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Jelacic S, Bowdle A, Boorman D, Nair BG. Checklist Design, Format, and Content: Benefits of Aviation-Style Computerized Checklists. Anesth Analg 2024; 139:e3-e4. [PMID: 38885401 DOI: 10.1213/ane.0000000000007027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology, University of Washington, Seattle, Washington,
| | - Andrew Bowdle
- Department of Anesthesiology, University of Washington, Seattle, Washington
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Jelacic S, Bowdle A, Nair BG, Nair AA, Edwards M, Boorman DJ. Lessons from aviation safety: pilot monitoring, the sterile flight deck rule, and aviation-style computerised checklists in the operating room. Br J Anaesth 2023; 131:796-801. [PMID: 37879776 DOI: 10.1016/j.bja.2023.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 10/27/2023] Open
Abstract
Commercial aviation practices including the role of the pilot monitoring, the sterile flight deck rule, and computerised checklists have direct applicability to anaesthesia care. The pilot monitoring performs specific tasks that complement the pilot flying who is directly controlling the aircraft flight path. The anaesthesia care team, with two providers, can be organised in a manner that is analogous to the two-pilot flight deck. However, solo providers, such as solo pilots, can emulate the pilot monitoring role by reading checklists aloud, and utilise non-anaesthesia providers to fulfil some of the functions of pilot monitoring. The sterile flight deck rule states that flight crew members should not engage in any non-essential or distracting activity during critical phases of flight. The application of the sterile flight deck rule in anaesthesia practice entails deliberately minimising distractions during critical phases of anaesthesia care. Checklists are commonly used in the operating room, especially the World Health Organization surgical safety checklist. However, the use of aviation-style computerised checklists offers additional benefits. Here we discuss how these commercial aviation practices may be applied in the operating room.
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Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Akira A Nair
- Department of Computer Science, Brown University, Providence, RI, USA
| | - Mark Edwards
- Department of Cardiothoracic and ORL Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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Bijok B, Jaulin F, Picard J, Michelet D, Fuzier R, Arzalier-Daret S, Basquin C, Blanié A, Chauveau L, Cros J, Delmas V, Dupanloup D, Gauss T, Hamada S, Le Guen Y, Lopes T, Robinson N, Vacher A, Valot C, Pasquier P, Blet A. Guidelines on human factors in critical situations 2023. Anaesth Crit Care Pain Med 2023; 42:101262. [PMID: 37290697 DOI: 10.1016/j.accpm.2023.101262] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care. DESIGN A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.
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Affiliation(s)
- Benjamin Bijok
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France; Pôle de l'Urgence, Bloc des Urgences/Déchocage, CHU de Lille, Lille, France.
| | - François Jaulin
- Président du Groupe Facteurs Humains en Santé, France; Directeur Général et Cofondateur Patient Safety Database, France; Directeur Général et Cofondateur Safe Team Academy, France.
| | - Julien Picard
- Pôle Anesthésie-Réanimation, Réanimation Chirurgicale Polyvalente - CHU Grenoble Alpes, Grenoble, France; Centre d'Evaluation et Simulation Alpes Recherche (CESAR) - ThEMAS, TIMC, UMR, CNRS 5525, Université Grenoble Alpes, Grenoble, France; Comité Analyse et Maîtrise du Risque (CAMR) de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Daphné Michelet
- Département d'Anesthésie-Réanimation du CHU de Reims, France; Laboratoire Cognition, Santé, Société - Université Reims-Champagne Ardenne, France
| | - Régis Fuzier
- Unité d'Anesthésiologie, Institut Claudius Regaud. IUCT-Oncopole de Toulouse, France
| | - Ségolène Arzalier-Daret
- Département d'Anesthésie-Réanimation, CHU de Caen Normandie, Avenue de la Côte de Nacre, 14000 Caen, France; Comité Vie Professionnelle-Santé au Travail (CVP-ST) de la Société Française d'Anesthésie-Réanimation (SFAR), France
| | - Cédric Basquin
- Département Anesthésie-Réanimation, CHU de Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France; CHP Saint-Grégoire, Groupe Vivalto-Santé, 6 Bd de la Boutière CS 56816, 35760 Saint-Grégoire, France
| | - Antonia Blanié
- Département d'Anesthésie-Réanimation Médecine Périopératoire, CHU Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France; Laboratoire de Formation par la Simulation et l'Image en Médecine et en Santé (LabForSIMS) - Faculté de Médecine Paris Saclay - UR CIAMS - Université Paris Saclay, France
| | - Lucille Chauveau
- Service des Urgences, SMUR et EVASAN, Centre Hospitalier de la Polynésie Française, France; Maison des Sciences de l'Homme du Pacifique, C9FV+855, Puna'auia, Polynésie Française, France
| | - Jérôme Cros
- Service d'Anesthésie et Réanimation, Polyclinique de Limoges Site Emailleurs Colombier, 1 Rue Victor-Schoelcher, 87038 Limoges Cedex 1, France; Membre Co-Fondateur Groupe Facteurs Humains en Santé, France
| | - Véronique Delmas
- Service d'Accueil des Urgences, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France; CAp'Sim, Centre d'Apprentissage par la Simulation, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France
| | - Danièle Dupanloup
- IADE, Cadre de Bloc, CHU de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France; Comité IADE de la Société Française d'Anesthésie Réanimation (SFAR), France
| | - Tobias Gauss
- Pôle Anesthésie-Réanimation, Bloc des Urgences/Déchocage, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Hamada
- Université Paris Cité, APHP, Hôpital Européen Georges Pompidou, Service d'Anesthésie Réanimation, F-75015, Paris, France; CESP, INSERM U 10-18, Université Paris-Saclay, France
| | - Yann Le Guen
- Pôle Anesthésie-Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Thomas Lopes
- Service d'Anesthésie-Réanimation, Hôpital Privé de Versailles, 78000 Versailles, France
| | | | - Anthony Vacher
- Unité Recherche et Expertise Aéromédicales, Institut de Recherche Biomédicale des Armées, Brétigny Sur Orge, France
| | | | - Pierre Pasquier
- 1ère Chefferie du Service de Santé, Villacoublay, France; Département d'Anesthésie-Réanimation, Hôpital d'Instruction des Armées Percy, Clamart, France; École du Val-de-Grâce, Paris, France
| | - Alice Blet
- Lyon University Hospital, Department of Anaesthesiology and Critical Care, Croix Rousse University Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Cancer Research Center of Lyon, Lyon, France
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Krombach JW, Zürcher C, Simon SG, Saxena S, Pirracchio R. Persisting high rates of omissions during anesthesia induction are decreased by utilization of a pre- & post-induction checklist. Anaesth Crit Care Pain Med 2023; 42:101186. [PMID: 36513348 DOI: 10.1016/j.accpm.2022.101186] [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: 05/23/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Although Checklists (CL) for routine anesthesia cases have demonstrated their values in various studies, they have found little traction so far. While several reports have shown the benefit of CL preventing omissions prior to anesthesia induction, no investigation yet has scrutinized omissions during the post-induction phase immediately after intubation. This study evaluated the rate of omissions prior to and following the induction of non-emergent general anesthesia, as well as the impact of checklists on omission prevention. METHODS We performed a monocentric, prospective, observational study during induction of general anesthesia cases. We evaluated the omission rate made for the pre- as well as the immediate post-induction phase and determined the impact of pre-and post-induction CL on the rate of omission corrections. The CL used were introduced two years prior to the study. The observed providers were limited to those familiar with the institutional CL. Usage of CL was not mandated. RESULTS 237 general anesthesia inductions were included in the observation. At least one omission in 32% of all cases in the pre-induction setup was found and in 40% within the immediate post-induction phases. CL significantly reduced omission rates (relative risk = 0.64, 95% CI = 0.45-0.92, p = 0.01). CONCLUSION Omission rates during the pre- and post-induction phases of routine general anesthesia procedures remain high. Pre- and post-induction CL have the potential to increase patient safety and should be considered for routine anesthesia with appropriate training provided.
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Affiliation(s)
- Jens W Krombach
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA; Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA.
| | - Claudia Zürcher
- Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA
| | - Stefan G Simon
- Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA
| | - Sarah Saxena
- Department of Anesthesia & Reanimation, AZ Sint-Jan Brugge Oostende AV, Bruges, Belgium
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, USA
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Singh D, Zhang R, Hori KH, Parsa FD. Is Iatrogenic Implant Contamination Preventable Using a 16-Step No-Touch Protocol? EPLASTY 2022; 22:e38. [PMID: 36160667 PMCID: PMC9490878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Intraoperative contamination of the surgical field during aesthetic breast augmentation may lead to implant infection with devastating consequences. This study covers a period of 30 years and is divided into 2 phases: a retrospective phase from 1992-2004 when a standard approach was used and a prospective phase from 2004-2022 when a no-touch approach was implemented to avoid contamination. METHODS Patients in the standard and no-touch groups underwent aesthetic breast augmentation by the same senior surgeon (FDP) in the same outpatient surgical facility during the 30-year period of the study. Patients are divided into 2 groups: from 1992-2004 and from the implementation of the no-touch protocol in 2004-2022. RESULTS Patients who underwent breast augmentation using the no-touch approach developed no infections, whereas the standard group had an infection rate of 3.54% (P = .017). The validity of this finding is discussed. CONCLUSIONS The no-touch approach as described in this article was effective in reducing implant infection rate when performing aesthetic breast augmentation by 1 surgeon at 1 surgical center during an 18-year observation period. Multicenter prospective cooperative studies are necessary to validate perioperative iatrogenic contamination as the cause of implant infection and to explore optimal approaches that could eliminate implant contamination.
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Affiliation(s)
- Dylan Singh
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | - Ruixue Zhang
- University of Hawaii, John A Burns School of Medicine, Honolulu, HI
| | | | - Fereydoun D Parsa
- Plastic Surgery Division, Department of Surgery, University of Hawaii, John A Burns School of Medicine. Honolulu, HI
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Laudanski K. Quo Vadis Anesthesiologist? The Value Proposition of Future Anesthesiologists Lies in Preserving or Restoring Presurgical Health after Surgical Insult. J Clin Med 2022; 11:1135. [PMID: 35207406 PMCID: PMC8879076 DOI: 10.3390/jcm11041135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 12/26/2022] Open
Abstract
This Special Issue of the Journal of Clinical Medicine is devoted to anesthesia and perioperative care [...].
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA 19104, USA; ; Tel.: +1-215-662-8000
- Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Liao X, Zhang P, Xu X, Zheng D, Wang J, Li Y, Xie L. Analysis of Factors Influencing Safety Attitudes of Operating Room Nurses and Their Cognition and Attitudes toward Adverse Event Reporting. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:8315511. [PMID: 35178235 PMCID: PMC8844141 DOI: 10.1155/2022/8315511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
Abstract
Operating room nurses play a critical role in patient safety. The evaluation of safety attitudes of operating room nurses reflects their awareness and belief of patient safety. Currently, however, the research on the safety attitudes of operating room nurses is hard to track in the existing literature in China. Therefore, this paper was conducted to explore the factors influencing the safety attitudes of operating room nurses and their cognition and attitudes toward adverse event reporting. A total of 711 operating room nurses from 16 tertiary hospitals in Sichuan Province from March 1, 2018, to 2019 were selected. The general information of operating room nurses, such as age, gender, and years of service in the operating room, was obtained through the basic information questionnaire. The Chinese version of the Safety Attitudes Questionnaire (C-SAQ) was used to evaluate the safety attitude of operating room nurses, and the cognition and attitude of the subjects to adverse event reports were assessed through the questionnaire of cognition and attitude toward adverse event reporting. The average score of safety attitudes of operating room nurses was 4.20 ± 0.49. The two dimensions with a lower positive reaction rate of the safety attitudes of operating room nurses were stress recognition and working conditions. The main factors affecting the safety attitude of operating room nurses were night shifts, as well as cognition and attitudes toward adverse event reporting. There was a positive correlation between the total score of C-SAQ and the total score of cognition and attitudes toward adverse event reporting (P < 0.01, r = 0.445). The safety attitude of operating room nurses is at the upper-middle level, but the stress recognition and working conditions need to be improved. Through the allocation of nursing human resources, the strengthening of hospital logistics support, and the establishment of nonpunitive nursing adverse event reporting system, the operating room safety can be significantly enhanced.
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Affiliation(s)
- Xin Liao
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Peijia Zhang
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Xiaofeng Xu
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Dan Zheng
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Jing Wang
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Yunfei Li
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
| | - Li Xie
- Department of Operating Room, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
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Torres Y, Rodríguez Y, Pérez E. [How to improve the quality of healthcare services and patient safety by adopting strategies from the aviation sector?]. J Healthc Qual Res 2021; 37:182-190. [PMID: 34887228 DOI: 10.1016/j.jhqr.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The World Health Organization recognizes patient safety as a priority as part of its global strategy to improve the quality of health services. However, several initiatives need to be integrated and systematized to increase the reliability of healthcare systems. This article discusses several management strategies developed in the aviation sector that have led to a drastic decrease in the accident rate. The aim is to describe each strategy and contrast them with their application in the healthcare sector. METHODS Different results and recommendations from the literature and institutions such as the World Health Organization and the International Civil Aviation Organization were consulted and compiled. A synthesis of the identified strategies was made, highlighting examples of their application and impact. RESULTS Five key strategies were identified: 1) no-blame incident reporting systems, 2) systematic use of checklists, 3) recurrent training and use of simulation, 4) management of fatigue and work schedules, and 5) management of teamwork. CONCLUSIONS The strategies from the aviation sector are presented as a valuable reference for improving patient safety and the quality of healthcare services. They should be consolidated and harmoniously integrated into the design and management of health systems.
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Affiliation(s)
- Y Torres
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canadá.
| | - Y Rodríguez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
| | - E Pérez
- Facultad de Ingeniería Industrial, Universidad Pontificia Bolivariana, Medellín, Colombia
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Liu LQ, Mehigan S. A Systematic Review of Interventions Used to Enhance Implementation of and Compliance With the World Health Organization Surgical Safety Checklist in Adult Surgery. AORN J 2021; 114:159-170. [PMID: 34314014 DOI: 10.1002/aorn.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/16/2020] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
The focus of this systematic review is to identify and synthesize the evidence for effectiveness of interventions to increase compliance with the World Health Organization Surgical Safety Checklist (SSC) for adult surgery. We searched a variety of databases and identified 24 peer-reviewed articles of either a quantitative (n = 17), qualitative (n = 4), or mixed-methods design (n = 3) published in English from January 1, 2008, to July 8, 2020. Interventions included modifying the ways of delivering the SSC, integrating or tailoring the SSC to local context or existing practice, promoting clinician awareness and engagement, and managing policies. Despite a lack of common outcome measures, all quantitative and mixed-methods study results showed a significant positive effect on SSC compliance. A few researchers reported nonsignificant or negative changes in certain aspects with the interventions. Additional research is needed to address SSC compliance measures globally and outcomes in developing countries.
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10
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Leite GR, Martins MA, Maia LG, Garcia-Zapata MTA. Safe surgery checklist: evaluation in a neotropical region. Rev Col Bras Cir 2021; 48:e20202710. [PMID: 33852703 PMCID: PMC10683426 DOI: 10.1590/0100-6991e-20202710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE assess patient responses and associated factors of items on a safe surgery checklist, and identify use before and after protocol implementation from the records. METHODS a cohort study conducted from 2014 to 2016 with 397 individuals in stage I and 257 in stage II, 12 months after implementation, totaling 654 patients. Data were obtained in structured interviews. In parallel, 450 checklist assessments were performed in medical records from public health institutions in the Southwest II Health Region of Goiás state, Brazil. RESULTS six items from the checklist were evaluated and all of these exhibited differences (p < 0.000). Of the medical records analyzed, 69.9% contained the checklist in stage I and 96.5% in stage II, with better data completeness. In stage II, after training, the checklist was associated with surgery (OR; 1.38; IC95%: 1.25-1.51; p < 0.000), medium-sized hospital (OR; 1.11; CI95%; 1.0-1.17; p < 0.001), male gender (OR; 1.07; CI95%; 1.0-1.14; p < 0.010), type of surgery (OR; 1.7; CI95%: 1.07-1.14; p < 0.014) and antibiotic prophylaxis 30 to 60 min after incision (OR; 1.10; CI95%: 1.04-1.17; p < 0.000) and 30 to 60 min after surgery (OR; 1.23; CI95%: 1.04-1.45; p = 0.015). CONCLUSIONS the implementation strategy of the safe surgery checklist in small and medium-sized healthcare institutions was relevant and associated with better responses based on patient, data availability and completeness of the data.
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Affiliation(s)
- Giulena Rosa Leite
- - Universidade Federal de Goiás, Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina - Goiânia - GO - Brasil
- - Universidade Federal de Jataí, Curso de Enfermagem - Jataí - GO - Brasil
| | | | - Ludmila Grego Maia
- - Universidade Federal de Jataí, Curso de Enfermagem - Jataí - GO - Brasil
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11
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Suresh V, Ushakumari PR, Pillai CM, Kutty RK, Prabhakar RB, Peethambaran A. Implementation and adherence to a speciality-specific checklist for neurosurgery and its influence on patient safety. Indian J Anaesth 2021; 65:108-114. [PMID: 33776084 PMCID: PMC7983834 DOI: 10.4103/ija.ija_419_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Neurosurgery involves a high level of expertise coupled with enduring and long duration of working hours. There is a paucity of published literature about the experience with a speciality-specific checklist in neurosurgery. We conducted a cross-sectional observational study to identify the adherence to various elements of the Modified World Health Organization Surgical Safety Checklist (WHO SSC) for neurosurgery by the operating room (OR) team. Methods We implemented an intra-operative Modified WHO SSC consisting of 40 tools for neurosurgery, in 200 consecutive elective cases. Trained anaesthesiologists assumed the role of checklist co-ordinator. The checklist divided the surgery into 5 phases, each corresponding to a specific time-period. The adherence rates to various tools were evaluated and areas where the checklist prompted a corrective measure were analysed. Results A total of 131 cases undergoing craniotomy and 69 cases undergoing spine surgery were studied. With the 40-point modified SSC applied in 200 cases, we analysed a total of 8000 observations. The modified checklist prompted the OR team to adhere to speciality-specific safety practices about application of compression stockings (9.5%); airway precautions in unstable cervical spine (2.5%); precautions for treatment of raised intracranial pressure (10.5%); and intraoperative neuro-monitoring (5%). Conclusion The implementation of Modified WHO SSC for Neurosurgery, by a designated checklist co-ordinator, can rectify anaesthetic and surgical facets promptly, without increasing the OR time. The anaesthesiologist as SSC coordinator can effectively implement an intraoperative checklist ensuring excellent participation of operating room team members.
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Affiliation(s)
- Varun Suresh
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - P R Ushakumari
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - C Madhusoodanan Pillai
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Raja Krishnan Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | | | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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12
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Jelacic S, Togashi K, Bussey L, Nair BG, Wu T, Boorman DJ, Bowdle A. Development of an aviation-style computerized checklist displayed on a tablet computer for improving handoff communication in the post-anesthesia care unit. J Clin Monit Comput 2020; 35:607-616. [PMID: 32405801 DOI: 10.1007/s10877-020-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
Critical patient care information is often omitted or misunderstood during handoffs, which can lead to inefficiencies, delays, and sometimes patient harm. We implemented an aviation-style post-anesthesia care unit (PACU) handoff checklist displayed on a tablet computer to improve PACU handoff communication. We developed an aviation-style computerized checklist system for use in procedural rooms and adapted it for tablet computers to facilitate the performance of PACU handoffs. We then compared the proportion of PACU handoff items communicated before and after the implementation of the PACU handoff checklist on a tablet computer. A trained observer recorded the proportion of PACU handoff information items communicated, any resistance during the performance of the checklist, the type of provider participating in the handoff, and the time required to perform the handoff. We also obtained these patient outcomes: PACU length of stay, respiratory events, post-operative nausea and vomiting, and pain. A total of 209 PACU handoffs were observed before and 210 after the implementation of the tablet-based PACU handoff checklist. The average proportion of PACU handoff items communicated increased from 49.3% (95% CI 47.7-51.0%) before checklist implementation to 72.0% (95% CI 69.2-74.9%) after checklist implementation (p < 0.001). A tablet-based aviation-style handoff checklist resulted in an increase in PACU handoff items communicated, but did not have an effect on patient outcomes.
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Affiliation(s)
- Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA.
| | - Kei Togashi
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Logan Bussey
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Bala G Nair
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Tim Wu
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
| | - Daniel J Boorman
- The Boeing Company, Boeing Test and Evaluation, Seattle, WA, USA
| | - Andrew Bowdle
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific Street, AA-117B, Box 356540, Seattle, WA, 98195-6540, USA
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