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Abstract
Congenital heart disease is a major public health concern in the United States. Outcomes of surgery for children with congenital heart disease have dramatically improved over the last several decades with current aggregate operative mortality rates approximating 3%, inclusive of all ages and defects. However, there remains significant variability among institutions, especially for higher-risk and more complex patients. As health care moves toward the quadruple aim of improving patient experience, improving the health of populations, lowering costs, and increasing satisfaction among providers, congenital heart surgery programs must evolve to meet the growing scrutiny, demands, and expectations of numerous stakeholders. Improved outcomes and reduced interinstitutional variability are achieved through prioritization of quality assurance and improvement.
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Affiliation(s)
- Timothy W Pettitt
- Department of Pediatric Cardiovascular Surgery, Children's Hospital of New Orleans, New Orleans, LA.,Department of Surgery, Louisiana State University Health Science Center, New Orleans, LA
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3
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Fitzgerald M, Reilly S, Smit DV, Kim Y, Mathew J, Boo E, Alqahtani A, Chowdhury S, Darez A, Mascarenhas JB, O'Keeffe F, Noonan M, Nickson C, Marquez M, Li WA, Zhang YL, Williams K, Mitra B. The World Health Organization trauma checklist versus Trauma Team Time-out: A perspective. Emerg Med Australas 2019; 31:882-885. [PMID: 31081585 PMCID: PMC6851662 DOI: 10.1111/1742-6723.13306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
Time‐out protocols have reportedly improved team dynamics and patients’ safety in various clinical settings – particularly in the operating room. In 2016, the World Health Organization (WHO) introduced a Trauma Care checklist, which outlines steps to follow immediately after the primary and secondary surveys and prior to the team leaving the patient. The WHO Trauma Care checklist's main perceived benefit is the prompting of clinicians to complete trauma admissions as per evidence‐based guidelines. The WHO Trauma Care checklist, while likely to be successful in reducing errors of omission related to hospital admission, may be limited in its ability to reduce errors that occur in the initial 30 min of trauma reception – when most of the life‐saving decisions are made. To address this limitation a Trauma Team Time‐out protocol is proposed for initial trauma resuscitation, targeting the critical first 30 min of hospital reception.
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Affiliation(s)
- Mark Fitzgerald
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Stephanie Reilly
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - De Villiers Smit
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Yesul Kim
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Joseph Mathew
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ellaine Boo
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Abdulrahman Alqahtani
- Trauma Service, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Sharfuddin Chowdhury
- Trauma Service, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ahamed Darez
- Tamil Nadu Accident and Emergency Initiative, Government of Tamil Nadu, Chennai, India
| | - Jma Bruno Mascarenhas
- Tamil Nadu Accident and Emergency Initiative, Government of Tamil Nadu, Chennai, India
| | - Francis O'Keeffe
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency Services, The Mater Misericordiae University Hospital, Dublin, Ireland
| | - Michael Noonan
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Chris Nickson
- Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Marc Marquez
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Wang An Li
- Trauma Service, Huizhou First Hospital, Guangdong, China
| | - Yan Ling Zhang
- Trauma Service, Huizhou First Hospital, Guangdong, China
| | - Kim Williams
- Trauma Services, The Alfred Hospital, Melbourne, Victoria, Australia.,National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- National Trauma Research Institute, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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4
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Gas BL, Mohan M, Jyot A, Buckarma EH, Farley DR. Does scripting operative plans in advance lead to better preparedness of trainees? A pilot study. Am J Surg 2016; 213:526-529. [PMID: 27839687 DOI: 10.1016/j.amjsurg.2016.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND We pondered if preoperative scripting might better prepare residents for the operating room (OR). METHODS Interns rotating on a general surgeon's service were instructed to script randomized cases prior to entering the OR. Scripts contained up to 20 points highlighting patient information perceived important for surgical management. The attending was blinded to the scripting process and completed a feedback sheet (Likert scale) following each procedure. Feedback questions were categorized into "preparedness" (aware of patient specific details, etc.) and "performance" (provided better assistance, etc.). RESULTS Eight surgical interns completed 55 scripted and 61 non-scripted cases. Total scores were higher in scripted cases (p = 0.02). Performance scores were higher for scripted cases (3.31 versus 3.13, p = 0.007), while preparedness did not differ (3.65 and 3.62, p = 0.51). CONCLUSIONS This pilot study suggests scripting cases may be a useful preoperative planning tool to increase interns' operative and patient care performance but may not affect perceived preparedness.
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Affiliation(s)
- Becca L Gas
- Department of Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Monali Mohan
- Department of Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - Apram Jyot
- Department of Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - EeeLN H Buckarma
- Department of Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA
| | - David R Farley
- Department of Surgery, Mayo Clinic, College of Medicine, Rochester, MN, USA.
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Abstract
BACKGROUND Wrong site surgery defines a category of rare but totally preventable complications in surgery and other invasive disciplines. Such complications could be associated with severe morbidity or even death. As such complications are entirely preventable, wrong site surgery has been declared by the World Health Organization to be a "never event". MATERIAL AND METHODS A selective search of the PubMed database using the MeSH terms "wrong site surgery", "wrong site procedure", "wrong side surgery" and "wrong side procedure" was performed. RESULTS The incidence of wrong site surgery has been estimated at 1 out of 112,994 procedures; however, the number of unreported cases is estimated to be higher. Although wrong site surgery occurs in all surgical specialities, the majority of cases have been recorded in orthopedic surgery. Breakdown in communication has been identified as the primary cause of wrong site surgery. Risk factors for wrong site surgery include time pressure, emergency procedures, multiple procedures on the same patient by different surgeons and obesity. Check lists have the potential to reduce or prevent the occurrence of wrong site surgery. CONCLUSION The awareness that to err is human and the individual willingness to recognize and prevent errors are the prerequisites for reducing and preventing wrong site surgery.
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Affiliation(s)
- P C Ambe
- Helios Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland. .,Chirurgische Klinik II, Universität Witten-Herdecke, Witten-Herdecke, Deutschland.
| | - B Sommer
- Helios Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland.,Chirurgische Klinik II, Universität Witten-Herdecke, Witten-Herdecke, Deutschland
| | - H Zirngibl
- Helios Klinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland.,Chirurgische Klinik II, Universität Witten-Herdecke, Witten-Herdecke, Deutschland
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Osada H, Nakajima H, Meshii K, Ohnaka M. Acute coronary artery bypass graft failure in a patient with polycythemia vera. Asian Cardiovasc Thorac Ann 2014; 24:175-7. [DOI: 10.1177/0218492314550725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Polycythemia vera in patients undergoing cardiac surgery is clinically rare. A 65-year-old man with polycythemia vera was admitted with effort-related chest discomfort. We planned coronary artery bypass grafting for left anterior descending artery and obtuse marginal branch stenosis, using bilateral internal thoracic arteries, with perioperative prophylactic management to avoid thromboembolism. His internal thoracic arterial grafts occluded during and after surgery due to thrombus, and ST-elevation myocardial infarction developed, which needed a percutaneous coronary intervention. This case suggests that optimal management methods should be studied further to contribute to better patient outcomes in this condition.
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Affiliation(s)
- Hiroaki Osada
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Japan
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Japan
| | - Katsuaki Meshii
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Japan
| | - Motoaki Ohnaka
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Japan
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Wei AC, Urbach DR, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Kennedy ED, Baxter NN. Improving quality through process change: a scoping review of process improvement tools in cancer surgery. BMC Surg 2014; 14:45. [PMID: 25038587 PMCID: PMC4112620 DOI: 10.1186/1471-2482-14-45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgery is a cornerstone of treatment for malignancy. However, significant variation has been reported in patterns and quality of cancer care for important health outcomes, including perioperative mortality. Surgical process improvement tools (SPITs) have been developed that focus on enhancing the processes of care at the point of care, as a means of quality improvement. This study describes SPITs and develops a conceptual framework by synthesizing the available literature on these novel quality improvement tools. METHODS A scoping review was conducted based on instruments developed for quality improvement in surgery. The search was executed on electronically indexed sources (MEDLINE, EMBASE, and the Cochrane library) from January 1990 to March 2011. Data were extracted, tabulated and reported thematically using a narrative synthesis approach. These results were used to develop a conceptual framework that describes and classifies SPITs. RESULTS 232 articles were reviewed for data extraction and analysis. SPITs identified were classified into 3 groups: clinical mapping tools, structure communication tools and error reduction instruments. The dominant instrument reported were clinical mapping tools, including: clinical pathways (113, 48%), fast track (46, 20%) and enhanced recovery after surgery protocols (36, 15%). Outcomes reported included: length of stay (174, 75%), readmission rates (116, 50%), morbidity (116, 50%), mortality (104, 45%), and economic (60, 26%). Many gaps in the literature were recognized. CONCLUSION We have developed a conceptual framework of SPITs and identified gaps in current knowledge. These results will guide the design and development of new quality instruments in surgery.
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Affiliation(s)
- Alice C Wei
- Princess Margaret Cancer Centre, University Health Network, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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