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Adolescent experiences of the safe surgical checklist and surgical care processes. Pediatr Surg Int 2023; 39:108. [PMID: 36759361 DOI: 10.1007/s00383-023-05396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To explore the perceptions, satisfaction, and needs of adolescent surgical patients with their perioperative pathway, including consent, the Safe Surgical Checklist (SSC), and post-operative care. METHODS We used qualitative methodology to examine adolescent experiences with surgical consent, SSC, and post-operative care. We purposively recruited ten patients aged 13-17 undergoing emergency and elective surgery and obtained consent from parents and patients. Semi-structured interview scripts were co-developed with an adolescent patient advisor, and interviews were performed, recorded, and transcribed verbatim. Thematic analysis was based on grounded theory and Participants were recruited and interviewed until thematic saturation was achieved. RESULTS Four themes emerged in thematic analysis: (1) Autonomy and Inclusion-Adolescents desire to participate in the consent process, including signing their own consent when appropriate, (2) Value of Repetition-Adolescents value the repetition of information in the pre-operative check and feel safer when the team reinforces the information, (3) Importance of Caregiver Involvement - Adolescents valued their caregivers being involved in critical conversations and decision making, and (4) Importance of Transparency in Communication-Adolescents desire to be directly given information about their surgery post-operatively and not told to parents alone. CONCLUSION Adolescents are situated uniquely between childhood and adulthood. Adolescents desired to be directly involved in the decision-making process of their surgery, including participation in the SSC and discussion of post-operative complications.
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Jakonen A, Mänty M, Nordquist H. Safety Checklists for Emergency Response Driving and Patient Transport: Experiences from Emergency Medical Services. Jt Comm J Qual Patient Saf 2021; 47:572-580. [PMID: 34183282 DOI: 10.1016/j.jcjq.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Emergency response driving (ERD) is considered one of the most significant occupational risk factors affecting both patient and traffic safety in emergency medical services (EMS). The majority of the risk factors in ERD are crew related and could be affected positively with crew resource management (CRM). The aim of this study was to examine how the safety checklists developed for ERD and patient transport are experienced in practical work in EMS by paramedics. METHODS Safety checklists for ERD and patient transport were developed and then piloted in practical work among 30 paramedics in five different EMS areas around Finland for a two-month period in fall 2019. Afterward, semistructured thematic interviews were performed with the pilot participants, and the material was analyzed using inductive content analysis. RESULTS Paramedics experienced that use of ERD and patient transport safety checklists improved safety, and deployment of the checklists required systematic planning. Use of the safety checklists was seen as changing the mindset of the ERD drivers to a more safety critical stance and increasing a systematic approach to ERD. Paramedics also stated that when deploying the checklists in EMS, their use should be standardized as a nationwide operating model and that service-dependent fine-tuning is required. CONCLUSION This study's findings support the use of ERD and patient transport safety checklists in practical work in EMS for promoting safety. In addition to safety checklists, other sections of CRM and its applications to EMS should also be studied.
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Arshad SA, Ferguson DM, Garcia EI, Hebballi NB, Noorbaksh AA, Vehawn JW, Ceron SA, Tsao K. Implementation of a Parent-centered Approach to the Preinduction Checklist in Pediatric Surgery. J Surg Res 2020; 257:455-461. [PMID: 32892145 DOI: 10.1016/j.jss.2020.08.026] [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: 04/17/2020] [Revised: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The preinduction checklist, part of the three-phase surgical safety checklist, is performed before induction of anesthesia. Our previous research demonstrated higher checklist adherence by perioperative staff when parents were engaged in the preinduction checklist. We hypothesized that use of a parent-centered script (PCS) during the preinduction checklist would increase parent engagement and checklist adherence. METHODS A single-center, prospective, observational study was conducted in which parents of children (<18 y) undergoing nonemergent surgeries (June 2018-July 2019) were observed before and after PCS implementation. The PCS, developed by the health care team, engaged parents by directly asking them to contribute information relevant to parent knowledge. Parent engagement was rated using a five-point Likert scale, and adherence was scored for each relevant checkpoint completed. RESULTS Of 270 checklists, 154 (57%) occurred before and 116 (43%) after PCS implementation. Groups were similar by primary language, patient age, and type of surgery, but more postimplementation children had a prior surgery. The overall parent engagement score did not improve with the PCS (P = 0.8); however, there was an improvement in eye contact by parents. After introduction of the PCS, checklist adherence decreased from a median score of 6 (interquartile range 5-6) to 4 (interquartile range 4-5) (P < 0.001). CONCLUSIONS Use of a PCS did not improve parent engagement during the preinduction checklist and an unexpected decline in checklist adherence was observed. Further research, with parent and staff input, is necessary to determine how best to engage parents while ensuring high checklist adherence.
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Affiliation(s)
- Seyed A Arshad
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Dalya M Ferguson
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Elisa I Garcia
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas
| | - Ali A Noorbaksh
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Jeffrey W Vehawn
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Santiago A Ceron
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
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Elger BM, Esparaz JR, Nierstedt RT, Jennetten RC, Aprahamian CJ, Pearl RH. Engaging the patient and family in the surgical safety process utilizing. J Pediatr Surg 2020; 55:597-601. [PMID: 31262502 DOI: 10.1016/j.jpedsurg.2019.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/20/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Owing to the vulnerable nature of children, parental/caregiver engagement in surgical safety is a crucial aspect of care. Historically, the surgical safety process has been isolated from parent involvement. The digital, tablet-based surgical safety application, SafeStart, requires parent participation and provides multiple instances of verification of patient safety information from preoperative clinic visit, to perioperative care, and into the operating room. METHOD The SafeStart application was utilized for 100 pediatric general surgery patients in an IRB approved prospective study. Parent assessments of the surgical consent and safety processes were collected in pre- and postoperative surveys with a 100% response rate. Standard consent forms were used and compared as a control. RESULTS Only 31% of parents had knowledge of the surgical safety checklist process prior to their exposure to the study. 96% of the parents reported that the SafeStart patient portal was easy to use. A majority would prefer SafeStart to the standard consent process. CONCLUSION The SafeStart program connected the surgical safety process from the preoperative clinic visit through postoperative care. Parent's preferred SafeStart to the standard surgical safety checklist and consent process, felt that they were instrumental in protecting their child's safety, and would recommend SafeStart for the surgical care of others. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Breanna M Elger
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603.
| | - Joseph R Esparaz
- Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603.
| | - Ryan T Nierstedt
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603.
| | - Robert C Jennetten
- Jump Trading Simulation and Education Center, 1306 Berkeley Avenue, Peoria, IL 61603, USA.
| | - Charles J Aprahamian
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603; Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603.
| | - Richard H Pearl
- Children's Hospital of Illinois at OSF St Francis Medical Center, 420 NE Glen Oak Avenue, Suite 101, Peoria, IL 61603; Department of Surgery, University of Illinois College of Medicine at Peoria, 624 NE Glen Oak Avenue, Peoria, IL 61603; Jump Trading Simulation and Education Center, 1306 Berkeley Avenue, Peoria, IL 61603, USA.
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Abstract
The importance of defining and implementing a culture of safety in pediatric surgery is being increasingly seen as essential to decreasing complications and improving outcomes. The concept of a safety culture is a universal one, but the elements of such a culture are different for every disease and anomaly treated. In this paper, I will review these elements as they pertain to the treatment of abdominal wall defects starting from fetal evaluation to post-discharge care.
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Affiliation(s)
- Sherif Emil
- Department of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Room B04.2028, 1001 Decarie Boulevard, Montreal, QC H4A 3J1, Canada.
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Caruso TJ, Munshey F, Aldorfer B, Sharek PJ. Safety Stop: A Valuable Addition to the Pediatric Universal Protocol. Jt Comm J Qual Patient Saf 2018; 44:552-556. [PMID: 30166039 DOI: 10.1016/j.jcjq.2018.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/28/2018] [Indexed: 10/14/2022]
Abstract
PROBLEM DEFINITION The World Health Organization (WHO) guidelines and Joint Commission requirements state that the time-out component of the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™ must be performed just prior to incision. A mock Joint Commission survey at one institution revealed that the time-out was performed prior to preparation and draping (P&D) of the patient, not afterward, representing both a patient and regulatory risk. APPROACH The multidisciplinary perioperative quality improvement team at a freestanding, quaternary care, academic pediatric hospital led the development of a new time-out process. An enhanced pediatric Universal Protocol, which included a new component, the safety stop, was created. The safety stop occurred just prior to P&D of the patient, and the time-out was performed just prior to incision, aligning with WHO recommendations. After electronic correspondence and several perioperative leadership meetings, the enhanced pediatric Universal Protocol was initiated. Compliance audits were performed to demonstrate comprehensive adoption. OUTCOMES In seven operating room locations, 60 audits were completed in four weeks, with 96.7% (58/60) demonstrating compliance with the new policy. During a subsequent Joint Commission accreditation survey, the enhanced pediatric Universal Protocol with inclusion of the safety stop was highlighted as a leading practice. KEY INSIGHTS Although initially it was believed that moving the time-out from prior to P&D to just prior to incision would be a simple solution, flow mapping the complete time-out process identified significant risk of wrong-site or wrong-patient surgery with this solution. This risk was exacerbated by the small body size of pediatric patients being obscured by draping on a typical operating room table.
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Affiliation(s)
- Thomas J Caruso
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, and Physician Lead, Perioperative Improvement Team, Stanford University School of Medicine, Stanford, California.
| | - Farrukh Munshey
- Division of Pediatric Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Brea Aldorfer
- Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Paul J Sharek
- Division of Hospitalist Medicine, Department of Pediatrics, Stanford University School of Medicine
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Adherence to the Pediatric Preinduction Checklist Is Improved When Parents Are Engaged in Performing the Checklist. Surgery 2018; 164:344-349. [PMID: 29803562 DOI: 10.1016/j.surg.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/12/2018] [Accepted: 04/03/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The World Health Organization recommends including the parents in completion of the pediatric surgical safety checklist. At our hospital, the preinduction surgical safety checklist is conducted in the preoperative holding with anesthesia, nursing, and often with the parents of children undergoing an operative procedure. We hypothesized that adherence to the preinduction checklist is better when parents are engaged in surgical safety checklist performance. METHODS An observational study of adherence to the preinduction checklist for nonemergent pediatric operations was performed (2016-2017). Adherence was defined as verbalization of checkpoints. Only checkpoints (patient identification, procedure, site marking, weight, allergies, and NPO status) relevant to parental knowledge were evaluated. Parental engagement was based on: positive body language, eye contact, lack of distractions, and understanding of checkpoints. RESULTS 484 preinduction surgical safety checklists were observed (interrater reliability >0.7). Partial completion occurred in 55% cases; only 41% checklists were fully completed. Parents were present for 81% of checklists, and more checkpoints were performed when parents were present (5, IQR 4-6) versus absent (2, IQR 1-3, P < .001). Increased preinduction adherence was associated with increased parent engagement by linear regression analysis (1.20, 95%CI 1.05-1.33). Staff confirmed more checkpoints with engaged parents (28-78%) versus when parents were not engaged (1-9%, P < .001 for all checkpoints). CONCLUSION Overall preinduction surgical safety checklist performance was poor (less than half of checklists fully completed). In contrast, checklist adherence improved with parental presence and engagement during performance of the checklist.
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Anderson KT, Appelbaum R, Bartz-Kurycki MA, Tsao K, Browne M. Advances in perioperative quality and safety. Semin Pediatr Surg 2018; 27:92-101. [PMID: 29548358 DOI: 10.1053/j.sempedsurg.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
For decades, safe surgery focused on intraoperative technique and decision-making. The traditional hierarchy placed the surgeon as the leader with ultimate authority and responsibility. Despite the advances in surgical technique and equipment, too many patients have suffered unnecessary complications and suboptimal care. Today, we understand that the conduct of safe and effective surgery requires evidence-based decision-making, multifaceted treatment approaches to prevent complications, and effective communication in and out of the operating room. In this manuscript, we describe three significant advances in quality and safety that have changed the approach to surgical care: the National Surgical Quality Improvement Program, evidence-based bundled prevention of surgical site infections, and the Surgical Safety Checklist.
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Affiliation(s)
- Kathryn T Anderson
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rachel Appelbaum
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Marisa A Bartz-Kurycki
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - KuoJen Tsao
- Center for Surgical Trials and Evidence-based Practice, Division of General and Thoracic Surgery, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marybeth Browne
- USF Morsani College of Medicine, Division of Pediatric Surgical Specialties, Lehigh Valley Children's Hospital, Department of Surgery, Lehigh Valley Health Network, 1210 S Cedar Crest Blvd, Allentown, PA 18103-6241, USA.
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Akbilgic O, Langham MR, Walter AI, Jones TL, Huang EY, Davis RL. A novel risk classification system for 30-day mortality in children undergoing surgery. PLoS One 2018; 13:e0191176. [PMID: 29351327 PMCID: PMC5774754 DOI: 10.1371/journal.pone.0191176] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/03/2017] [Indexed: 12/21/2022] Open
Abstract
A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012-2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner.
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Affiliation(s)
- Oguz Akbilgic
- University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Max R. Langham
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Arianne I. Walter
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Tamekia L. Jones
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, United States of America
| | - Eunice Y. Huang
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Robert L. Davis
- University of Tennessee Health Science Center-Oak Ridge National Laboratory Center for Biomedical Informatics, Memphis, Tennessee, United States of America
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Lagoo J, Lopushinsky SR, Haynes AB, Bain P, Flageole H, Skarsgard ED, Brindle ME. Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis. BMJ Open 2017; 7:e016298. [PMID: 29042377 PMCID: PMC5652514 DOI: 10.1136/bmjopen-2017-016298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. SUMMARY BACKGROUND DATA Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. METHODS A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing. RESULTS 1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety. CONCLUSIONS A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs' role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.
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Affiliation(s)
- Janaka Lagoo
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Alex B Haynes
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts, USA
| | - Helene Flageole
- Section of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E Brindle
- Ariadne Labs: A joint center of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, Massachusetts, USA
- Section of Pediatric Surgery, University of Calgary, Calgary, Alberta, Canada
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