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Lia H, Hammond Mobilio M, Rudzicz F, Moulton CA. It's not the arrow, it's the archer: the role of the surgeon leader in a safety driven-era. Surg Endosc 2024; 38:992-998. [PMID: 37978083 DOI: 10.1007/s00464-023-10538-4] [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: 04/01/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In an era where team communication and patient safety are paramount, standardized tools have been deemed critical to safe, efficient practice. In some cases-perhaps most notably in the surgical safety checklist (SSC)-these tools have been elevated as the key to safe patient care. However, effects of the SSC on patient safety in practice remain mixed. We explore the role and impact of the surgeon leader in the use of structured communication tools to understand how surgeon engagement impacts intraoperative teamwork. METHODS Using a constructivist grounded theory approach, OR staff members (surgeons, anesthetists, nurses and perfusionists) were recruited to participate in a one-on-one semi-structured interview. The interview explored participant experiences working in the OR, focusing on the role and impact of the surgeon as leader. RESULTS Engaged use of the surgical safety checklist by the attending surgeon had the potential to improve teamwork in the operating room. Surgeons who used the checklist to engage with their team and facilitate group discussion were able to avoid tensions later in the operation typically arising from lack of situation awareness and familiarity with team member experience levels. Surgeons who engaged with the SSC as more than a memory aid were able to foster a better team environment. CONCLUSIONS Surgeons can harness their role as leader in the operating room by engaging with structured communication tools such as the SSC to foster improved teamwork.
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Affiliation(s)
- Hillary Lia
- The Wilson Centre, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada.
| | - Melanie Hammond Mobilio
- The Wilson Centre, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
- Temerty Faculty of Medicine Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Frank Rudzicz
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Carol-Anne Moulton
- The Wilson Centre, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, University Health Network, Toronto, ON, Canada
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Codner JA, Falconer EA, Mlaver E, Zeidan RH, Sharma J, Lynde GC. A Self-Sustaining Antibiotic Prophylaxis Program to Reduce Surgical Site Infections. Surg Infect (Larchmt) 2023; 24:716-724. [PMID: 37831935 DOI: 10.1089/sur.2023.111] [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] [Indexed: 10/15/2023] Open
Abstract
Background: Our multi-institutional healthcare system had a higher-than-expected surgical site infection (SSI) rate. We aimed to improve our peri-operative antibiotic administration process. Gap analysis identified three opportunities for process improvement: standardized antibiotic selection, standardized second-line antibiotic agents for patients with allergies, and feedback regarding antibiotic administration compliance. Hypothesis: Implementation of a multifaceted quality improvement initiative including a near-real-time pre-operative antibiotic compliance feedback tool will improve compliance with antibiotic administration protocols, subsequently lowering SSI rate. Methods: A compliance feedback tool designed to provide monthly reports to all anesthesia and surgical personnel was implemented at two facilities, in September 2017 and December 2018. Internal case data were tracked for antibiotic compliance through June 2021, and these data were merged with American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data at the case level to provide process and outcome measures for SSIs. Implementation success was evaluated by comparing protocol compliance and risk-adjusted rates of superficial and deep SSI before and after the quality improvement implementation. Results: A total of 20,385 patients were included in this study; 11,548 patients in the pre-implementation and 8,837 in the post-implementation groups. Baseline patient and operative characteristics were similar between groups, except the post-implementation group had a higher median expected SSI rate (2.2% vs. 1.6%). Post-implementation, antibiotic protocol compliance increased from 86.3% to 97.6%, and superficial and deep SSIs decreased from 2.8% to 1.9% (p < 0.001). The odds of superficial and deep SSI in patients in the post-implementation group was 0.69 (0.57, 0.83) times the odds of superficial and deep SSI in pre-implementation patients while adjusting for age, gender, diabetes mellitus, American Society of Anesthesiologists Physical Status (ASA) classification, wound class, smoking, and chronic obstructive pulmonary disease (COPD). Observed-to-expected ratios of superficial and deep SSI decreased from 0.82 to 0.48 after the intervention. Conclusions: Surgical antibiotic prophylaxis standardization and providing near-real-time individualized feedback resulted in sustained improvement in peri-operative antibiotic compliance rates and reduced superficial and deep SSIs.
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Affiliation(s)
- Jesse A Codner
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elissa A Falconer
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Eli Mlaver
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ronnie H Zeidan
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Grant C Lynde
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
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Goldman J, Rotteau L, Flintoft V, Jeffs L, Baker GR. Measurement and Monitoring of Safety Framework: a qualitative study of implementation through a Canadian learning collaborative. BMJ Qual Saf 2022:bmjqs-2022-015017. [PMID: 36598000 DOI: 10.1136/bmjqs-2022-015017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Measurement and Monitoring of Safety Framework (MMSF) aims to move beyond a narrow focus on measurement and past harmful events as the major focus for safety in healthcare organisations. There is limited evidence of MMSF implementation and impact. OBJECTIVE We aimed to examine participants' perspectives and experiences to increase understanding of the adaptive work of implementing the MMSF through a learning collaborative programme in diverse healthcare contexts across Canada. METHODS The Collaborative consisted of 11 teams from seven provinces. We conducted a qualitative study involving interviews with 36 participants, observations of 5 sites and learning sessions, and collection of documents. RESULTS Collaborative sessions and coaching allowed participants to explore reliability, sensitivity to operations, anticipation and preparedness, and integration and learning, in addition to past harm, and move beyond a project and measurement oriented safety approach. Participants noted the importance of time dedicated to engaging stakeholders in talk about MMSF concepts and their significance to their settings, prior to moving to implementing the Framework into practice. While participants generally started with a small number of ways of integrating the MMSF into practice such as rounds or huddles, many teams continued to experiment with incorporating the MMSF into a range of practices. Participants reported changes in thinking about safety, discussions and behaviours, which were perceived to impact healthcare processes. However, participants also reported challenges to sharing the Framework broadly and moving beyond its surface implementation, and difficulties with its sustained and widespread use given misalignments with existing quality and safety processes. CONCLUSION The MMSF requires a dramatic departure from traditional safety strategies that focus on discrete problems and emphasise measurement. MMSF implementation requires extensive discussion, coaching and experimentation. Future implementation should consider engaging local leaders and coaches and an organisation or system approach to enable broader reach and systemic change.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Virginia Flintoft
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada.,Institute for the Science of Care and Innovation, Sinai Health System, Toronto, Ontario, Canada
| | - G Ross Baker
- Health Policy, Management and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
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4
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Tartaglia A, Matos MAA. Surgical safety checklist: fact or fake? EINSTEIN-SAO PAULO 2022; 20:eCE0059. [PMID: 36102408 PMCID: PMC9469871 DOI: 10.31744/einstein_journal/2022ce0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
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Lamm R, Creisher B, Curran J, Munden E, Williamson J, Schleider C, Shindle K, Cowan S, Lavu H, Costanzo C. Postoperative Pneumonia Prevention Checklist Improves Provider Compliance and Patient Awareness of Previously Established Reduction Protocol. PATIENT SAFETY 2022. [DOI: 10.33940/med/2022.6.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Postoperative pneumonia (PoPNA) is a highly prevalent complication in patients. Despite a previously successful protocol, this institution has become a high outlier on national metrics for PoPNA in the last four years.
Methods: Between October 2020 and May 2021, patients were surveyed to measure 10 initiatives which have shown previous success. A provider-driven 10-item checklist was implemented and patients were resurveyed.
Results: 135 patients were included: 96 pre-checklist and 39 post-checklist. Improvement was seen in all 10 categories. This included provider-driven initiatives, such as patient oral care, ambulation, frequency of patient being in chair, having incentive spirometer (IS) within reach, having information booklet within reach, and the patient’s ability to perform IS correctly, as well as patient awareness initiatives, including importance of oral care, cough and deep breathing, ambulation, and IS use.
Conclusions: Implementation of a simple checklist can improve awareness and compliance with previously successful established protocols.
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Affiliation(s)
- Ryan Lamm
- Thomas Jefferson University Hospital
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Technical skills in the operating room: Implications for perioperative leadership and patient outcomes. Best Pract Res Clin Anaesthesiol 2022; 36:237-245. [DOI: 10.1016/j.bpa.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 01/02/2023]
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Tschan F, Keller S, Semmer NK, Timm-Holzer E, Zimmermann J, Huber SA, Wrann S, Hübner M, Banz V, Prevost GA, Marschall J, Candinas D, Demartines N, Weber M, Beldi G. Effects of structured intraoperative briefings on patient outcomes: multicentre before-and-after study. Br J Surg 2021; 109:136-144. [PMID: 34850862 PMCID: PMC10401893 DOI: 10.1093/bjs/znab384] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/29/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Operations require collaboration between surgeons, anaesthetia professionals, and nurses. The aim of this study was to determine whether intraoperative briefings influence patient outcomes. METHODS In a before-and-after controlled trial (9 months baseline; 9 months intervention), intraoperative briefings were introduced in four general surgery centres between 2015 and 2018. During the operation, the responsible surgeon (most senior surgeon present) briefed the surgical team using the StOP? protocol about: progress of the operation (Status), next steps (Objectives), possible problems (Problems), and encouraged asking questions (?). Differences between baseline and intervention were analysed regarding surgical-site infections (primary outcome), mortality, unplanned reoperations, and duration of hospital stay (secondary outcomes), using inverse probability of treatment (IPT) weighting based on propensity scores. RESULTS In total, 8256 patients underwent surgery in the study. Endpoint data were available for 7745 patients (93.8 per cent). IPT-weighted and adjusted intention-to-treat analyses showed no differences in surgical-site infections between baseline and intervention (9.8 versus 9.6 per cent respectively; adjusted difference (AD) -0.15 (95 per cent c.i. -1.45 to 1.14) per cent; odds ratio (OR) 0.92, 95 per cent c.i. 0.83 to 1.15; P = 0.797), but there were reductions in mortality (1.6 versus 1.1 per cent; AD -0.54 (-1.04 to -0.03) per cent; OR 0.60, 0.39 to 0.92; P = 0.018), unplanned reoperations (6.4 versus 4.8 per cent; AD -1.66 (-2.69 to -0.62) per cent; OR 0.72, 0.59 to 0.89; P = 0.002), and fewer prolonged hospital stays (21.6 versus 19.8 per cent; AD -1.82 (-3.48 to -0.15) per cent; OR 0.87, 0.77 to 0.98; P = 0.024). CONCLUSION Short intraoperative briefings improve patient outcomes and should be performed routinely.
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Affiliation(s)
- Franziska Tschan
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Sandra Keller
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Norbert K Semmer
- Department of Psychology, University of Berne, Berne, Switzerland
| | - Eliane Timm-Holzer
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon A Huber
- Institute for Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Simon Wrann
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Vanessa Banz
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Gian Andrea Prevost
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland.,Department of Surgery, Kantonsspital Graubünden, Chur, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, University Hospital Berne, Berne, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital Lausanne (CHUV), Lausanne, Switzerland
| | - Markus Weber
- Department of Surgery, Triemli Hospital, Zurich, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland
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Innocenti F, Stefanone VT. Errare humanum est, not using the checklist diabolicum. Intern Emerg Med 2021; 16:2227-2229. [PMID: 34148180 DOI: 10.1007/s11739-021-02789-7] [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: 05/24/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Francesca Innocenti
- High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy.
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Incident Reporting Systems: What Will It Take to Make Them Less Frustrating and Achieve Anything Useful? Jt Comm J Qual Patient Saf 2021; 47:755-758. [PMID: 34716115 DOI: 10.1016/j.jcjq.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Gong J, Ma Y, An Y, Yuan Q, Li Y, Hu J. The surgical safety checklist: a quantitative study on attitudes and barriers among gynecological surgery teams. BMC Health Serv Res 2021; 21:1106. [PMID: 34656136 PMCID: PMC8520325 DOI: 10.1186/s12913-021-07130-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Implementation of the surgical safety checklist (SSC) plays a significant role in improving surgical patient safety, but levels of compliance to a SSC implementation by surgical team members vary significantly. We aimed to investigate the factors affecting satisfaction levels of gynecologists, anesthesiologists, and operating room registered nurses (OR-RNs) with SSC implementation. Methods We conducted a survey based on 267 questionnaires completed by 85 gynecologists from 14 gynecological surgery teams, 86 anesthesiologists, and 96 OR-RNs at a hospital in China from March 3 to March 16, 2020. The self-reported questionnaire was used to collect respondent’s demographic information, levels of satisfaction with overall implementation of the SSC and its implementation in each of the three phases of a surgery, namely sign-in, time-out, and sign-out, and reasons for not giving a satisfaction score of 10 to its implementation in all phases. Results The subjective ratings regarding the overall implementation of the SSC between the surgical team members were different significantly. “Too many operations to check” was the primary factor causing gynecologists and anesthesiologists not to assign a score of 10 to sign-in implementation. The OR-RNs gave the lowest score to time-out implementation and 82 (85.42%) did not assign a score of 10 to it. “Surgeon is eager to start for surgery” was recognized as a major factor ranking first by OR-RNs and ranking second by anesthesiologists, and 57 (69.51%) OR-RNs chose “Too many operations to check” as the reason for not giving a score of 10 to time-out implementation. “No one initiates” and “Surgeon is not present for ‘sign out’” were commonly cited as the reasons for not assigning a score of 10 to sign-out implementation. Conclusion Factors affecting satisfaction with SSC implementation were various. These factors might be essentially related to heavy workloads and lack of ability about SSC implementation. It is advisable to reduce surgical team members’ excessive workloads and enhance their understanding of importance of SSC implementation, thereby improving surgical team members’ satisfaction with SSC implementation and facilitating compliance of SSC completion.
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Affiliation(s)
- Junming Gong
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yushan Ma
- Department of Anesthesiology, West China Second University Hospital/West China School of Medicine, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yunfei An
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, P. R. China
| | - Qi Yuan
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China
| | - Yun Li
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Juan Hu
- Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, P. R. China.
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Schiff G, Shojania KG. Looking back on the history of patient safety: an opportunity to reflect and ponder future challenges. BMJ Qual Saf 2021; 31:148-152. [PMID: 34625484 PMCID: PMC8785050 DOI: 10.1136/bmjqs-2021-014163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Gordon Schiff
- General Medicine, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
| | - Kaveh G Shojania
- Department of Medicine and the Centre for Quality Improvement and Patient Safety, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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12
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Sotto KT, Burian BK, Brindle ME. Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis. J Am Coll Surg 2021; 233:794-809.e8. [PMID: 34592406 DOI: 10.1016/j.jamcollsurg.2021.08.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. STUDY DESIGN We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. CONCLUSIONS The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Affiliation(s)
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA
| | - Mary E Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB; Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
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13
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Urban D, Burian BK, Patel K, Turley NW, Elam M, MacRobie AG, Merry AF, Kumar M, Hannenberg A, Haynes AB, Brindle ME. Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey. ANNALS OF SURGERY OPEN 2021; 2:e075. [PMID: 36590849 PMCID: PMC9770110 DOI: 10.1097/as9.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/20/2021] [Indexed: 01/04/2023] Open
Abstract
To assess health care professionals' attitudes on the Surgical Safety Checklist ("the Checklist") in resource-rich health systems and provide insights on strategies for optimizing Checklist use. Background In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. Methods An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. Results A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). Conclusions While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.
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Affiliation(s)
- Denisa Urban
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Kripa Patel
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Nathan W. Turley
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Meagan Elam
- School of Public Health, Boston University, Boston, MA
| | - Ali G. MacRobie
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Alan F. Merry
- Department of Anesthesia, University of Auckland, Auckland, New Zealand
| | - Manoj Kumar
- Department of Surgery, University of Aberdeen, Aberdeen, Scotland
| | - Alexander Hannenberg
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
| | | | - Mary E. Brindle
- From the Department of Surgery, University of Calgary, Calgary, AB, Canada
- Ariadne Labs, TH Chan Harvard School of Public Health and Brigham and Women’s Hospital, Boston, MA, Harvard
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Affiliation(s)
- Dhananjaya Sharma
- Professor, Department of Surgery, Government NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Michael Cotton
- Professor of Clinical Practice, Consultant Surgeon, Quai Sante, Montreux, Switzerland
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15
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Redelmeier DA, Kao MM. Harnessing choice architecture to improve medical care. BMJ Qual Saf 2021; 30:bmjqs-2020-012598. [PMID: 33452140 DOI: 10.1136/bmjqs-2020-012598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
| | - Mian-Mian Kao
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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Lasinski AM, Ladha P, Ho VP. Provision of Defect-Free Care: Implementation Science in Surgical Patient Safety. Surg Clin North Am 2020; 101:81-95. [PMID: 33212082 DOI: 10.1016/j.suc.2020.09.009] [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: 10/23/2022]
Abstract
Implementation science is the study of the translation of evidence-based practices to real-world clinical environments. Implementation is measured with specific outcomes including acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability, and implementation cost. There are defined frameworks and models that outline implementation strategies and assist researchers in identifying barriers and facilitators to achieve implementation and conduct implementation research using methods such as qualitative analysis, parallel group, pre-/postintervention, interrupted time series, and cluster or stepped-wedge randomized trials. Deimplementation is the study of how to remove ineffective or unnecessary practices from the clinical setting and is an equally important component of implementation science.
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Affiliation(s)
- Alaina M Lasinski
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Prerna Ladha
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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Peñataro-Pintado E, Rodríguez E, Castillo J, Martín-Ferreres ML, De Juan MÁ, Díaz Agea JL. Perioperative nurses' experiences in relation to surgical patient safety: A qualitative study. Nurs Inq 2020; 28:e12390. [PMID: 33152131 DOI: 10.1111/nin.12390] [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: 05/07/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022]
Abstract
Surgical patient safety remains a concern worldwide as, despite World Health Organization recommendations and implementation of its Surgical Safety Checklist, adverse events continue to occur. The aim of this qualitative study was to explore the views and experiences of perioperative nurses regarding the factors that impact surgical patient safety. Data were collected through five focus groups involving a total of 50 perioperative nurses recruited from four public hospitals in Spain. Content analysis of the focus groups yielded four main themes: personal qualities of the perioperative nurse, the surgical environment, safety culture, and perioperative nursing care plans. One of the main findings concerned barriers to the exercise of leadership by nurses, especially regarding completion of the Surgical Safety Checklist. Some of the key factors that impacted the ability of perioperative nurses to fulfil their duties and ensure patient safety were the stress associated with working in the operating room, time pressures, and ineffective communication in the multidisciplinary team. Targeting these aspects through training initiatives could contribute to the professional development of perioperative nurses and reduce the incidence of adverse events by enhancing the surgical safety culture.
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Affiliation(s)
- Ester Peñataro-Pintado
- Nursing Department, University School of Nursing and Occupational Therapy of Terrassa (EUIT), Autonomous University of Barcelona (UAB), Terrassa, Spain
| | - Encarna Rodríguez
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - Jordi Castillo
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain.,Hospital Universitari de Bellvitge (HUB), Barcelona, Spain
| | - María Luisa Martín-Ferreres
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - María Ángeles De Juan
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
| | - José Luis Díaz Agea
- Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat, Spain
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18
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Espin S, Indar A, Gross M, Labricciosa A, D'Arpino M. Processes and tools to improve teamwork and communication in surgical settings: a narrative review. BMJ Open Qual 2020; 9:bmjoq-2020-000937. [PMID: 32554445 PMCID: PMC7304801 DOI: 10.1136/bmjoq-2020-000937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alyssa Indar
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | | | | | - Maryanne D'Arpino
- Safety Improvement and Capability Building, Canadian Patient Safety Institute, Ottawa, Ontario, Canada
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19
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Portugal LG, Adams DR, Baroody FM, Agrawal N. A Surgical Safety Checklist for Performing Tracheotomy in Patients with Coronavirus Disease 19. Otolaryngol Head Neck Surg 2020; 163:42-46. [DOI: 10.1177/0194599820922981] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Performance of tracheotomy is a potential necessary step in the patient with coronavirus disease 19 (COVID-19) and prolonged mechanical ventilation. Due to viral aerosolization, tracheotomy carries a high risk of transmission of COVID-19 to the health care team performing the procedure. We share our institution’s surgical safety checklist for performing tracheotomy in patients with COVID-19, including key modifications intended to mitigate risk to the surgical team.
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Affiliation(s)
- Louis G. Portugal
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Dara R. Adams
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Fuad M. Baroody
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Nishant Agrawal
- Section of Otolaryngology–Head and Neck Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, Illinois, USA
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20
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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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