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Erkan HN, Soyer Er Ö. The Retained Surgical Items Risk Assessment Scale: Development and Psychometric Characteristics. J Surg Res 2024; 296:581-588. [PMID: 38340492 DOI: 10.1016/j.jss.2023.12.052] [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: 08/18/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Retained surgical items in operating rooms (ORs) continue to contribute significantly to medical errors. The first step in addressing the problem of retained surgical items is to identify the main risk factors. Identification of risk factors can impact OR standards and reduce such errors. METHODS The research included 270 participants. The data of the study were collected with the Sociodemographic and Clinical Characteristics Form, Operating Room Count Control Form and the Retained Surgical Items Risk Assessment Scale developed. In the analysis of the data, Content Validity Index, Cronbach α, item-total score correlation, Kuder-Richardson, Kappa, exploratory and confirmatory factor analysis, and Receiver Operating Characteristic (ROC) curve analysis were performed. RESULTS The Content Validity Index of the scale was 0.92. Kappa value was 0.993. The explained variance in the exploratory factor analysis of the scale was 50.03%. After confirmatory factor analysis, two factors were obtained for the final version of the 15 items. Factors had been determined as "Count and Surgery" and "Equipment". Among the subdimensions of the scale, Cronbach's α values were between 0.742 and 0.760, and 0.722 for the entire scale. When the ROC analysis results were examined, the cut-off point was ≥8, the specificity was 93.13%, and the sensitivity was 87.50%. The area under the ROC curve was calculated as 0.938. CONCLUSIONS The scale was presented as a valid and reliable measurement tool developed to assess the Retained Surgical Items Risk in ORs. If high-risk patients are checked and necessary precautions are taken before leaving the ORs, the incidence of retained surgical items can be significantly reduced.
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Affiliation(s)
- Hamide Nur Erkan
- Surgical Nursing Department, Afyonkarahisar Health Sciences University, Graduate Education Institute, Afyonkarahisar, Turkey
| | - Özlem Soyer Er
- Assistant Professor, Surgical Nursing Department, Afyonkarahisar Health Sciences University, Faculty of Health Sciences, Afyonkarahisar, Turkey.
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Bourabaa S, El Hamdani H, Hamid M, Zhim M, Settaf A. Gossypiboma mimicking a hydatid cyst: A case report. Int J Surg Case Rep 2023; 113:109034. [PMID: 37980773 PMCID: PMC10694283 DOI: 10.1016/j.ijscr.2023.109034] [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: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Retained foreign bodies have become very rare in countries where the safety rules in the operating theater are very rigorous and follow precise guidelines. Maintaining awareness of this issue among surgeons and radiologists is of paramount importance to minimize avoidable morbidity and facilitate the selection of the most suitable therapeutic strategy. This consideration is particularly relevant in the differential diagnosis of hydatid cysts. This study describes a case of intra-abdominal gossypiboma, which mimicked hydatid cyst on preoperative assessment. CASE PRESENTATION We report the case of a 63-year-old female who was referred to our department for the management of a hepatic hydatid cyst. She has history of open cholecystectomy and oophorocystectomy. During the intervention, we discovered a 10 cm mass located in the interhepatogastric region. Complete resection of the mass was performed, and pathology results were compatible with a piece of gauze surrounded by reactive changes (gossypiboma). DISCUSSION Gossypiboma is undeniably a source of concern for surgeons. It's a genuine and serious surgical complication which can potentially arise from any type of surgery and may manifest with diverse complaints. However, it is crucial to emphasize that this complication is preventable with the primary preventive measure being meticulous counting of surgical materials during the procedure. CONCLUSION The potential embarrassment experienced by the surgeon and the significant legal consequences associated with this iatrogenic complication are substantial. Hence, it becomes imperative to adopt all requisite preventive measures to avert such incidents, as there is no excuse that can justify their occurrence.
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Affiliation(s)
- S Bourabaa
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco.
| | - H El Hamdani
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - M Hamid
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - M Zhim
- Radiology Department, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
| | - A Settaf
- Surgical Department B, Ibn Sina University Hospital, Rabat, Morocco; Université Mohamed V of Rabat, Rabat, Morocco
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Schwappach D, Havranek MM. Are temporal trends in retained foreign object rates after surgery in Switzerland impacted by increasing coding intensity? A retrospective analysis of hospital routine data from 2000 to 2019. BMJ Open 2023; 13:e075660. [PMID: 37562932 PMCID: PMC10423772 DOI: 10.1136/bmjopen-2023-075660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES Retained foreign objects (RFOs) after surgery can cause harm to patients and negatively impact clinician and hospital reputation. RFO incidence based on administrative data is used as a metric of patient safety. However, it is unknown how differences in coding intensity across hospitals and years impact the number of reported RFO cases. The objective of this study is to investigate the temporal trend of RFO incidence at a national level and the impact of changes in coding practices across hospitals and years. DESIGN Retrospective study using administrative hospital data. SETTING AND PARTICIPANTS 21 805 005 hospitalisations at 354 Swiss acute-care hospital sites PRIMARY AND SECONDARY OUTCOME MEASURES: RFO incidence over time, the distribution of RFOs across hospitals and the impact of differences in coding intensity across the hospitals and years. RESULTS The annual RFO rate more than doubled between 2000 and 2019 (from 4.6 to 11.8 with a peak of 17.0 in 2014) and coincided with increasing coding intensity (mean number of diagnoses: 3.4, SD 2.0 in 2000; 7.40, SD 5.2 in 2019). After adjusting for patient characteristics, two regression models confirmed that coding intensity was a significant predictor of both whether RFO cases were reported at the hospital level (OR: 12.94; 95% CI: 7.38 to 22.68) and the number of reported cases throughout the period at the national level (Incidence Rate Ratio (IRR): 5.95; 95% CI: 1.11 to 31.82). CONCLUSIONS Our results raise concerns about the use of RFO incidence for comparing hospitals, countries and years. Utilising coding indices could be employed to mitigate the effects of coding intensity on RFO rates.
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Affiliation(s)
- David Schwappach
- Faculty of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
| | - Michael M Havranek
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Ventura Spagnolo E, Mondello C, Roccuzzo S, Baldino G, Sapienza D, Gualniera P, Asmundo A. Fire in operating room: The adverse "never" event. Case report, mini-review and medico-legal considerations. Leg Med (Tokyo) 2021; 51:101879. [PMID: 33862320 DOI: 10.1016/j.legalmed.2021.101879] [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: 07/15/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
The patient's security and safety represent a topic of great importance for public health that led several healthcare organizations in many Countries to share documents to promote risk management and preventing adverse events. Surgical Fire (SF) is an infrequent adverse event generally occurring in the operating room (OR) and consisting of a fire that occurs in, on, or around a patient undergoing a medical or surgical procedure. Here a medico-legal case involving a 65-year-old woman reporting burns to the neck due to an SF during a thyroidectomy was described. A literature review was performed using Pubmed and Scopus databases, focusing on epidemiology, causes, prevention activities associated with the SF, and the related best practices recommendations. The medico-legal analysis of the case led to admit the professional liability because the suggested time (3 min) to use the electrocautery after CHG application was not respected. The case analysis and the literature review suggest the importance of implementing National and Local procedures to promote the management of SF risk. Finally, it is necessary to highlight the role of incident reporting and root causes analysis in understanding the cause of the adverse events and thus enforce their prevention.
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Affiliation(s)
- Elvira Ventura Spagnolo
- Section Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy.
| | - Cristina Mondello
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.
| | - Salvatore Roccuzzo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Gennaro Baldino
- Section Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy
| | - Daniela Sapienza
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Patrizia Gualniera
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessio Asmundo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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Melloni ND, Bosco C, Cena G, Putzu MG, Di Vella G. Retained surgical thread and forensic investigation: Malpractice or complication? Leg Med (Tokyo) 2020; 47:101749. [PMID: 32682295 DOI: 10.1016/j.legalmed.2020.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Niccolò D Melloni
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy.
| | - Caterina Bosco
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
| | - Greta Cena
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
| | - Maria Grazia Putzu
- University Occupational Medicine and Hospital Occupational Hazards Unit, A.O.U Città della Salute e della Scienza di Torino, Italy
| | - Giancarlo Di Vella
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
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Gualniera P, Mondello C, Scurria S, Oliva A, Grassi S, Pizzicannella J, Alibrandi A, Sapienza D, Asmundo A. Experience of an Italian Hospital Claims Management Committee: A tool for extrajudicial litigations resolution. Leg Med (Tokyo) 2019; 42:101657. [PMID: 31884219 DOI: 10.1016/j.legalmed.2019.101657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/23/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
Litigation related to medical liability has a great impact on Italian healthcare expenditure. Recently, many Italian Regions have adopted a "self-insurance system" and, in Sicilian Hospitals, were established the Claims Management Committees (CMC) to provide the direct management of claims. Here the experience of a Sicilian University Hospital CMC was described to analyze the claims features and their outcomes providing evidence on CMC usefulness. The analysis involved claims for compensation received during 4 years, using data obtained by a retrospective analysis of claims database created by Forensic Medicine Service. Claims data, obtained from the insurance broker, were used to perform the statistical comparison. During the examined period a total of 377 claims were received by CMC, respectively 63.6% for professional liability and 36.4% for other causes (damages not related to medical malpractice). The prevalence of complaints about malpractice regarded surgery. The CMC had expressed an opinion on 120 claims related to malpractice with the percentages of admission or rejection of liability respectively of 55% and 45%. The statistical analysis revealed a greater number of lawsuits in the Insurance system and, moreover, the CMC higher probability to reach the amicable settlement of litigations. CMC provides specific data on claims trend and economic expenditure, demonstrating its usefulness for analysis and monitoring the causes of patients/people damage. It is a tool for medical malpractice risk assessment and prevention. It can encourage the amicable settlement and prevention of civil action. It seems to be an efficient system to reduce the health liability costs.
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Affiliation(s)
- Patrizia Gualniera
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Cristina Mondello
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy.
| | - Serena Scurria
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Antonio Oliva
- Section of Legal Medicine, Institute of Public Health, Catholic University, Fondazione Policlinico A. Gemelli, IRCCS, Italy
| | - Simone Grassi
- Section of Legal Medicine, Institute of Public Health, Catholic University, Fondazione Policlinico A. Gemelli, IRCCS, Italy
| | - Jacopo Pizzicannella
- Department of Medical, Oral and Biotechnological Sciences, University "Gabriele d'Annunzio", Chieti-Pescara, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Via dei Verdi 75, 98122 Messina, Italy.
| | - Daniela Sapienza
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessio Asmundo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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