®: Do Proposed Quality Measures for Carpal Tunnel Release Reveal Important Quality Gaps and Are They Reliable? Clin Orthop Relat Res 2022; 480:1751-1753. [PMID: 35384914 PMCID: PMC9384935 DOI: 10.1097/corr.0000000000002205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 01/31/2023]
Affiliation(s)
- David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Reply: Supercharge End-to-Side Anterior Interosseous-to-Ulnar Motor Nerve Transfer Restores Intrinsic Function in Cubital Tunnel Syndrome. Plast Reconstr Surg 2022; 149:1042e-1043e. [PMID: 35312663 DOI: 10.1097/prs.0000000000009019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crain N, Qiu CY, Moy S, Thomas S, Nguyen VT, Lee-Brown M, Laplace D, Naughton J, Morkos J, Desai V. Implementation science for the adductor canal block: A new and adaptable methodology process. World J Orthop 2021; 12:899-908. [PMID: 34888150 PMCID: PMC8613678 DOI: 10.5312/wjo.v12.i11.899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/18/2021] [Accepted: 09/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Following the successful Perioperative Surgical Home (PSH) practice for total knee arthroplasty (TKA) at our institution, the need for continuous improvement was realized, including the deimplementation of antiquated PSH elements and introduction of new practices.
AIM To investigate the transition from femoral nerve blocks (FNB) to adductor canal nerve blocks (ACB) during TKA.
METHODS Our 13-month study from June 2016 to 2017 was divided into four periods: a three-month baseline (103 patients), a one-month pilot (47 patients), a three-month implementation and hardwiring period (100 patients), and a six-month evaluation period (185 patients). In total, 435 subjects were reviewed. Data within 30 postoperative days were extracted from electronic medical records, such as physical therapy results and administration of oral morphine equivalents (OME).
RESULTS Our institution reduced FNB application (64% to 3%) and increased ACB utilization (36% to 97%) at 10 mo. Patients in the ACB group were found to have increased ambulation on the day of surgery (4.1 vs 2.0 m) and lower incidence of falls (0 vs 1%) and buckling (5% vs 27%) compared with FNB patients (P < 0.05). While ACB patients (13.9) reported lower OME than FNB patients (15.9), the difference (P = 0.087) did not fall below our designated statistical threshold of P value < 0.05.
CONCLUSION By demonstrating closure of the “knowledge to action gap” within 6 mo, our institution’s findings demonstrate evidence in the value of implementation science. Physician education, technical support, and performance monitoring were deemed key facilitators of our program’s success. Expanded patient populations and additional orthopedic procedures are recommended for future study.
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Affiliation(s)
- Nikhil Crain
- Bowman Gray Center for Medical Education, Wake Forest School of Medicine, Winston-Salem, NC 27103, United States
| | - Chun-Yuan Qiu
- Perioperative Service and Anesthesiology, Kaiser Permanente Medical Center, Baldwin Park, CA 91706, United States
| | - Stephen Moy
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - Shawn Thomas
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - Vu Thuy Nguyen
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - Mijin Lee-Brown
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - Diana Laplace
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - Jennifer Naughton
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
| | - John Morkos
- Johns Hopkins University, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, United States
| | - Vimal Desai
- Department of Anesthesiology, Baldwin Park Medical Center, Southern California Kaiser Permanente Medical Group, Baldwin Park, CA 91706, United States
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Kaud Y, Lydon S, O'Connor P. Measuring and monitoring patient safety in hospitals in Saudi Arabia. BMC Health Serv Res 2021; 21:1224. [PMID: 34772409 PMCID: PMC8588732 DOI: 10.1186/s12913-021-07228-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background There is much variability in the measurement and monitoring of patient safety across healthcare organizations. With no recognized standardized approach, this study examines how the key components outlined in Vincent et al’s Measuring and Monitoring Safety (MMS) framework can be utilized to critically appraise a healthcare safety surveillance system. The aim of this study is to use the MMS framework to evaluate the Saudi Arabian healthcare safety surveillance system for hospital care. Methods This qualitative study consisted of two distinct phases. The first phase used document analysis to review national-level guidance relevant to measuring and monitoring safety in Saudi Arabia. The second phase consisted of semi-structured interviews with key stakeholders between May and August 2020 via a video conference call and focused on exploring their knowledge of how patient safety is measured and monitored in hospitals. The MMS framework was used to support data analysis. Results Three documents were included for analysis and 21 semi-structured interviews were conducted with key stakeholders working in the Saudi Arabian healthcare system. A total of 39 unique methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods: 10 (25 %) were concerned with past harm; 14 (35 %) were concerned with the reliability of safety critical processes, 3 (7.5 %) were concerned with sensitivity to operations, 2 (5 %) were concerned with anticipation and preparedness, and 11 (27.5 %) were concerned with integration and learning. Conclusions The document analysis and interviews show an extensive system of MMS is in place in Saudi Arabian hospitals. The assessment of MMS offers a useful framework to help healthcare organizations and researchers to think critically about MMS, and how the data from different methods of MMS can be integrated in individual countries or health systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07228-z.
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Affiliation(s)
- Yazeed Kaud
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland. .,Department of Public Health, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, 1 Distillery Road, Newcastle, Co Galway, H91 TK33, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, County Galway, H91 TK33, Galway, Ireland
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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15
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Powers B, Smith CD, Arroyo N, Francis DO, Fernandes-Taylor S. How Do Academic Otolaryngologists Decide to Implement New Procedures Into Practice? Otolaryngol Head Neck Surg 2021; 167:253-261. [PMID: 34546818 DOI: 10.1177/01945998211047434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify barriers and facilitators to adoption of a new surgical procedure via an implementation science framework to characterize associated socioemotional, clinical, and decision-making processes. STUDY DESIGN Qualitative study with a semistructured interview approach. SETTING Large tertiary care referral center. METHODS Academic otolaryngologists with at least 2 years of practice were identified and interviewed. Transcripts were thematically coded and separated into steps in the clinical pathway. Synthesis of major themes characterized facilitators and barriers to uptake of a new surgical technique. RESULTS Of 22 otolaryngologists, 19 were interviewed (85% male). They had a median 18 years of practice (interquartile range, 7.8-26.3), and 65% were subspecialty trained. In the decision to implement a new procedure, improving patient outcomes and addressing unmet clinical needs facilitated adoption, whereas costs and adopting profit-driven technologies without improved outcomes were barriers. In patient consults, establishing trust facilitated implementation of new techniques; barriers included participants' hesitation to communicate about the unknowns of a new procedure. Intraoperatively, little change to existing workflow or improved efficiency facilitated adoption, while a substantial learning curve for the new procedure was a barrier. Achieving favorable outcomes and patient satisfaction sustained implementation of new procedures. Too few referrals or indications for the new procedure hindered implementation. CONCLUSION Our study demonstrates that innovation in otolaryngology is often an individual iterative process that providers pursue to improve patients' outcomes. Although models for the oversight of surgical innovation emphasize the need for evidence, obtaining sufficient numbers of providers and patients to generate evidence remains a challenge in specialty surgical practice.
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Affiliation(s)
- Bethany Powers
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Cara Damico Smith
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - David O Francis
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Heiden BT, Tetteh E, Robbins KJ, Tabak RG, Nava RG, Marklin GF, Kreisel D, Meyers BF, Kozower BD, McKay VR, Puri V. Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study. Ann Thorac Surg 2021; 114:373-382. [PMID: 34499861 PMCID: PMC9112075 DOI: 10.1016/j.athoracsur.2021.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Dissemination and implementation (D&I) science is the practice of taking evidence-based interventions (EBI) and sustainably incorporating them in routine clinical practice. As a relatively young field, D&I techniques are underutilized in cardiothoracic surgery. This review offers an overview of D&I science from the context of the cardiothoracic surgeon. First, we provide a general introduction to D&I science and basic terminology that is used in the field. Second, to illustrate D&I techniques in a real-world example, we discuss a case study for implementing lung protective management (LPM) strategies for lung donor optimization nationally. Finally, we discuss challenges to successful implementation that are unique to cardiothoracic surgery and give several examples of EBIs that have been poorly implemented into surgical practice. We also provide examples of successful D&I interventions - including de-implementation strategies - from other surgical subspecialties. We hope that this review offers additional tools for cardiothoracic surgeons to explore when introducing EBIs into routine practice.
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Affiliation(s)
- Brendan T Heiden
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Emmanuel Tetteh
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Keenan J Robbins
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Rachel G Tabak
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO; Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Ruben G Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Gary F Marklin
- Institute for Implementation Science, Washington University in St. Louis, St. Louis, MO
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Virginia R McKay
- Brown School of Public Health, Washington University in St. Louis, St. Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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Implementation Strategies and the Uptake of the World Health Organization Surgical Safety Checklist in Low and Middle Income Countries: A Systematic Review and Meta-analysis. Ann Surg 2021; 273:e196-e205. [PMID: 33064387 DOI: 10.1097/sla.0000000000003944] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To identify the implementation strategies used in World Health Organization Surgical Safety Checklist (SSC) uptake in low- and middle-income countries (LMICs); examine any association of implementation strategies with implementation effectiveness; and to assess the clinical impact. BACKGROUND The SSC is associated with improved surgical outcomes but effective implementation strategies are poorly understood. METHODS We searched the Cochrane library, MEDLINE, EMBASE and PsycINFO from June 2008 to February 2019 and included primary studies on SSC use in LMICs. Coprimary objectives were identification of implementation strategies used and evaluation of associations between strategies and implementation effectiveness. To assess the clinical impact of the SSC, we estimated overall pooled relative risks for mortality and morbidity. The study was registered on PROSPERO (CRD42018100034). RESULTS We screened 1562 citations and included 47 papers. Median number of discrete implementation strategies used per study was 4 (IQR: 1-14, range 0-28). No strategies were identified in 12 studies. SSC implementation occurred with high penetration (81%, SD 20%) and fidelity (85%, SD 13%), but we did not detect an association between implementation strategies and implementation outcomes. SSC use was associated with a reduction in mortality (RR 0.77; 95% CI 0.67-0.89), all complications (RR 0.56; 95% CI 0.45-0.71) and infectious complications (RR 0.44; 95% CI 0.37-0.52). CONCLUSIONS The SSC is used with high fidelity and penetration is associated with improved clinical outcomes in LMICs. Implementation appears well supported by a small number of tailored strategies. Further application of implementation science methodology is required among the global surgical community.
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18
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Sam-Agudu NA. Applying an Implementation Science Framework to Surgical Research and Practice in Tanzania. J Am Coll Surg 2021; 233:191-192. [PMID: 34304815 DOI: 10.1016/j.jamcollsurg.2021.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/30/2022]
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Dissemination and Implementation Science in Plastic and Reconstructive Surgery: Perfecting, Protecting, and Promoting the Innovation That Defines Our Specialty. Plast Reconstr Surg 2021; 147:303e-313e. [PMID: 33009331 DOI: 10.1097/prs.0000000000007492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
SUMMARY Plastic and reconstructive surgery has an illustrious history of innovation. The advancement, if not the survival, of the specialty depends on the continual development and improvement of procedures, practices, and technologies. It follows that the safe adoption of innovation into clinical practice is also paramount. Traditionally, adoption has relied on the diffusion of new knowledge, which is a consistent but slow and passive process. The emerging field of dissemination and implementation science promises to expedite the spread and adoption of evidence-based interventions into clinical practice. The field is increasingly recognized as an important function of academia and is a growing priority for major health-related funding institutions. The authors discuss the contemporary challenges of the safe implementation and dissemination of new innovations in plastic and reconstructive surgery, and call on their colleagues to engage in this growing field of dissemination and implementation science.
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20
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AlleaBelle Gongola M, Reif RJ, Cosgrove PC, Sexton KW, Marino KA, Steliga MA, Muesse JL. Preoperative nutritional counselling in patients undergoing oesophagectomy. J Perioper Pract 2021; 32:183-189. [PMID: 34197238 DOI: 10.1177/17504589211006026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients undergoing surgery for oesophageal cancer are at high risk of malnutrition due to pathology and neoadjuvent therapy. This study sought to determine if oesophageal cancer patients undergoing oesophagectomy achieve superior clinical outcomes when preoperative nutritional counselling is performed. METHODS Oesophageal cancer patients undergoing oesophagectomy were retrospectively divided into cohorts based on those who received (n = 48) and did not receive (n = 58) preoperative nutritional counselling. We compared weight loss, length of stay, 30-day readmission related to nutrition or feeding tube problems, and 90-day mortality. RESULTS Per cent weight loss was less in patients who received preoperative nutritional counselling. There was a trend toward decreased mean length of stay and there were fewer readmissions for feeding tube-related complications in patients who received counselling. CONCLUSIONS Nutritional counselling before surgery may lead to decreased weight loss and reduced readmissions for feeding tube-related complications in patients with oesophageal cancer undergoing oesophagectomy.
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Affiliation(s)
- M AlleaBelle Gongola
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rebecca J Reif
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peggy C Cosgrove
- Department of Surgery, Division of Thoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kevin W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Katy A Marino
- Department of Surgery, Division of Thoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Matthew A Steliga
- Department of Surgery, Division of Thoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jason L Muesse
- Department of Surgery, Division of Thoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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21
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Howard R, Delaney L, Kilbourne AM, Kidwell KM, Smith S, Englesbe M, Dimick J, Telem D. Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia. JAMA Netw Open 2021; 4:e216836. [PMID: 33978723 PMCID: PMC8116983 DOI: 10.1001/jamanetworkopen.2021.6836] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before ventral and incisional hernia repair improves outcomes, as many as 25% of these patients have a high-risk characteristic at the time of surgery. Implementation strategies may effectively increase use of evidence-based practice. OBJECTIVE To describe current trends in preoperative optimization among patients undergoing ventral hernia repair, identify barriers to optimization, develop interventions to address these barriers, and then pilot these interventions. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used a retrospective medical record review to identify hospital-level trends in preoperative optimization among patients undergoing ventral and incisional hernia repair. Semistructured interviews with 21 practicing surgeons were conducted to elicit barriers to optimizing high-risk patients before surgery. Next, a task force of experts was convened to develop pragmatic interventions to increase surgeon use of preoperative optimization. Finally, these interventions were piloted at 2 sites to assess acceptability and feasibility. This study was performed from January 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES The main outcome was rate of referrals for preoperative patient optimization at the 2 pilot sites. RESULTS Among 23 000 patients undergoing ventral hernia repair, the mean (SD) age was 53.9 (14.3) years, and 12 315 (53.5%) were men. Of these, 8786 patients (38.2%) had at least 1 high-risk characteristic at the time of surgery, including 7683 with 1, 1079 with 2, and 24 with 3. At the hospital level, the mean proportion of patients with at least 1 of 3 high-risk characteristics at the time of surgery was 38.2% (95% CI, 38.1%-38.3%). This proportion varied widely from 21.5% (95% CI, 17.6%-25.5%) to 52.8% (95% CI, 43.9%-61.8%) across hospitals. Interviews with surgeons identified 3 major barriers to improving this practice: lost financial opportunity by not offering a patient an operation, lack of surgeon awareness of available resources for optimization, and organizational barriers. A task force therefore developed 3 interventions: a financial incentive to optimize high-risk patients, an educational intervention to make surgeons aware of available optimization resources, and on-site facilitation. These strategies were piloted at 2 sites where preoperative risk optimization referrals increased 860%. CONCLUSIONS AND RELEVANCE This study demonstrates a stepwise process of identifying a practice gap, eliciting barriers that contribute to this gap, using expert consensus and local resources to develop strategies to address these barriers, and piloting these strategies. This implementation strategy can be adopted to diverse settings given that it relies on developing and implementing strategies based on local practice patterns.
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Affiliation(s)
- Ryan Howard
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Lia Delaney
- University of Michigan Medical School, Ann Arbor
| | - Amy M. Kilbourne
- University of Michigan Medical School, Ann Arbor
- Health Services Research and Development, Office of Research and Development, US Department of Veterans Affairs, Washington, DC
| | | | - Shawna Smith
- Health Services Research and Development, Office of Research and Development, US Department of Veterans Affairs, Washington, DC
| | - Michael Englesbe
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Justin Dimick
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Dana Telem
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
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Howard R, Delaney L, Kilbourne AM, Kidwell KM, Smith S, Englesbe M, Dimick J, Telem D. Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia. JAMA Netw Open 2021. [PMID: 33978723 DOI: 10.1001/jamanetworkopen.2021.683610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
IMPORTANCE Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before ventral and incisional hernia repair improves outcomes, as many as 25% of these patients have a high-risk characteristic at the time of surgery. Implementation strategies may effectively increase use of evidence-based practice. OBJECTIVE To describe current trends in preoperative optimization among patients undergoing ventral hernia repair, identify barriers to optimization, develop interventions to address these barriers, and then pilot these interventions. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used a retrospective medical record review to identify hospital-level trends in preoperative optimization among patients undergoing ventral and incisional hernia repair. Semistructured interviews with 21 practicing surgeons were conducted to elicit barriers to optimizing high-risk patients before surgery. Next, a task force of experts was convened to develop pragmatic interventions to increase surgeon use of preoperative optimization. Finally, these interventions were piloted at 2 sites to assess acceptability and feasibility. This study was performed from January 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES The main outcome was rate of referrals for preoperative patient optimization at the 2 pilot sites. RESULTS Among 23 000 patients undergoing ventral hernia repair, the mean (SD) age was 53.9 (14.3) years, and 12 315 (53.5%) were men. Of these, 8786 patients (38.2%) had at least 1 high-risk characteristic at the time of surgery, including 7683 with 1, 1079 with 2, and 24 with 3. At the hospital level, the mean proportion of patients with at least 1 of 3 high-risk characteristics at the time of surgery was 38.2% (95% CI, 38.1%-38.3%). This proportion varied widely from 21.5% (95% CI, 17.6%-25.5%) to 52.8% (95% CI, 43.9%-61.8%) across hospitals. Interviews with surgeons identified 3 major barriers to improving this practice: lost financial opportunity by not offering a patient an operation, lack of surgeon awareness of available resources for optimization, and organizational barriers. A task force therefore developed 3 interventions: a financial incentive to optimize high-risk patients, an educational intervention to make surgeons aware of available optimization resources, and on-site facilitation. These strategies were piloted at 2 sites where preoperative risk optimization referrals increased 860%. CONCLUSIONS AND RELEVANCE This study demonstrates a stepwise process of identifying a practice gap, eliciting barriers that contribute to this gap, using expert consensus and local resources to develop strategies to address these barriers, and piloting these strategies. This implementation strategy can be adopted to diverse settings given that it relies on developing and implementing strategies based on local practice patterns.
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Affiliation(s)
- Ryan Howard
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Lia Delaney
- University of Michigan Medical School, Ann Arbor
| | - Amy M Kilbourne
- University of Michigan Medical School, Ann Arbor
- Health Services Research and Development, Office of Research and Development, US Department of Veterans Affairs, Washington, DC
| | | | - Shawna Smith
- Health Services Research and Development, Office of Research and Development, US Department of Veterans Affairs, Washington, DC
| | - Michael Englesbe
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Justin Dimick
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
| | - Dana Telem
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, Ann Arbor
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Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to Safe Surgery 2020 Implementation in Tanzania's Lake Zone. J Am Coll Surg 2021; 233:177-191.e5. [PMID: 33957259 DOI: 10.1016/j.jamcollsurg.2021.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality. METHODS We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania's Lake Zone. We used documentation analysis with confirmatory key informant interviews (n = 6) to describe the exploration and preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n = 101) post initiation to characterize the implementation phase. Data were analyzed using the constant comparison method. RESULTS In the exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the preparation phase, onsite visits identified priorities and barriers to implementation to adapt the intervention components and curriculum. In the active implementation phase, 4 themes related to the inner organizational context-vision for safe surgery, existing surgical practices, leadership support, and resilience-and 3 themes related to the intervention-innovation-value fit, holistic approach, and buy-in-facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their need to deliver safe surgery evolved during the implementation period. CONCLUSIONS Examining implementation through the exploration, preparation, implementation, and sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability.
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Boelig RC, Wanees M, Zhan T, Berghella V, Roman A. Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study. Am J Perinatol 2021; 38:544-552. [PMID: 33099285 PMCID: PMC8491097 DOI: 10.1055/s-0040-1718580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the utilization of aspirin for preeclampsia prevention before and after implementation of a screening tool during nuchal translucency (NT) ultrasound. STUDY DESIGN One-year prospective cohort study of patients at high risk for preeclampsia after the implementation of a screening tool (postscreen) administered to all patients at check in for NT (11-13 weeks) ultrasound. Prospective cohort was compared with one-year retrospective cohort (prescreen) the year prior (2017). All patients who presented for NT ultrasound in both cohorts were evaluated for the presence of one or more risk factor for preeclampsia with screening tool collected prospectively and chart review retrospectively. Provider recommendation for aspirin determined by documentation in prenatal record. Primary outcome was rate of provider recommendation for aspirin pre versus post screening tool, compared by Chi-square test and adjusted for potential confounders with multiple regression analysis. RESULTS Pre- (n = 156) and postscreen (n = 136) cohorts were similar except for race and multifetal gestation. Prescreen, rate of provider recommendation for aspirin was 74%. Of those with prior preeclampsia, 96% were recommended aspirin, compared with 64% of patients with other risk factors (p < 0.001). Postscreen, provider recommendation of aspirin improved to 95% (p < 0.001). Rate of preeclampsia/gestational hypertension were similar between cohorts; however, there was a reduced adjusted risk in overall preterm birth <37 weeks (adjusted odds ratio [aOR] = 0.50 [0.25-0.99]) and preterm birth <34 weeks (aOR = 0.33 [0.13-0.88]) postscreening tool implementation. CONCLUSION Prior to implementation of a simple screening questionnaire, approximately 25% of high risk patients did not receive the recommendation of aspirin for preeclampsia prevention. High-risk patients who lack a history of preeclampsia were less likely to be advised of aspirin prophylaxis. Use of a simple universal screening tool at time of NT ultrasound significantly improved utilization of aspirin for preeclampsia prevention and may improve patient outcomes. KEY POINTS · Despite recommendations, aspirin use for preeclampsia prevention is suboptimal.. · High-risk patients who lack a history preeclampsia were less likely to be advised of aspirin use.. · A simple universal screening tool can significantly improve aspirin utilization..
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Affiliation(s)
- Rupsa C Boelig
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mariam Wanees
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Amanda Roman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Delaney LD, Kattapuram M, Haidar JA, Chen AS, Quiroga G, Telem DA, Howard R. The Impact of Surgeon Adherence to Preoperative Optimization of Hernia Repairs. J Surg Res 2021; 264:8-15. [PMID: 33744776 DOI: 10.1016/j.jss.2021.01.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/18/2021] [Accepted: 01/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND At the patient level, optimizing risk factors before surgery is a proven approach to improve patient outcomes after hernia repair. However, nearly 25% of patients are not adequately optimized before surgery. It is currently unknown how surgeon-level adherence to preoperative optimization impacts postoperative outcomes. In this context, we evaluated the association between surgeon adherence to optimization practices and surgeon-level postoperative outcomes. MATERIALS AND METHODS Michigan Surgical Quality Collaborative data from 2014 to 2018 was analyzed to examine rates of surgeon adherence to preoperative optimization when performing elective ventral and incisional hernia repair. Adherence was defined as operating on patients who were nontobacco users with a body mass index >18.5 kg/m2 and <40 kg/m2. Surgeons were assigned a risk- and reliability-adjusted adherence rate which was used to divide surgeons into tertiles. Outcomes were compared between adherence tertiles. RESULTS Across 70 hospitals in Michigan, 15,016 patients underwent ventral and incisional hernia repair, cared for by 454 surgeons. Surgeon adherence to preoperative optimization ranged from 51% to 76%. Surgeons in the lowest optimization tertile had higher rates of emergency department visits (8.78% versus 7.05% versus 7.03%, P < 0.001), serious complications (2.12% versus 1.56% versus 1.84%, P = 0.041), and any complication (4.08% versus 3.37% versus 4.04%, P = 0.043), than middle and high optimization tertiles. CONCLUSIONS Surgeons' clinical outcomes, including complication rates, are affected by the proportion of their patients who are preoperatively optimized with regard to obesity and tobacco use. These results suggest that surgeons can improve their postoperative outcomes by addressing these issues before surgery.
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Affiliation(s)
- Lia D Delaney
- University of Michigan Medical School, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | | | | | - Alyssa S Chen
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Grecia Quiroga
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Dana A Telem
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ryan Howard
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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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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Lin SJ, Tsan CY, Su MY, Wu CL, Chen LC, Hsieh HJ, Hsiao WL, Cheng JC, Kuo YW, Jerng JS, Wu HD, Sun JS. Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness. BMJ Open Qual 2021; 9:bmjoq-2019-000698. [PMID: 32317274 PMCID: PMC7202726 DOI: 10.1136/bmjoq-2019-000698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/24/2023] Open
Abstract
Aim Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. Design and implementation We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including ‘VITAL’ (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, ‘STOP’ (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and ‘STOP’ (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. Results The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). Conclusion The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.
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Affiliation(s)
- Shwu-Jen Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Yuan Tsan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Mao-Yuan Su
- Department of Radiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chao-Ling Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chin Chen
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Jung Hsieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Chen Cheng
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Dong Wu
- Division of Respiratory Therapy, Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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System Factors Affecting Intraoperative Risk and Resilience: Applying a Novel Integrated Approach to Study Surgical Performance and Patient Safety. Ann Surg 2020; 272:1164-1170. [PMID: 30946083 DOI: 10.1097/sla.0000000000003280] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify and categorize system factors in complex laparoscopic surgery that have the potential to either threaten patient safety or support system resilience. BACKGROUND The operating room is a uniquely complex sociotechnical work system wherein surgical successes prevail despite pervasive safety threats. Holistically characterizing intraoperative factors that thus support system resilience in addition to those that threaten patient safety using contextual methodologies is critical for optimizing surgical safety overall. METHOD In this prospective descriptive interdisciplinary study, 19 audio/video recordings of complex laparoscopic general surgical procedures were directly observed and transcribed. Using a qualitative systems-based approach, intraoperative human factors with the potential to impact patient safety, either as a safety threat or as a support for resilience, were identified. Adverse events were further assessed for shared threats and supports. Data collection was guided by the Systems Engineering Initiative for Patient Safety 2.0 work system model. RESULTS A total of 1083 relevant observations were made over 39.8 hours of operative time, enabling the identification of 79 distinct safety threats and 67 resilience supports within the surgical system. Safety threats associated with the physical environment, tasks, organization, and equipment were prevalent and observed in equal measure, whereas supports for resilience were predominantly attributed to clinician behaviors, including proactive team management and skills coaching. Two subclinical adverse events were identified; shared safety threats included suboptimal technology design, whereas shared resilience supports included calm clinician behavior and redundant intraoperative resourcing. CONCLUSIONS Safety threats and resilience supports were found to be systematic in the surgical setting. Identified safety threats should be prioritized for remediation, and clinician behaviors that contribute to fostering resilience should be valued and protected.
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Balayah Z, Khadjesari Z, Keohane A, To W, Green JSA, Sevdalis N. National implementation of a pragmatic quality improvement skills curriculum for urology residents in the UK: Application and results of 'theory-of-change' methodology. Am J Surg 2020; 221:401-409. [PMID: 33323275 DOI: 10.1016/j.amjsurg.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is global momentum to establish scalable Quality Improvement (QI) skills training curricula. We report development of an implementation plan for national scale-up of the 'Education in Quality Improvement' program (EQUIP) in UK urology residencies. MATERIALS & METHODS Theory-of-Change (ToC) methodology was used, which engaged EQUIP stakeholders in developing a single-page implementation 'Logic Model' in 4 study phases (2 stakeholder workshops (N = 20); 10 stakeholder interviews). The framework method was used for analysis. RESULTS Core elements of the EQUIP Logic Model include: (i) QI curriculum integration into national surgical curricula; (ii) resident-led, modular, team-based QI projects; (iii) development of a national web-platform as QI projects library; (iv) a train-the-trainers module to develop attendings as QI mentors; and (v) knowledge transfer activities (e.g., peer-reviewed publications of residents' QI projects). CONCLUSIONS ToC methodology was useful in developing a stakeholder-driven, actionable implementation plan for the national scale-up of EQUIP in the UK.
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Affiliation(s)
- Zuhur Balayah
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK.
| | | | - Aoife Keohane
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
| | - Wilson To
- Bart's Health, Whipps Cross Hospital, Urological Department, London, UK
| | - James S A Green
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK; Bart's Health, Whipps Cross Hospital, Urological Department, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, UK
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30
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An Implementation Assessment of the Virtual Acute Care for Elders Program From the Perspective of Key Stakeholders. Ann Surg 2020; 275:e752-e758. [PMID: 33201090 PMCID: PMC9272911 DOI: 10.1097/sla.0000000000004433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to obtain feedback from key stakeholders and end users to identify program strengths and weaknesses to plan for wider dissemination and implementation of the Virtual Acute Care for Elders (Virtual ACE) program, a novel intervention that improves outcomes for older surgical patients. BACKGROUND Virtual ACE was developed to deliver evidence-based geriatric care without requiring daily presence of a geriatrician. Previous work demonstrated that Virtual ACE increased mobility and decreased delirium rates for surgical patients. METHODS We conducted semi-structured interviews with 30 key stakeholders (physicians, nurses, hospital leadership, nurse managers, information technology staff, and physical/occupational therapists) involved in the implementation and use of the program. RESULTS Our stakeholders indicated that Virtual ACE was extremely empowering for bedside nurses. The program helped nurses identify older patients who were at risk for a difficult postoperative recovery. Virtual ACE also gave them skills to manage complex older patients and more effectively communicate their needs to surgeons and other providers. Nurse managers felt that Virtual ACE helped them allocate limited resources and plan their unit staffing assignments to better manage the needs of older patients. The main criticism was that the Virtual ACE Tracker that displayed patient status was difficult to interpret and could be improved by a better design interface. Stakeholders also felt that program training needed to be improved to accommodate staff turnover. CONCLUSIONS Although respondents identified areas for improvement, our stakeholders felt that Virtual ACE empowered them and provided effective tools to improve outcomes for older surgical patients.
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Raval MV, Wymore E, Ingram MCE, Tian Y, Johnson JK, Holl JL. Assessing effectiveness and implementation of a perioperative enhanced recovery protocol for children undergoing surgery: study protocol for a prospective, stepped-wedge, cluster, randomized, controlled clinical trial. Trials 2020; 21:926. [PMID: 33198767 PMCID: PMC7667817 DOI: 10.1186/s13063-020-04851-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perioperative enhanced recovery protocols (ERPs) have been found to decrease hospital length of stay, in-hospital costs, and complications among adult surgical populations but evidence for pediatric populations is lacking. The study is designed to evaluate the adoption, effectiveness, and generalizability of a 21-element ERP, adapted for pediatric surgery. METHODS The multicenter study is a stepped-wedge, cluster-randomized, pragmatic clinical trial that will evaluate the effectiveness of the ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) intervention while also assessing site-specific adaptations, implementation fidelity, and sustainability. The target patient population is pediatric patients, between 10 and 18 years old, who undergo elective gastrointestinal surgery. Eighteen (N = 18) participating sites will be randomly assigned to one of three clusters with each cluster, in turn, being randomly assigned to an intervention start period (stepped-wedge). Each cluster will participate in a Learning Collaborative, using the National Implementation Research Network's five Active Implementation Frameworks (AIFs) (competency, organization, and leadership), as drivers of facilitation of rapid-cycle adaptations and implementation. The primary study outcome is hospital length of stay, with implementation metrics being used to evaluate adoption, fidelity, and sustainability. Additional clinical outcomes include opioid use, post-surgical complications, and post-discharge healthcare utilization (clinic/emergency room visits, telephone calls to clinic, and re-hospitalizations), as well as, assess patient- and parent-reported health-related quality of life outcomes. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. DISCUSSION The study provides a unique opportunity to accelerate the adoption of ERPs across 18 US pediatric surgical centers and to evaluate, for the first time, the effect of a pediatric-specific ENRICH-US intervention on clinical and implementation outcomes. The study design and methods can serve as a model for future pediatric surgical quality improvement implementation efforts. TRIAL REGISTRATION ClinicalTrials.gov NCT04060303 . Registered on 07 August 2019.
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Affiliation(s)
- Mehul V Raval
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA. .,Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
| | - Erin Wymore
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA
| | - Martha-Conley E Ingram
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.,Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA
| | - Julie K Johnson
- Surgical Outcomes Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA
| | - Jane L Holl
- Biological Science Division, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
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Koike D, Nomura Y, Nagai M, Matsunaga T, Yasuda A. Bundle interventions including nontechnical skills for surgeons can reduce operative time and improve patient safety. Int J Qual Health Care 2020; 32:522-530. [PMID: 32648898 PMCID: PMC7654384 DOI: 10.1093/intqhc/mzaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aimed to determine if introducing nontechnical skills to surgical trainees during surgical education can reduce the operation time and contribute to patient safety. DESIGN Quality improvement initiatives using the KAIZEN as a problem-solving method. SETTING Department of surgery in a referral and educational hospital. PARTICIPANTS Surgical team and quality management team. INTERVENTION The KAIZEN was used as a problem-solving method between 2015 and 2018 to reduce the operation time. First, baseline measurement was performed to understand the current situations in our department. To achieve continuous improvement, periodical feedback of the current status was obtained from all staff. Bundles, including nontechnical skills, were established. Briefing and debriefing were performed by the surgical team. MAIN OUTCOME MEASURES Excessively long operation rates with a standard procedure. RESULTS We included 1573 operations in this initiative. Excessively long operation rates were reduced in all types of surgeries, from 27.1% to 15.2% for herniorrhaphy (P = 0.005), 58.3-40.0% for gastrectomy (P = 0.03), 50.0-4.1% for total gastrectomy (P = 0.12), 65.6-45.0% for colectomy (P = 0.004), 67.8-43.2% for high anterior resection (P = 0.02) and 69.6-47.9% for low anterior resection (P = 0.03). The adherence to briefing and debriefing were improved, and majority of the surgeons favored the bundle elements. CONCLUSIONS The KAIZEN initiative was effective in clinical healthcare settings. In the event of scaling-up this initiative, the educational program for physicians should include project management strategies and leadership skills.
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Affiliation(s)
- Daisuke Koike
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
- Total Quality Management Center, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
- Department of Quality and Safety in Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
- ASUISHI Project, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yukihiro Nomura
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Motoki Nagai
- Department of Surgery, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Takashi Matsunaga
- Total Quality Management Center, Asahi General Hospital, 1326, I, Asahi, Chiba 289-2511, Japan
| | - Ayuko Yasuda
- Department of Quality and Safety in Healthcare, Fujita Health University, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
- ASUISHI Project, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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Curtis MS, Forman NA, Donovan AL, Whitlock EL. Postoperative delirium: why, what, and how to confront it at your institution. Curr Opin Anaesthesiol 2020; 33:668-673. [PMID: 32796170 PMCID: PMC7489931 DOI: 10.1097/aco.0000000000000907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW The current article reviews the importance of postoperative delirium (POD), focusing on the older surgical population, and summarizes the best-practice guidelines about POD prevention and treatment which have been published within the last several years. We also describe our local experience with implementing a perioperative delirium risk stratification and prevention pathway, and review implementation science principles which others may find useful as they move toward risk stratification and prevention in their own institutions. RECENT FINDINGS There are few areas of consensus, backed by strong experimental data, in POD best-practice guidelines. Most guidelines recommend preoperative cognitive screening, nonpharmacologic delirium prevention measures, and avoidance of deliriogenic medications. The field of implementation science offers strategies for closing the evidence-practice gap, which we supplement with lessons learned from our own experience implementing a perioperative delirium risk stratification and prevention pathway. SUMMARY POD continues to be a serious perioperative complication commonly experienced by older adults. Growing appreciation of its prognostic implications and evidence behind multidisciplinary, collaborative, and focused prevention strategies rooted in implementation science have prompted several major groups to issue consensus guidelines. Adopting best practices POD risk stratification and prevention pathways will improve perioperative care for older adults.
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Affiliation(s)
- Michael S. Curtis
- Department of Anesthesia & Perioperative Care, University of California, San Francisco; 500 Parnassus Ave, San Francisco, CA 94143
| | - Nell A. Forman
- Department of Anesthesia & Perioperative Care, University of California, San Francisco; 500 Parnassus Ave, San Francisco, CA 94143
| | - Anne L. Donovan
- Department of Anesthesia & Perioperative Care, University of California, San Francisco; 500 Parnassus Ave, San Francisco, CA 94143
| | - Elizabeth L. Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco; 500 Parnassus Ave, San Francisco, CA 94143
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Nguyen MXB, Chu AV, Powell BJ, Tran HV, Nguyen LH, Dao ATM, Pham MD, Vo SH, Bui NH, Dowdy DW, Latkin CA, Lancaster KE, Pence BW, Sripaipan T, Hoffman I, Miller WC, Go VF. Comparing a standard and tailored approach to scaling up an evidence-based intervention for antiretroviral therapy for people who inject drugs in Vietnam: study protocol for a cluster randomized hybrid type III trial. Implement Sci 2020; 15:64. [PMID: 32771017 PMCID: PMC7414564 DOI: 10.1186/s13012-020-01020-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Background People who inject drugs (PWID) bear a disproportionate burden of HIV infection and experience poor outcomes. A randomized trial demonstrated the efficacy of an integrated System Navigation and Psychosocial Counseling (SNaP) intervention in improving HIV outcomes, including antiretroviral therapy (ART) and medications for opioid use disorder (MOUD) uptake, viral suppression, and mortality. There is limited evidence about how to effectively scale such intervention. This protocol presents a hybrid type III effectiveness-implementation trial comparing two approaches for scaling-up SNaP. We will evaluate the effectiveness of SNaP implementation approaches as well as cost and the characteristics of HIV testing sites achieving successful or unsuccessful implementation of SNaP in Vietnam. Methods Design: In this cluster randomized controlled trial, two approaches to scaling-up SNaP for PWID in Vietnam will be compared. HIV testing sites (n = 42) were randomized 1:1 to the standard approach or the tailored approach. Intervention mapping was used to develop implementation strategies for both arms. The standard arm will receive a uniform package of these strategies, while implementation strategies for the tailored arm will be designed to address site-specific needs. Participants: HIV-positive PWID participants (n = 6200) will be recruited for medical record assessment at baseline; of those, 1500 will be enrolled for detailed assessments at baseline, 12, and 24 months. Site directors and staff at each of the 42 HIV testing sites will complete surveys at baseline, 12, and 24 months. Outcomes: Implementation outcomes (fidelity, penetration, acceptability) and effectiveness outcomes (ART, MOUD uptake, viral suppression) will be compared between the arms. To measure incremental costs, we will conduct an empirical costing study of each arm and the actual process of implementation from a societal perspective. Qualitative and quantitative site-level data will be used to explore key characteristics of HIV testing sites that successfully or unsuccessfully implement the intervention for each arm. Discussion Scaling up evidence-based interventions poses substantial challenges. The proposed trial contributes to the field of implementation science by applying a systematic approach to designing and tailoring implementation strategies, conducting a rigorous comparison of two promising implementation approaches, and assessing their incremental costs. Our study will provide critical guidance to Ministries of Health worldwide regarding the most effective, cost-efficient approach to SNaP implementation. Trial registration NCT03952520 on Clinialtrials.gov. Registered 16 May 2019.
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Affiliation(s)
- Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA. .,Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam.
| | - Anh V Chu
- University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ha V Tran
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.,University of North Carolina Project Vietnam, Lot E2 Duong Dinh Nghe St., Cau Giay, Hanoi, Vietnam
| | - Long H Nguyen
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - An T M Dao
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - Manh D Pham
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Son H Vo
- Vietnam Authority of HIV/AIDS Control, Land 8 That Thuyet St., Ba Dinh, Hanoi, Vietnam
| | - Ngoc H Bui
- Department of Epidemiology, Institute of Preventive Medicine and Public Health, 1 Ton That Tung St., Dong Da, Hanoi, Vietnam
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Kathryn E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Teerada Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA
| | - Irving Hoffman
- Division of Infectious Diseases, UNC School of Medicine, 321 S Columbia St, Chapel Hill, NC, 27516, USA
| | - William C Miller
- Department of Epidemiology, College of Public Health, Ohio State University, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
| | - Vivian F Go
- Department of Health Behavior, Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
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White MC, Daya L, Karel FKB, White G, Abid S, Fitzgerald A, Mballa GAE, Sevdalis N, Leather AJM. Using the Knowledge to Action Framework to Describe a Nationwide Implementation of the WHO Surgical Safety Checklist in Cameroon. Anesth Analg 2020; 130:1425-1434. [PMID: 31856007 PMCID: PMC7147425 DOI: 10.1213/ane.0000000000004586] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical safety has advanced rapidly with evidence of improved patient outcomes through structural and process interventions. However, knowledge of how to apply these interventions successfully and sustainably at scale is often lacking. The 2019 Global Ministerial Patient Safety Summit called for a focus on implementation strategies to maintain momentum in patient safety improvements, especially in low- and middle-income settings. This study uses an implementation framework, knowledge to action, to examine a model of nationwide World Health Organization (WHO) Surgical Safety Checklist implementation in Cameroon. Cameroon is a lower-middle-income country, and based on data from high- and low-income countries, we hypothesized that more than 50% of participants would be using the checklist (penetration) in the correct manner (fidelity) 4 months postintervention. METHODS A collaboration of 3 stakeholders (Ministry of Health, academic institution, and nongovernmental organization) used a prospective observational design. Based on knowledge to action, there were 3 phases to the study implementation: problem identification (lack of routine checklist use in Cameroonian hospitals), multifaceted implementation strategy (3-day multidisciplinary training course, coaching, facilitated leadership engagement, and support networks), and outcome evaluation 4 months postintervention. Validated implementation outcomes were assessed. Primary outcomes were checklist use (penetration) and fidelity; secondary outcomes were perioperative teams' reactions, learning and behavior change; and tertiary outcomes were perioperative teams' acceptability of the checklist. RESULTS Three hundred and fifty-one operating room staff members from 25 hospitals received training. Median time to evaluation was 4.5 months (interquartile range [IQR]: 4.5-5.5, range 3-7); checklist use (penetration) increased from 20% (95% confidence interval [CI], 16-25) to 56% (95% CI, 49-63); fidelity for adherence to 6 basic safety processes was high: verification of patient identification was 91% (95% CI, 87-95); risk assessment for difficult intubation was 79% (95% CI, 73-85): risk assessment for blood loss was 88% (95% CI, 83-93) use of pulse oximetry was 93% (95% CI, 90-97); antibiotic administration was 95% (95% CI, 91-98); surgical counting was 89% (95% CI, 84-93); and fidelity for nontechnical skills measured by the WHO Behaviorally Anchored Rating Scale was 4.5 of 7 (95% CI, 3.5-5.4). Median scores for all secondary outcomes were 10/10, and 7 acceptability measures were consistently more than 70%. CONCLUSIONS This study shows that a multifaceted implementation strategy is associated with successful checklist implementation in a lower-middle-income country such as Cameroon, and suggests that a theoretical framework can be used to practically drive nationwide scale-up of checklist use.
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Affiliation(s)
- Michelle C White
- From the Centre for Global Health and Health Partnerships, King's College London, London, United Kingdom.,Department of Anaesthesia, Great Ormond Street Hospital, London, United Kingdom.,Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | - Leonid Daya
- Department of Anaesthesia and Intensive Care, Faculty of Medicine and Biomedical Sciences of Yaounde, Yaounde, Cameroon
| | | | - Graham White
- Department of Anaesthesia, Royal Alexandra Hospital, Paisley, United Kingdom.,Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin
| | - Sonia Abid
- Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin.,Imperial School of Anaesthesia, London, United Kingdom
| | - Aoife Fitzgerald
- Department of Medical Capacity Building, Mercy Ships Africa Bureau, Cotonou, Benin.,Department of Intensive Care, Oxford University Hospitals, Oxford, United Kingdom
| | - G Alain Etoundi Mballa
- Ministry of Public Health, Cameroon.,Faculty of Medicine and Biomedical Sciences of Yaounde, Yaounde, Cameroon
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, United Kingdom
| | - Andrew J M Leather
- From the Centre for Global Health and Health Partnerships, King's College London, London, United Kingdom
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Wæhle HV, Haugen AS, Wiig S, Søfteland E, Sevdalis N, Harthug S. How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties. BMC Health Serv Res 2020; 20:111. [PMID: 32050960 PMCID: PMC7017532 DOI: 10.1186/s12913-020-4965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies. METHODS An ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. RESULTS We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSC's practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. CONCLUSION When the SSC is not integrated within existing risk management strategies, but perceived as an "add on", its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London, London, UK
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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P Ho V, A Dicker R, Haut ER. Dissemination, implementation, and de-implementation: the trauma perspective. Trauma Surg Acute Care Open 2020; 5:e000423. [PMID: 32154382 PMCID: PMC7046940 DOI: 10.1136/tsaco-2019-000423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Vanessa P Ho
- Departments of Surgery and Population and Quantitative Health Sciences, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Rochelle A Dicker
- Department of Surgery, David Geffen School of Medicine, Los Angeles, California, USA
| | - Elliott R Haut
- Departments of Surgery, Anesthesiology and Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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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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Causal Analysis of World Health Organization's Surgical Safety Checklist Implementation Quality and Impact on Care Processes and Patient Outcomes: Secondary Analysis From a Large Stepped Wedge Cluster Randomized Controlled Trial in Norway. Ann Surg 2019; 269:283-290. [PMID: 29112512 PMCID: PMC6326038 DOI: 10.1097/sla.0000000000002584] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text Objective: We hypothesize that high-quality implementation of the World Health Organization's Surgical Safety Checklist (SSC) will lead to improved care processes and subsequently reduction of peri- and postoperative complications. Background: Implementation of the SSC was associated with robust reduction in morbidity and length of in-hospital stay in a stepped wedge cluster randomized controlled trial conducted in 2 Norwegian hospitals. Further investigation of precisely how the SSC improves care processes and subsequently patient outcomes is needed to understand the causal mechanisms of improvement. Methods: Care process metrics are reported from one of our earlier trial hospitals. Primary outcomes were in-hospital complications and care process metrics, e.g., patient warming and antibiotics. Secondary outcome was quality of SSC implementation. Analyses include Pearson's exact χ2 test and binary logistic regression. Results: A total of 3702 procedures (1398 control vs. 2304 intervention procedures) were analyzed. High-quality SSC implementation (all 3 checklist parts) improved processes and outcomes of care. Use of forced air warming blankets increased from 35.3% to 42.4% (P < 0.001). Antibiotic administration postincision decreased from 12.5% to 9.8%, antibiotic administration preincision increased from 54.5% to 63.1%, and nonadministration of antibiotics decreased from 33.0% to 27.1%. Surgical infections decreased from 7.4% (104/1398) to 3.6% (P < 0.001). Adjusted SSC effect on surgical infections resulted in an odds ratio (OR) of 0.52 (95% confidence interval (CI): 0.38–0.72) for intervention procedures, 0.54 (95% CI: 0.37–0.79) for antibiotics provided before incision, and 0.24 (95% CI: 0.11–0.52) when using forced air warming blankets. Blood transfusion costs were reduced by 40% with the use of the SSC. Conclusions: When implemented well, the SSC improved operating room care processes; subsequently, high-quality SSC implementation and improved care processes led to better patient outcomes.
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Sharplin G, Adelson P, Kennedy K, Williams N, Hewlett R, Wood J, Bonner R, Dabars E, Eckert M. Establishing and Sustaining a Culture of Evidence-Based Practice: An Evaluation of Barriers and Facilitators to Implementing the Best Practice Spotlight Organization Program in the Australian Healthcare Context. Healthcare (Basel) 2019; 7:healthcare7040142. [PMID: 31726668 PMCID: PMC6956050 DOI: 10.3390/healthcare7040142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Nurses and midwives are central to the implementation and delivery of quality care through evidence-based practice (EBP). However, implementation of EBP in nursing and midwifery is under-researched with few examples of systematic and sustained change. The Registered Nurses Association of Ontario’s Best-Practice Spotlight Organization (BPSO) Program was adopted in South Australia as a framework to systematically implement EBP in two diverse and complex healthcare settings. Methods: The study was a post-implementation, mixed-method evaluation conducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative data. Proctor’s implementation evaluation framework guided the evaluation design. Information sources included; interviews, focus groups, questionnaires, and document review. Results: Clinical and executive staff (n = 109 participants) from a broad range of stakeholder groups participated in the interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting program implementation were identified; these pertained to embedding continuity into the program’s implementation and delivery, a robust governance structure, and executive sponsorship. Barriers to implementation were also identified. These barriers pertained to organizational or workforce challenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend training, and a lack of organizational commitment to the program, especially at an executive level. As a result of successful implementation, it was observed that over three years, the BPSO program positively influenced the uptake and implementation of EBP by clinicians and the organizations into which they were introduced. Conclusions: The BPSO model can be translocated to new healthcare systems and has the potential to act as a mechanism for establishing and sustaining EBP change. This study was the first to apply an implementation evaluation framework to the BPSO program, which allowed for structured analysis of facilitating or impeding factors that affected implementation success. The findings have important implications for other health systems looking to translocate the same or similar EBP programs, as well as contributing to the growing body of implementation evaluation literature.
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Affiliation(s)
- Greg Sharplin
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
- Correspondence: ; Tel.: +61-8-8302-2846
| | - Pam Adelson
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Kate Kennedy
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
| | - Nicola Williams
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Roslyn Hewlett
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Jackie Wood
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Rob Bonner
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Elizabeth Dabars
- Australian Nursing and Midwifery Federation (SA Branch), Ridleyton SA 5008, Australia; (N.W.); (R.H.); (J.W.); (R.B.); (E.D.)
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Division of Health Sciences, University of South Australia, Adelaide 5000, Australia; (P.A.); (K.K.); (M.E.)
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Weiss A, Lopez NE, Ward EP, Lee KC, Caudle AS, Dickson-Witmer D, Chang C, Kelly K, Martin LW, Jacobs LK, Hunt KK, Yao K, Blair SL. Challenges in Clinical Trial Implementation: Results from a Survey of the National Accreditation Program of Breast Centers (NAPBC). Ann Surg Oncol 2019; 26:4364-4371. [PMID: 31625045 DOI: 10.1245/s10434-019-07807-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the results of clinical trials often guide best practices, changing clinical practice based on clinical trial results can be challenging. The objective of this study was to examine provider-reported barriers to adopting best clinical practices according to clinical trial data. METHODS A cross-sectional survey was conducted of providers from the National Accreditation Program for Breast Centers about barriers that prevent the incorporation of trial findings. Descriptive analyses and multivariable analyses were performed to determine provider characteristics that were significantly associated with reported barriers. RESULTS Overall, 383 institutions participated (63.5% response rate), with a total of 1226 physicians responding to the survey (80% response rate). Providers identified national guidelines and meetings as the most compelling way to receive practice-changing information. They reported the following internal barriers to trial implementation: patient preference (45%), strongly held beliefs by partners/colleagues (37%), and insufficient time to discuss new practices (30%). External barriers preventing trial implementation included a lack of agreement from multidisciplinary tumor boards (32%), fear of reimbursement loss (23%), and resistance from clinical staff (20%). Reported barriers differed by provider specialty, with plastic surgeons and radiation oncologists reporting that strongly held beliefs by partners/colleagues and disagreement from multidisciplinary tumor boards were the most significant factors preventing clinical trial implementation. CONCLUSIONS Physician beliefs and patient preferences are the most frequently reported barriers to clinical trial implementation. Tactics to better educate providers about how to explain new clinical trial data to their patients and colleagues are needed.
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Affiliation(s)
- Anna Weiss
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, MA, USA. .,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
| | - Nicole E Lopez
- Department of Surgery, University of California - San Diego, San Diego, CA, USA
| | - Erin P Ward
- Department of Surgery, University of California - San Diego, San Diego, CA, USA
| | - Katherine C Lee
- Department of Surgery, University of California - San Diego, San Diego, CA, USA
| | - Abigail S Caudle
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana Dickson-Witmer
- Department of Surgery, Helen F. Graham Cancer Center and Research Institute, Newark, DE, USA
| | - Cecilia Chang
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Kaitlyn Kelly
- Department of Surgery, University of California - San Diego, San Diego, CA, USA
| | | | - Lisa Kay Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly K Hunt
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine Yao
- Department of Surgery, NorthShore University Health System, Evanston, IL, USA
| | - Sarah L Blair
- Department of Surgery, University of California - San Diego, San Diego, CA, USA
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Billig JI, Speth KA, Nasser JS, Wang L, Chung KC. Assessment of Surgeon Variation in Adherence to Evidence-Based Recommendations for Treatment of Trigger Finger. JAMA Netw Open 2019; 2:e1912960. [PMID: 31603484 PMCID: PMC6804023 DOI: 10.1001/jamanetworkopen.2019.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Stenosing tenosynovitis (trigger finger) affects approximately 2% of the population. Given the prevalence of trigger finger and rising health care costs, adherence to the cost-effective and evidence-based treatment algorithm will permit better outcomes and allocation of resources. OBJECTIVES To examine treatment patterns for trigger finger and to determine surgeon-level and patient-level factors that influence adherence to evidence-based treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study examined deidentified claims for treatment of trigger finger from a national insurance provider using the Clinformatics Data Mart database. Patients were included if they were 18 years or older and treated from January 1, 2002, through December 31, 2016 (excluding a washout period from July 1, 2008, until June 30, 2010), with a new diagnosis of single-digit trigger finger. Data were analyzed from December 21, 2018, through April 28, 2019. EXPOSURES Cost-effective and evidence-based research published in July 2009 for the treatment of trigger finger. MAIN OUTCOMES AND MEASURES After excluding the 1-year washout period on either side of July 1, 2009, adherence to the recommended treatment algorithm of 2 corticosteroid injections before surgical release of trigger finger was compared with practice before publication of research supporting this cost-effective and evidence-based approach. RESULTS In this analysis of 83 667 patients with trigger finger, 52 698 (63.0%) were women, and 20 045 (24.0%) had type 1 or 2 diabetes. Mean (SD) age was 61 (13) years. From 2002 to 2016, an overall increasing trend in adherence to the cost-effective and evidence-based approach to treatment was noted, with no significant increase in adherence in the postpublication era (67.5% vs 73.3%; P = .27). Substantial variation in adherence was observed at the surgeon level (intraclass correlation, 33%). Plastic surgeons had no change in adherence over time compared with orthopedic surgeons (odds ratio [OR], 1.00; 95% CI, 0.98-1.02; P = .90), whereas general surgeons had increased adherence (OR, 1.04; 95% CI, 1.02-1.06; P < .001). Higher-volume surgeons were also more adherent to these evidence-based recommendations (OR, 1.59; 95% CI, 1.53-1.65; P < .001). CONCLUSIONS AND RELEVANCE This study found substantial surgeon-level variation in adherence to evidence-based treatment of trigger finger. Surgeon specialty and volume were associated with differences in adherence. Efforts to understand surgeon barriers to implementation, regardless of physician specialty, appear to be necessary, and better implementation strategies may permit increased uptake of evidence-based treatment of trigger finger.
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Affiliation(s)
- Jessica I. Billig
- Veterans Affairs (VA)/National Clinician Scholars Program, VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor
| | - Kelly A. Speth
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Jacob S. Nasser
- Comprehensive Hand Center, Section of Plastic Surgery, Michigan Medicine, Ann Arbor
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Kevin C. Chung
- Comprehensive Hand Center, Section of Plastic Surgery, Michigan Medicine, Ann Arbor
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Yu X, Han W, Jiang J, Wang Y, Xin S, Wu S, Sun H, Wang Z, Zhao Y. Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program. J Med Internet Res 2019; 21:e13576. [PMID: 31237241 PMCID: PMC6613327 DOI: 10.2196/13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 01/04/2023] Open
Abstract
Surgery is still far from being completely safe and reliable. Surgical safety has, therefore, been the focus of considerable attention over the last few decades, and there are a growing number of national drives to improve it. There are also a number of large surgical complication reporting systems and system-based interventions, both of which have made remarkable progress in the past two decades. These systems, however, have either mainly focused on reporting complications and played a limited role in guiding practice or have provided nonselective interventions to all patients, perhaps imposing unnecessary burdens on frontline medical staff. We have, therefore, developed an evidence-based stratified surgical safety information system based on a multicenter surgical safety improvement program. This study discusses some critical issues in the process of developing this information system, including (1) decisions about data gathering, (2) establishing and sharing knowledge, (3) developing functions for the system, (4) system implementation, and (5) evaluation and continuous improvement. Using examples drawn from the surgical safety improvement program, we have shown how this type of system can be fitted into day-to-day clinical practice and how it can guide medical practice by incorporating inherent patient-related risk and providing tailored interventions for patients with different levels of risk. We concluded that multidisciplinary collaboration, involving experts in health care (including senior staff in surgery, nursing, and anesthesia), data science, health care management, and health information technology, can help build an evidence-based stratified surgical patient safety improvement system. This can provide an information-intensified surgical safety learning platform and, therefore, benefit surgical patients by delivering tailored interventions and an integrated workflow.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Yipeng Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- The First Hospital of China Medical University, Shenyang, China
| | - Shizheng Wu
- Qinghai Provincial People's Hospital, Xining, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Science, Beijing, China
| | - Yupei Zhao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Fernandez ME, ten Hoor GA, van Lieshout S, Rodriguez SA, Beidas RS, Parcel G, Ruiter RAC, Markham CM, Kok G. Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies. Front Public Health 2019; 7:158. [PMID: 31275915 PMCID: PMC6592155 DOI: 10.3389/fpubh.2019.00158] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 05/29/2019] [Indexed: 11/22/2022] Open
Abstract
Background: The ultimate impact of a health innovation depends not only on its effectiveness but also on its reach in the population and the extent to which it is implemented with high levels of completeness and fidelity. Implementation science has emerged as the potential solution to the failure to translate evidence from research into effective practice and policy evident in many fields. Implementation scientists have developed many frameworks, theories and models, which describe implementation determinants, processes, or outcomes; yet, there is little guidance about how these can inform the development or selection of implementation strategies (methods or techniques used to improve adoption, implementation, sustainment, and scale-up of interventions) (1, 2). To move the implementation science field forward and to provide a practical tool to apply the knowledge in this field, we describe a systematic process for planning or selecting implementation strategies: Implementation Mapping. Methods: Implementation Mapping is based on Intervention Mapping (a six-step protocol that guides the design of multi-level health promotion interventions and implementation strategies) and expands on Intervention Mapping step 5. It includes insights from both the implementation science field and Intervention Mapping. Implementation Mapping involves five tasks: (1) conduct an implementation needs assessment and identify program adopters and implementers; (2) state adoption and implementation outcomes and performance objectives, identify determinants, and create matrices of change objectives; (3) choose theoretical methods (mechanisms of change) and select or design implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. The tasks are iterative with the planner circling back to previous steps throughout this process to ensure all adopters and implementers, outcomes, determinants, and objectives are addressed. Discussion: Implementation Mapping provides a systematic process for developing strategies to improve the adoption, implementation, and maintenance of evidence-based interventions in real-world settings.
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Affiliation(s)
- Maria E. Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Gill A. ten Hoor
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Sanne van Lieshout
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Serena A. Rodriguez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States
| | - Guy Parcel
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Christine M. Markham
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Gerjo Kok
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
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Yu X, Jiang J, Shang H, Wu S, Sun H, Li H, Xin S, Zhao S, Huang Y, Wu X, Zhang X, Wang Y, Xue F, Han W, Wang Z, Hu Y, Wang L, Zhao Y. Effect of a risk-stratified intervention strategy on surgical complications: experience from a multicentre prospective study in China. BMJ Open 2019; 9:e025401. [PMID: 31182441 PMCID: PMC6561454 DOI: 10.1136/bmjopen-2018-025401] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To develop a risk-stratified intervention strategy and evaluate its effect on reducing surgical complications. DESIGN A multicentre prospective study with preintervention and postintervention stages: period I (January to June 2015) to develop the intervention strategy and period II (January to June 2016) to evaluate its effectiveness. SETTING Four academic/teaching hospitals representing major Chinese administrative and economic regions. PARTICIPANTS All surgical (elective and emergent) inpatients aged ≥14 years with a minimum hospital stay of 24 hours, who underwent a surgical procedure requiring an anesthesiologist. INTERVENTIONS Targeted complications were grouped into three categories (common, specific, serious) according to their incidence pattern, severity and preventability. The corresponding expert consensus-generated interventions, which focused on both regulating medical practices and managing inherent patient-related risks, were implemented in a patient-tailored way via an electronic checklist system. PRIMARY AND SECONDARY OUTCOMES Primary outcomes were (1) in-hospital death/confirmed death within 30 days after discharge and (2) complications during hospitalisation. Secondary outcome was length of stay (LOS). RESULTS We included 51 030 patients in this analysis (eligibility rate 87.7%): 23 413 during period I, 27 617 during period II. Patients' characteristics were comparable during the two periods. After adjustment, the mean number of overall complications per 100 patients decreased from 8.84 to 7.56 (relative change 14.5%; P<0.0001). Specifically, complication rates decreased from 3.96 to 3.65 (7.8%) for common complications (P=0.0677), from 0.50 to 0.36 (28.0%) for specific complications (P=0.0153) and from 3.64 to 2.88 (20.9%) for serious complications (P<0.0001). From period I to period II, there was a decreasing trend for mortality (from 0.64 to 0.53; P=0.1031) and median LOS (by 1 day; P=0.8293), without statistical significance. CONCLUSIONS Implementing a risk-stratified intervention strategy may be a target-sensitive, convenient means to improve surgical outcomes.
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Affiliation(s)
- Xiaochu Yu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingmei Jiang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Shang
- The First Hospital of China Medical University, Shenyang, China
| | - Shizheng Wu
- Qinghai Provincial People’s Hospital, Xining, China
| | - Hong Sun
- Xiangya Hospital, Central South University, Changsha, China
| | - Hanzhong Li
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- The First Hospital of China Medical University, Shenyang, China
| | | | - Yuguang Huang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinjuan Wu
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Zhang
- The First Hospital of China Medical University, Shenyang, China
| | - Yaolei Wang
- Xiangya Hospital, Central South University, Changsha, China
| | - Fang Xue
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Zixing Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoda Hu
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Lei Wang
- Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Yupei Zhao
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Mahmood T, Mylopoulos M, Bagli D, Damignani R, Aminmohamed Haji F. A mixed methods study of challenges in the implementation and use of the surgical safety checklist. Surgery 2019; 165:832-837. [DOI: 10.1016/j.surg.2018.09.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 09/19/2018] [Accepted: 09/21/2018] [Indexed: 12/01/2022]
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Clarke MJ, Steffens FL, Mallory GW, Starr SR, Porter BL, Krauss WE, Dankbar EC. Incorporating Quality Improvement into Resident Education: Structured Curriculum, Evaluation, and Quality Improvement Projects. World Neurosurg 2019; 126:e1112-e1120. [PMID: 30880201 DOI: 10.1016/j.wneu.2019.02.214] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Quality Improvement (QI) is essential for improving health care delivery and is now a required component of neurosurgery residency. However, neither a formal curriculum nor implementation strategies have been established by the Accreditation Council for Graduate Medical Education. METHODS We describe our experience with implementing a formal QI curriculum, including structured didactics and resident led group-based QI projects. Course materials and didactics were provided by the Mayo Quality Academy. Participants were required to take a 30-question multiple-choice exam to demonstrate basic proficiency in QI methods following completion of didactic. An anonymous survey also was performed to elicit feedback from course participants. RESULTS All of the 40 student participants (17 residents) were able to demonstrate basic proficiency in QI methods on a standardized exam upon course completion. Of the 9 attempted QI projects, 7 were completed, with 5 of those resulting in sustained process changes. The majority of participants felt formal training improved confidence in QI processes and was a valuable professional tool for their careers. CONCLUSIONS A formal didactic curriculum and practical application of QI methodologies adds value to resident training. Further, it has the potential to positively impact practice. Consideration should be given to adopting a formal QI curriculum by other neurosurgery departments and perhaps standardization on national level.
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Affiliation(s)
- Michelle J Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Fay L Steffens
- Mayo Quality Academy, Mayo Clinic, Rochester, Minnesota, USA
| | - Grant W Mallory
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephanie R Starr
- Mayo Quality Academy, Mayo Clinic, Rochester, Minnesota, USA; Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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48
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Wright N, Abantanga F, Amoah M, Appeadu-Mensah W, Bokhary Z, Bvulani B, Davies J, Miti S, Nandi B, Nimako B, Poenaru D, Tabiri S, Yifieyeh A, Ade-Ajayi N, Sevdalis N, Leather A. Developing and implementing an interventional bundle to reduce mortality from gastroschisis in low-resource settings. Wellcome Open Res 2019; 4:46. [PMID: 30984879 PMCID: PMC6456836 DOI: 10.12688/wellcomeopenres.15113.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Gastroschisis is associated with less than 4% mortality in high-income countries and over 90% mortality in many tertiary paediatric surgery centres across sub-Saharan Africa (SSA). The aim of this trial is to develop, implement and prospectively evaluate an interventional bundle to reduce mortality from gastroschisis in seven tertiary paediatric surgery centres across SSA. Methods: A hybrid type-2 effectiveness-implementation, pre-post study design will be utilised. Using current literature an evidence-based, low-technology interventional bundle has been developed. A systematic review, qualitative study and Delphi process will provide further evidence to optimise the interventional bundle and implementation strategy. The interventional bundle has core components, which will remain consistent across all sites, and adaptable components, which will be determined through in-country co-development meetings. Pre- and post-intervention data will be collected on clinical, service delivery and implementation outcomes for 2-years at each site. The primary clinical outcome will be all-cause, in-hospital mortality. Secondary outcomes include the occurrence of a major complication, length of hospital stay and time to full enteral feeds. Service delivery outcomes include time to hospital and primary intervention, and adherence to the pre-hospital and in-hospital protocols. Implementation outcomes are acceptability, adoption, appropriateness, feasibility, fidelity, coverage, cost and sustainability. Pre- and post-intervention clinical outcomes will be compared using Chi-squared analysis, unpaired t-test and/or Mann-Whitney U test. Time-series analysis will be undertaken using Statistical Process Control to identify significant trends and shifts in outcome overtime. Multivariate logistic regression analysis will be used to identify clinical and implementation factors affecting outcome with adjustment for confounders. Outcome: This will be the first multi-centre interventional study to our knowledge aimed at reducing mortality from gastroschisis in low-resource settings. If successful, detailed evaluation of both the clinical and implementation components of the study will allow sustainability in the study sites and further scale-up. Registration: ClinicalTrials.gov Identifier NCT03724214.
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Affiliation(s)
- Naomi Wright
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
| | - Francis Abantanga
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Michael Amoah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | | | - Zaitun Bokhary
- Department of Paediatric Surgery, Muhimbili National Hospital, Dar es Salaam, P.O Box 65000, Tanzania
| | - Bruce Bvulani
- Department of Paediatric Surgery, University Teaching Hospital of Lusaka, Lusaka, 10101, Zambia
| | - Justine Davies
- Global Health and Education Department, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sam Miti
- Department of Paediatrics, Arthur Davison Children's Hospital, Ndola, Zambia
| | - Bip Nandi
- Department of Paediatric Surgery, Kamuzu Central Hospital, Lilongwe, P.O. Box 149, Malawi
| | - Boateng Nimako
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Dan Poenaru
- McGill University, Montreal, Quebec, H3A 0G4, Canada
| | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, P.O. Box TL 16, Ghana
| | - Abiboye Yifieyeh
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, P.O.Box 1934, Ghana
| | - Niyi Ade-Ajayi
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, SE5 8AF, UK
| | - Andy Leather
- King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, King's College London, London, SE5 9RJ, UK
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Storesund A, Haugen AS, Wæhle HV, Mahesparan R, Boermeester MA, Nortvedt MW, Søfteland E. Validation of a Norwegian version of SURgical PAtient Safety System (SURPASS) in combination with the World Health Organizations' Surgical Safety Checklist (WHO SSC). BMJ Open Qual 2019; 8:e000488. [PMID: 30687799 PMCID: PMC6327875 DOI: 10.1136/bmjoq-2018-000488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/31/2018] [Accepted: 11/26/2018] [Indexed: 01/29/2023] Open
Abstract
Introduction Surgical safety checklists may contribute to reduction of complications and mortality. The WHO’s Surgical Safety Checklist (WHO SSC) could prevent incidents in operating theatres, but errors also occur before and after surgery. The SURgical PAtient Safety System (SURPASS) is designed to intercept errors with use of checklists throughout the surgical pathway. Objective We aimed to validate a Norwegian version of the SURPASS’ preoperative and postoperative checklists for use in combination with the already established Sign In, Time Out and Sign Out parts of the WHO SSC. Methods and materials The validation of the SURPASS checklists content followed WHOs recommended guidelines. The process consisted of six steps: forward translation; testing the content; focus groups; expert panels; back translation; and approval of the final version. Qualitative content analysis was used to identify codes and categories for adaption of the SURPASS checklist items throughout Norwegian surgical care. Content validity index (CVI) was used by expert panels to score the relevance of each checklist item. The study was carried out in a neurosurgical ward in a large tertiary teaching hospital in Norway. Results Testing the preoperative and postoperative SURPASS checklists was performed in 29 neurosurgical procedures. This involved all professional groups in the entire surgical patient care pathway. Eight clinical focus groups revealed two main categories: ‘Adapt the wording to fit clinical practice’ and ‘The checklist items challenge existing workflow’. Interprofessional scoring of the content validity of the checklists reached >80% for all the SURPASS checklists. Conclusions The first version of the SURPASS checklists combined with the WHO SSC was validated for use in Norwegian surgical care with face validity confirmed and CVI >0.80%. Trial registration number NCT01872195.
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Affiliation(s)
- Anette Storesund
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Monica Wammen Nortvedt
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.,Accident and Emergency Department, City of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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50
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Lane-Fall MB, Cobb BT, Cené CW, Beidas RS. Implementation Science in Perioperative Care. Anesthesiol Clin 2018; 36:1-15. [PMID: 29425593 DOI: 10.1016/j.anclin.2017.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation.
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Affiliation(s)
- Meghan B Lane-Fall
- Penn Center for Perioperative Outcomes Research and Transformation, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, 333 Blockley Hall, Philadelphia, PA 19104, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center, 3641 Locust Walk Philadelphia, PA 19104-6218; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 680 Dulles (Anesthesia), Philadelphia, PA 19104, USA.
| | - Benjamin T Cobb
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, 680 Dulles (Anesthesia), Philadelphia, PA 19104, USA; National Clinician Scholar Program, University of Pennsylvania, 423 Guardian Drive, 1310 Blockley Hall, Philadelphia, PA 19104, USA
| | - Crystal Wiley Cené
- Division of General Internal Medicine, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive #1050, Chapel Hill, NC 27514, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 3015, Philadelphia, PA 19104, USA
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