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Levy BE, Wilt WS, Lantz S, Ballert E, Harris A. Standardization and Visualization of the Surgical Time-Out. J Patient Saf 2023; 19:453-459. [PMID: 37729643 DOI: 10.1097/pts.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
INTRODUCTION The time-out (TO) can prevent adverse events but is subject to TO engagement. We hypothesize transforming the TO to an auditable, active process will improve compliance and engagement. METHODS The passive nature of the current TO was identified as a potential safety issue on staff patient safety culture surveys. Subsequently, the Time Out Engagement and Standardization quality improvement initiative was developed and included a whiteboard checklist to be used in the operating room. As a baseline, 11 TOs were audited concerning engagement and content. Key stakeholders were engaged to determine potential interventions. A TO consisting of 15 elements using a TO whiteboard checklist with role-specific objectives was developed. Plan, Do, Study, Act cycles commenced. After implementation, 17 TOs were audited based on engagement and content. RESULTS Before intervention, engagement varied with nurse participating in 100% compared with anesthesia provider or surgeon participating in 18%. No TO included all 15 elements and only 13% of elements included in all TOs. After implementation of Time Out Engagement and Standardization, anesthesia and surgeon who participated increased to 100% and 76.5%, respectively (P < 0.0001, P = 0.006). The 15 standardized elements of the TO were discussed in 90% of cases. Overall, preintervention 88 elements (57.1%) were completed across all TOs, while postintervention 243 elements (98.8%) were completed (P < 0.001). CONCLUSIONS We identified a need for increased engagement of the TO based on staff concerns, which were verified through auditing. Implementation of a team-driven intervention and 3 rapid Plan, Do, Study, Act cycles led to measurable improvement of the surgical TO.
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Affiliation(s)
| | - Wesley S Wilt
- From the Department of Surgery, University of Kentucky
| | - Sherry Lantz
- Department of Surgery, Lexington Veteran's Affairs Medical Center
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Pati AB, Mishra TS, Chappity P, Venkateshan M, Pillai JSK. Use of Technology to Improve the Adherence to Surgical Safety Checklists in the Operating Room. Jt Comm J Qual Patient Saf 2023; 49:572-576. [PMID: 37198060 DOI: 10.1016/j.jcjq.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Although checklists can improve safety in the operating room (OR), compliance with their use is variable. Use of a forcing function, a principle of human factors engineering, has not been reported earlier as a method of increasing checklist use. The authors conducted this study to determine the feasibility and effects of introducing a forcing function on OR surgical safety checklist implementation and adherence. METHODS The authors developed and introduced the use of an electronic version of the surgical safety checklist on an Android application, provided on a personal device available in the OR. This application was linked by Bluetooth to electrocautery equipment, which could not be started before the electronic checklist was completed on the screen of the personal device. In the same OR, retrospective data from use of the traditional (paper-based) checklist were compared with data from the new electronic checklist for frequency of use, and completeness (percentage of all checklist items completed) at three stages of the surgical process-sign-in, time-out, and sign-out. RESULTS The frequency of use was 100.0% for the electronic checklist, compared with 97.9% for the traditional checklist. The frequency of completeness was 27.1% for the traditional vs. 100.0% for the electronic (p < 0.001).The manual checklist's sign-out component was completed only 37.0% of the time. CONCLUSION Although checklist use in some form was already high with the traditional checklist, completion rate was low and significantly increased with the use of the electronic checklist with a forcing function.
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Rydenfält C, Persson J, Erlingsdóttir G, Larsson R, Johansson G. Home care nurses' and managers' work environment during the Covid-19 pandemic: Increased workload, competing demands, and unsustainable trade-offs. APPLIED ERGONOMICS 2023; 111:104056. [PMID: 37257218 DOI: 10.1016/j.apergo.2023.104056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/31/2022] [Accepted: 05/26/2023] [Indexed: 06/02/2023]
Abstract
Little research exists on how home care nursing personnel have experienced the Covid-19 pandemic. This qualitative study explores the work environment related challenges nurses and managers in home care faced during the pandemic. We discuss these challenges in relation to the Demand-Control-Support Model and reflect on how the organizational dynamics associated with them can be understood using the competing pressures model. During the pandemic, home care nurses and managers experienced both an increased workload and psychosocial strain. For managers, the increased complexity of work was a major problem. We identify three key takeaways related to sustainable crisis management: 1) to support managers' ability to provide social support to their personnel, 2) to increase crisis communication preparedness, and 3) to apply a holistic perspective on protective gear use. We also conclude that the competing pressures model is useful when exploring the dynamics of the work environment in complex organizational contexts.
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Affiliation(s)
- Christofer Rydenfält
- Department of Design Sciences, Lund University, Faculty of Engineering, P.O. Box 118, SE-221 00, Lund, Sweden.
| | - Johanna Persson
- Department of Design Sciences, Lund University, Faculty of Engineering, P.O. Box 118, SE-221 00, Lund, Sweden.
| | - Gudbjörg Erlingsdóttir
- Department of Design Sciences, Lund University, Faculty of Engineering, P.O. Box 118, SE-221 00, Lund, Sweden.
| | - Roger Larsson
- Department of Design Sciences, Lund University, Faculty of Engineering, P.O. Box 118, SE-221 00, Lund, Sweden.
| | - Gerd Johansson
- Department of Design Sciences, Lund University, Faculty of Engineering, P.O. Box 118, SE-221 00, Lund, Sweden.
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Toru HK, Aman Z, Ali MH, Kundi W, Khan MA, Ali F, Khan S, Zahid MJ, Jan ZU. Compliance With the World Health Organization Surgical Safety Checklist at a Tertiary Care Hospital: A Closed Loop Audit Study. Cureus 2023; 15:e39808. [PMID: 37398744 PMCID: PMC10313906 DOI: 10.7759/cureus.39808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The WHO launched the "Safe Surgery Saves Lives" campaign in 2008 to improve patient safety during surgery. The campaign includes the use of the WHO Surgical Safety Checklist, which has been proven effective in reducing complications and mortality rates in several studies. This article discusses a clinical audit at a tertiary healthcare facility that assesses compliance with all three components of the checklist to minimize errors and improve safety standards. MATERIALS AND METHODS This prospective, observational, closed-loop clinical audit study was conducted at Hayatabad Medical Complex, a tertiary care public sector hospital located in Peshawar, Pakistan. The audit aimed to assess compliance with the WHO Surgical Safety Checklist. The first phase of the audit cycle commenced on October 5, 2022, and involved collecting data from 91 surgical cases in randomly selected operating rooms. Following the completion of the first phase on December 13, 2022, an educational intervention was then conducted on December 15 to underscore the significance of adhering to the checklist, and the second phase of data collection began the following day, ending on February 22, 2023. The results were analyzed using SPSS Statistics version 27.0. RESULTS The first phase of the audit showed that there was poor compliance with the latter two parts of the checklist. Certain components of the WHO Surgical Safety Checklist were well-complied with, including patient identity confirmation (95.6%), obtaining informed consent (94.5%), and counting of sponges and instruments (95.6%), while the lowest compliance rates were in recording allergies (26.3%), assessing blood loss risk (15.3%), introducing team members (62.6%), and inquiring about patient recovery concerns (64.8%, 34%, and 20.8% for surgeons, anesthetists, and nurses, respectively). In the second phase, after an educational intervention, compliance with the checklist improved significantly, particularly for those components with low compliance rates in the first phase, marking recording allergies (89.0%), introducing team members 91.2%), and inquiring about patient recovery concerns (79.1%, 73.6%, and 70.3% for surgeons, anesthetists, and nurses, respectively). CONCLUSION The study showed that education is a critical factor in improving compliance with the WHO Surgical Safety Checklist. The study suggests that overcoming the obstacles to implementing the checklist requires a collaborative environment and effective instruction. It emphasizes the importance of adhering to the checklist in all surgical settings.
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Affiliation(s)
- Hamza K Toru
- General Surgery, Khyber Teaching Hospital, Peshawar, PAK
| | - Zahid Aman
- General Surgery, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Waqas Kundi
- General Surgery, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Fawad Ali
- General Surgery, Hayatabad Medical Complex, Peshawar, PAK
| | - Shandana Khan
- General Surgery, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Zaka Ullah Jan
- General Surgery, Khyber Teaching Hospital, Peshawar, PAK
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Gul F, Nazir M, Abbas K, Khan AA, Malick DS, Khan H, Kazmi SNH, Naseem AO. Surgical safety checklist compliance: The clinical audit. Ann Med Surg (Lond) 2022; 81:104397. [PMID: 36147088 PMCID: PMC9486577 DOI: 10.1016/j.amsu.2022.104397] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Fahad Gul
- Department of Surgery, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Maheen Nazir
- Department of Surgery, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Khawar Abbas
- Department of Surgery, Rawalpindi Medical University, Rawalpindi, Pakistan
- Corresponding author.
| | | | | | - Hashim Khan
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Arbab Osama Naseem
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
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McGhee I, Tarshis J, DeSousa S. Improving Ad Hoc Medical Team Performance with an Innovative "I START-END" Communication Tool. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:809-820. [PMID: 35959135 PMCID: PMC9359176 DOI: 10.2147/amep.s367973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To study the effect of a communication tool entitled: "I START-END" (I-Identify; S-Story; T-Task; A-Accomplish/Adjust; R-Resources; T-Timely Updates; E-Exit; N-Next; D-Document and Debrief) in simulated urgent scenarios in non-operating room settings (referred to as "Ad Hoc") with anesthesia residents. The "I START-END" tool was created by incorporating Crisis Resource Management (CRM) principles into a practical and user-friendly format. METHODS This was a mixed methods pre/post observational study with 47 anesthesia resident volunteers participating from July 2014 to June 2016. Each resident served as their own control, and participated in three simulated Ad Hoc scenarios. The first simulation served as a baseline. The second simulation occurred 1-2 weeks after I START-END training. The third simulation occurred 3-6 months later. Simulation performance was videotaped and reviewed by trained experts using technical skill checklists and Anesthesia Non-Technical Skills (ANTS) score. Residents filled out questionnaires, pre-simulation, 1-2 weeks after I START-END training and 3-6 months later. Concurrently, resident performance at actual Code Blue events was scored by trained observers using the Mayo High Performance Teamwork Scale. RESULTS 80-90% of residents stated the tool provided an organized approach to Ad Hoc scenarios - specifically, information helpful to care of the patient was obtained more readily and better resource planning occurred as communication with the team improved. Residents stated they would continue to use the tool and apply it to other clinical settings. Resident video performance scores of technical skills showed significant improvement at the "late" session (3-6 months post exposure to the I START-END). ANTS scores were satisfactory and remained unchanged throughout. There was no difference between residents with and without I START-END training as measured by the Mayo High Performance Teamwork Scale, however, debriefing at Code Blues occurred twice as often when residents had I START-END training. CONCLUSION Non-operating room settings are fraught with unfamiliarity that create many challenges. The I START-END tool operationalizes key CRM elements. The tool was well received by residents; it enabled them to speak up more readily, obtain vital information and continually update each other by anticipating, planning, and debriefing in an organized and collaborative way.
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Affiliation(s)
- Irene McGhee
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jordan Tarshis
- Department of Anesthesiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan DeSousa
- Sunnybrook Canadian Simulation Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Armstrong BA, Dutescu IA, Nemoy L, Bhavsar E, Carter DN, Ng KD, Boet S, Trbovich P, Palter V. Effect of the surgical safety checklist on provider and patient outcomes: a systematic review. BMJ Qual Saf 2022; 31:463-478. [PMID: 35393355 DOI: 10.1136/bmjqs-2021-014361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite being implemented for over a decade, literature describing how the surgical safety checklist (SSC) is completed by operating room (OR) teams and how this relates to its effectiveness is scarce. This systematic review aimed to: (1) quantify how many studies reported SSC completion versus described how the SSC was completed; (2) evaluate the impact of the SSC on provider outcomes (Communication, case Understanding, Safety Culture, CUSC), patient outcomes (complications, mortality rates) and moderators of these relationships. METHODS A systematic literature search was conducted using Medline, CINAHL, Embase, PsycINFO, PubMed, Scopus and Web of Science on 10 January 2020. We included providers who treat human patients and completed any type of SSC in any OR or simulation centre. Statistical directional findings were extracted for provider and patient outcomes and key factors (eg, attentiveness) were used to determine moderating effects. RESULTS 300 studies were included in the analysis comprising over 7 302 674 operations and 2 480 748 providers and patients. Thirty-eight per cent of studies provided at least some description of how the SSC was completed. Of the studies that described SSC completion, a clearer positive relationship was observed concerning the SSC's influence on provider outcomes (CUSC) compared with patient outcomes (complications and mortality), as well as related moderators. CONCLUSION There is a scarcity of research that examines how the SSC is completed and how this influences safety outcomes. Examining how a checklist is completed is critical for understanding why the checklist is successful in some instances and not others.
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Affiliation(s)
- Bonnie A Armstrong
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ilinca A Dutescu
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Lori Nemoy
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ekta Bhavsar
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana N Carter
- General Surgery, Milton District Hospital, Milton, Ontario, Canada
| | | | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada.,Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,Institut du Savoir Montfort, Ottawa, ON, Canada.,Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Patricia Trbovich
- Surgery, North York General Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Vanessa Palter
- Surgery, International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Serou N, Slight RD, Husband AK, Forrest SP, Slight SP. A Retrospective Review of Serious Surgical Incidents in 5 Large UK Teaching Hospitals: A System-Based Approach. J Patient Saf 2022; 18:358-364. [PMID: 35617594 DOI: 10.1097/pts.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Surgical incidents are the most common serious patient safety incidents worldwide. We conducted a review of serious surgical incidents recorded in 5 large teaching hospitals located in one London NHS trust to identify possible contributing factors and propose recommendations for safer healthcare systems. METHODS We searched the Datix system for all serious surgical incidents that occurred in any operating room, excluding critical care departments, and were recorded between October 2014 and December 2016. We used the London Protocol system analysis framework, which involved a 2-stage approach. A brief description of each incident was produced, and an expert panel analyzed these incidents to identify the most likely contributing factors and what changes should be recommended. RESULTS One thousand fifty-one surgical incidents were recorded, 14 of which were categorized as "serious" with contributing factors relating to task, equipment and resources, teamwork, work environmental, and organizational and management. Operating room protocols were found to be unavailable, outdated, or not followed correctly in 8 incidents studied. The World Health Organization surgical safety checklist was not adhered to in 8 incidents, with the surgical and anesthetic team not informed about faulty equipment or product shortages before surgery. The lack of effective communication within multidisciplinary teams and inadequate medical staffing levels were perceived to have contributed. CONCLUSIONS Multiple factors contributed to the occurrence of serious surgical incidents, many of which related to human failures and faulty equipment. The use of faulty equipment needs to be recognized as a major risk within departments and promptly addressed.
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Affiliation(s)
| | | | - Andy K Husband
- From the School of Pharmacy, Newcastle University, Newcastle Upon Tyne
| | - Simon P Forrest
- Department of Sociology, Durham University, Durham, United Kingdom
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Albsoul R, Alshyyab MA, Al Odat BA, Al Dwekat NB, Al-masri BE, Alkubaisi FA, Flefil SA, Al-Khawaldeh MH, Sa'ed RA, Abu Ajamieh MW, Fitzgerald G. Surgical team perceptions of the surgical safety checklist in a tertiary hospital in Jordan: a descriptive qualitative study. TQM JOURNAL 2022. [DOI: 10.1108/tqm-02-2022-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore the perceptions of operating room staff towards the use of the World Health Organization Surgical Safety Checklist in a tertiary hospital in Jordan.Design/methodology/approachThis was a qualitative descriptive study. Semi-structured interviews were conducted with a purposeful sample of 21 healthcare staff employed in the operating room (nurses, residents, surgeons and anaesthesiologists). The interviews were conducted in the period from October to December 2021. Thematic analysis was used to analyse the data.FindingsThree main themes emerged from data analysis namely compliance with the surgical safety checklist, the impact of surgical safety checklist, and barriers and facilitators to the use of the surgical safety checklist. The use of the checklist was seen as enabling staff to communicate effectively and thus to accomplish patient safety and positive outcomes. The perceived barriers to compliance included excessive workload, congestion and lack of training and awareness. Enhanced training and education were thought to improve the utilization of the surgical safety checklist, and help enhance awareness about its importance.Originality/valueWhile steps to utilize the surgical safety checklist by the operation room personnel may seem simple, the quality of its administration is not necessarily robust. There are several challenges for consistent, complete and effective administration of the surgical safety checklist by the surgical team members. Healthcare managers must employ interventions to eliminate barriers to and offer facilitators of adherence to the application of the surgical safety checklist, therefore promoting quality healthcare and patient safety.
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Rydenfält C. Safety-II and the study of healthcare safety routines: Two paths forward for research. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Safety routines such as the WHO surgical safety checklist and SBAR have gained widespread attention and implementation in healthcare. However, there has also been criticism. With the ongoing Covid-19 pandemic, the need for knowledge about how safety routines work in practice is larger than ever. In light of these obstacles, I suggest two approaches to the study of healthcare safety routines, based on a human factors perspective and a safety II mind-set that so far has gained little attention. The WHO surgical safety checklist, is used as an example. However, the suggestions presented here applies to other safety routines as well. The first approach is that instead of being preoccupied with what people do not do, investigate what they value with the routine . The perceived importance of different parts of the routine can expose the rationality behind the personnel's choice of actions when using the routine. Knowledge that could be used both to investigate the dynamics of everyday performance and for redesign and adjustment of the routine. The second approach is that instead of looking for failure, investigate and highlight when the routine works. Examples of when the routine works, i.e. avert adverse events, can be used both as positive reinforcement, and as an opportunity for learning with regards to everyday performance variability. Since a safety-II perspective is largely missing in the literature on healthcare safety routines, the two approaches suggested here comes with a huge potential for learning about how to improve safety.
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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van Dalen ASH, Swinkels JA, Coolen S, Hackett R, Schijven MP. Improving teamwork and communication in the operating room by introducing the theatre cap challenge. J Perioper Pract 2022; 32:4-9. [PMID: 35001734 PMCID: PMC8750134 DOI: 10.1177/17504589211046723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective One of the steps of the Surgical Safety Checklist is for the team members to
introduce themselves. The objective of this study was to implement a tool to
help remember and use each other’s names and roles in the operating
theatre. Methods This study was part of a pilot study in which a video and medical data
recorder was implemented in one operating theatre and used as a tool for
postoperative multidisciplinary debriefings. During these debriefings, name
recall was evaluated. Following the implementation of the medical data
recorder, this study was started by introducing the theatre cap challenge,
meaning the use of name (including role) stickers on the surgical cap in the
operating theatre. Findings In total, 41% (n = 40 out of 98) of the operating theatre members were able
to recall all the names of their team at the team briefings. On average
44.8% (n = 103) was wearing the name sticker. Conclusions The time-out stage of the Surgical Safety Checklist might be inadequate for
correctly remembering and using your operating theatre team members’ names.
For this, the theatre cap challenge may help.
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Affiliation(s)
- Anne Sophie Hm van Dalen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan A Swinkels
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Stan Coolen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Hackett
- Department of Anesthesiology, 2205Royal Prince Alfred Hospital, 2205Royal Prince Alfred Hospital, Sydney, Australia
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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13
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Lindström P, Krupic F, Rahim Y, Grbic K. As a member of the surgical team, the nurse anesthetist's view of using the WHO surgical safety checklist in Swedish health care. Int J Appl Basic Med Res 2022; 12:111-116. [PMID: 35754663 PMCID: PMC9215185 DOI: 10.4103/ijabmr.ijabmr_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction: In Sweden, during specialty training, the nurse anesthetist learns how to ensure patient safety in a health-care setting by implementing the surgical checklist measures during perioperative care. To date, there are still considerable shortcomings when it comes to implementing these patient safety measures in Swedish hospitals. Aim: The purpose of this study is to describe the use of the WHO surgical safety checklist (WHOSSC) by surgical teams, with special emphasis on nurse anesthetists to increase patient safety. Materials and Methods: This descriptive questionnaire-based study was performed between September 2018 and March 2019 and included 196 health-care professionals who completed the questionnaire. The survey was carried out among all the health-care professionals at two surgical units at a university hospital during the data collection period. Results: The results reveal that the majority of health-care staff in this study agree with the need to implement the WHOSSC during surgery and the necessity of doing so to ensure patient safety. However, it is not clear whether this checklist needs to be made a matter of routine at the clinics and whether this is possible in emergency situations. Conclusion: The nurse anesthetists, as members of the surgical team, use the list all the time in emergency situations and conclude, like other members of the team, that the list improves patient safety. Clearer procedures are needed during surgery regarding the usage of the checklist in practice, and there should be a designated person in the surgical team responsible for implementing the checklist.
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Lee JY, Szulewski A, Young JQ, Donkers J, Jarodzka H, van Merriënboer JJG. The medical pause: Importance, processes and training. MEDICAL EDUCATION 2021; 55:1152-1160. [PMID: 33772840 PMCID: PMC8518691 DOI: 10.1111/medu.14529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 02/28/2021] [Accepted: 03/19/2021] [Indexed: 05/10/2023]
Abstract
Research has shown that taking 'timeouts' in medical practice improves performance and patient safety. However, the benefits of taking timeouts, or pausing, are not sufficiently acknowledged in workplaces and training programmes. To promote this acknowledgement, we suggest a systematic conceptualisation of the medical pause, focusing on its importance, processes and implementation in training programmes. By employing insights from educational and cognitive psychology, we first identified pausing as an important skill to interrupt negative momentum and bolster learning. Subsequently, we categorised constituent cognitive processes for pausing skills into two phases: the decision-making phase (determining when and how to take pauses) and the executive phase (applying relaxation or reflection during pauses). We present a model that describes how relaxation and reflection during pauses can optimise cognitive load in performance. Several strategies to implement pause training in medical curricula are proposed: intertwining pause training with training of primary skills, providing second-order scaffolding through shared control and employing auxiliary tools such as computer-based simulations with a pause function.
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Affiliation(s)
- Joy Yeonjoo Lee
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Adam Szulewski
- Departments of Emergency Medicine and PsychologyQueen’s UniversityKingstonONCanada
| | - John Q. Young
- Department of PsychiatryDonald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Zucker Hillside Hospital at Northwell HealthGlen OaksNYUSA
| | - Jeroen Donkers
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Halszka Jarodzka
- Faculty of Education SciencesOpen UniversityHeerlenThe Netherlands
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15
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Neuhaus C, Spies A, Wilk H, Weigand MA, Lichtenstern C. "Attention Everyone, Time Out!": Safety Attitudes and Checklist Practices in Anesthesiology in Germany. A Cross-Sectional Study. J Patient Saf 2021; 17:467-471. [PMID: 28574957 DOI: 10.1097/pts.0000000000000386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of perioperative checklists has generated a growing body of evidence pointing toward reduction of mortality and morbidity, improved compliance with guidelines, reduction of adverse events, and improvements in human factor-related areas. Usual quality management metrics generally fall short in assessing compliance with their perioperative application. Our study assessed application attitudes and compliance with safety measures centered around the World Health Organization (WHO) "Safe Surgery Saves Lives" campaign as perceived by anesthesia professionals in Germany. METHODS Three hundred sixteen physicians and nurses participated in our cross-sectional survey, and 304 completed all 35 questions. RESULTS Only 59.5% of participants had knowledge of the theoretical framework behind the WHO campaign. During the "sign-in," patient ID and surgical site were checked in 99.6% and 95.1% as recommended by the WHO. Allergies were addressed by 89.2%, expected difficult airway by 65.7%, and the availability of blood products by 70.5%. A total of 84.9% of participants advocated for the time-out to include all persons present in the operating room, which was the case in 57.0%. A total of 40.8% stated that the time-out was only performed between anesthetist and surgeon; in 17.0% of cases, the patient was simultaneously draped and/or surgically scrubbed. No significant differences between hospital types were observed. CONCLUSIONS Our study paints a heterogeneous picture of the implementation, usage, and safety attitudes concerning the Safe Surgery Checklist as promoted by the WHO. The lack of standardized execution and team-mindedness can be taken as further evidence for the importance of interdisciplinary training focusing on human factors, communication, and collaboration rather than the mere implementation by decree.
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Affiliation(s)
- Christopher Neuhaus
- From the Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
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16
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Alexander HC, McLaughlin SJ, Thomas RH, Merry AF. Checklists for image-guided interventions: a systematic review. Br J Radiol 2021; 94:20200980. [PMID: 33684307 DOI: 10.1259/bjr.20200980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Safety checklists have improved safety in patients undergoing surgery. Checklists have been designed specifically for use in image-guided interventions. This systematic review aimed to identify checklists designed for use in radiological interventions and to evaluate their efficacy for improving patient safety. Secondary aims were to evaluate attitudes toward checklists and barriers to their use. METHODS OVID, MEDLINE, CENTRAL and CINAHL were searched using terms for "interventional radiology" and "checklist". Studies were included if they described pre-procedural checklist use in vascular/body interventional radiology (IR), paediatric IR or interventional neuro-radiology (INR). Data on checklist design, implementation and outcomes were extracted. RESULTS Sixteen studies were included. Most studies (n = 14, 87.5%) focused on body IR. Two studies (12.5%) measured perioperative outcome after checklist implementation, but both had important limitations. Checklist use varied between 54 and 100% and completion of items on the checklists varied between 28 and 100%. Several barriers to checklist use were identified, including a lack of leadership and education and cultural challenges unique to radiology. CONCLUSIONS We found few reports of the use of checklists in image-guided interventions. Approaches to checklist implementation varied, and several barriers to their use were identified. Evaluation has been limited. There seems to be considerable potential to improve the effective use of checklists in radiological procedures. ADVANCES IN KNOWLEDGE There are few reports of the use of checklists in radiological interventions, those identified reported significant barriers to the effective use of checklists.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Scott Jp McLaughlin
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Robert H Thomas
- Department of Interventional Radiology, Saint Mary's Hospital, London, UK
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
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17
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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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18
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Krupic F, Svantesson E, Seffo N, Westin O, Hamrin Senorski E. Use of the World Health Organization Checklist—Swedish Health Care Professionals' Experience: A Mixed-Method Study. J Perianesth Nurs 2020; 35:288-293. [DOI: 10.1016/j.jopan.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/16/2022]
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19
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van Dalen ASHM, Jansen M, van Haperen M, van Dieren S, Buskens CJ, Nieveen van Dijkum EJM, Bemelman WA, Grantcharov TP, Schijven MP. Implementing structured team debriefing using a Black Box in the operating room: surveying team satisfaction. Surg Endosc 2020; 35:1406-1419. [PMID: 32253558 PMCID: PMC7886753 DOI: 10.1007/s00464-020-07526-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
Background Surgical safety may be improved using a medical data recorder (MDR) for the purpose of postoperative team debriefing. It provides the team in the operating room (OR) with the opportunity to look back upon their joint performance objectively to discuss and learn from suboptimal situations or possible adverse events. The aim of this study was to investigate the satisfaction of the OR team using an MDR, the OR Black Box®, in the OR as a tool providing output for structured team debriefing. Methods In this longitudinal survey study, 35 gastro-intestinal laparoscopic operations were recorded using the OR Black Box® and the output was subsequently debriefed with the operating team. Prior to study, a privacy impact assessment was conducted to ensure alignment with applicable legal and regulatory requirements. A structured debrief model and an OR Back Box® performance report was developed. A standardized survey was used to measure participant’s satisfaction with the team debriefing, the debrief model used and the performance report. Factor analysis was performed to assess the questionnaire’s quality and identified contributing satisfaction factors. Multivariable analysis was performed to identify variables associated with participants’ opinions. Results In total, 81 team members of various disciplines in the OR participated, comprising 35 laparoscopic procedures. Mean satisfaction with the OR Black Box® performance report and team debriefing was high for all 3 identified independent satisfaction factors. Of all participants, 98% recommend using the OR Black Box® and the outcome report in team debriefing. Conclusion The use of an MDR in the OR for the purpose of team debriefing is considered to be both beneficial and important. Team debriefing using the OR Black Box® outcome report is highly recommended by 98% of team members participating. Electronic supplementary material The online version of this article (10.1007/s00464-020-07526-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Jansen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Haperen
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S van Dieren
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P Grantcharov
- International Centre for Surgical Safety, St Michael's Hospital, Toronto, Canada
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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20
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Wæhle HV, Haugen AS, Wiig S, Søfteland E, Sevdalis N, Harthug S. How does the WHO Surgical Safety Checklist fit with existing perioperative risk management strategies? An ethnographic study across surgical specialties. BMC Health Serv Res 2020; 20:111. [PMID: 32050960 PMCID: PMC7017532 DOI: 10.1186/s12913-020-4965-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) Surgical Safety Checklist (SSC) has demonstrated beneficial impacts on a range of patient- and team outcomes, though variation in SSC implementation and staff's perception of it remain challenging. Precisely how frontline personnel integrate the SSC with pre-existing perioperative clinical risk management remains underexplored - yet likely an impactful factor on how SSC is being used and its potential to improve clinical safety. This study aimed to explore how members of the multidisciplinary perioperative team integrate the SSC within their risk management strategies. METHODS An ethnographic case study including observations (40 h) in operating theatres and in-depth interviews of 17 perioperative team members was carried out at two hospitals in 2016. Data were analysed using content analysis. RESULTS We identified three themes reflecting the integration of the SSC in daily surgical practice: 1) Perceived usefullness; implying an intuitive advantage assessment of the SSC's practical utility in relation to relevant work; 2) Modification of implementation; reflecting performance variability of SSC on confirmation of items due to precence of team members; barriers of performance; and definition of SSC as performance indicator, and 3) Communication outside of the checklist; including formal- and informal micro-team formations where detailed, specific risk communication unfolded. CONCLUSION When the SSC is not integrated within existing risk management strategies, but perceived as an "add on", its fidelity is compromised, hence limiting its potential clinical effectiveness. Implementation strategies for the SSC should thus integrate it as a risk-management tool and include it as part of risk-management education and training. This can improve team learning around risk comunication, foster mutual understanding of safety perspectives and enhance SSC implementation.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway. .,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College London, London, UK
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Jonas Liesvei 65, N-5021, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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21
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Forsyth KL, Hildebrand EA, Hallbeck MS, Branaghan RJ, Blocker RC. Characteristics of team briefings in gynecological surgery. APPLIED ERGONOMICS 2019; 78:263-269. [PMID: 29482840 DOI: 10.1016/j.apergo.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/02/2017] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
Preoperative briefings have been proven beneficial for improving team performance in the operating room. However, there has been minimal research regarding team briefings in specific surgical domains. As part of a larger project to develop a briefing structure for gynecological surgery, the study aimed to better understand the current state of pre-operative team briefings in one department of an academic hospital. Twenty-four team briefings were observed and video recorded. Communication was analyzed and social network metrics were created based on the team member verbal interactions. Introductions occurred in only 25% of the briefings. Network analysis revealed that average team briefings exhibited a hierarchical structure of communication, with the surgeon speaking the most frequently. The average network for resident-led briefings displayed a non-hierarchical structure with all team members communicating with the resident. Briefings conducted without a standardized protocol can produce variable communication between the role leading and the team members present.
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Affiliation(s)
- Katherine L Forsyth
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA
| | | | - M Susan Hallbeck
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA; Mayo Clinic, Department of Surgery, Rochester, MN, USA
| | | | - Renaldo C Blocker
- Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA; Mayo Clinic, Department of Health Sciences Research, Rochester, MN, USA.
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22
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Wang H, Zheng T, Chen D, Niu Z, Zhou X, Li S, Zhou Y, Cao S. Impacts of the surgical safety checklist on postoperative clinical outcomes in gastrointestinal tumor patients: A single-center cohort study. Medicine (Baltimore) 2019; 98:e16418. [PMID: 31305459 PMCID: PMC6641844 DOI: 10.1097/md.0000000000016418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 19-item surgical safety checklist (SSC) was published by the World Health Organization in 2008 and was proved to reduce postoperative complications. To date, however, the impacts of SSC implementation in China have not been evaluated clearly. The study was performed to evaluate the impacts of the SSC on postoperative clinical outcomes in gastrointestinal tumor patients.Between April 2007 and March 2013, 7209 patients with gastrointestinal tumor who underwent elective surgery at the Affiliated Hospital of Qingdao University were studied. Data on the clinical records and outcomes of 3238 consecutive surgeries prior to SSC implementation were retrospectively collected; data on another 3971 consecutive surgeries performed after SSC implementation were prospectively collected. The clinical outcomes (including mortality, morbidity, readmission, reoperation, unplanned intervention and postoperative hospital stay) within postoperative 30 days were compared between the two groups. Univariate and multivariate logistic regression analysis were performed to identify independent factors for postoperative complications.The rates of morbidity and in-hospital mortality before and after SSC implementation were 16.43% vs 14.33% (P = .018), 0.46% vs 0.18% (P = .028), respectively. Median of postoperative hospital stay in post-implementation group was shorter than that in pre-implementation group (8 vs 9 days, P < .001). Multivariable analysis demonstrated that the SSC was an independent factor influencing postoperative complications (odds ratio = 0.860; 95% CI, 0.750-0.988).Implementation of the SSC could improve the clinical outcomes in gastrointestinal tumor patients undergoing elective surgery in China.
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Affiliation(s)
- Hao Wang
- Department of General Surgery, Dongying People's Hospital, Shandong, China
- Department of Gastrointestinal Surgery
| | - Taohua Zheng
- Hepatic Disease Center, Affiliated Hospital of Qingdao University
| | - Dong Chen
- Department of Gastrointestinal Surgery
| | | | - Xiaobin Zhou
- Department of Epidemiology and Health Statistics, Qingdao University Medical College, Shandong, China
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23
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Wæhle HV, Harthug S, Søfteland E, Sevdalis N, Smith I, Wiig S, Aase K, Haugen AS. Investigation of perioperative work processes in provision of antibiotic prophylaxis: a prospective descriptive qualitative study across surgical specialties in Norway. BMJ Open 2019; 9:e029671. [PMID: 31230033 PMCID: PMC6596935 DOI: 10.1136/bmjopen-2019-029671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Surgical site infections are known postoperative complications, yet the most preventable of healthcare-associated infections. Correct provision of surgical antibiotic prophylaxis (SAP) is crucial. Use of the WHO Safe Surgical Checklist (SSC) has been reported to improve provision of SAP, and reduce infections postoperatively. To understand possible mechanisms and interactions generating such effects, we explored the underlying work processes of SAP provision and SSC performance at the intersection of perioperative procedures and actual team working. DESIGN An ethnographic study including observations and in-depth interviews. A combination of deductive and inductive content analysis of the data was conducted. SETTING Operating theatres with different surgical specialities, in three Norwegian hospitals. PARTICIPANTS Observations of perioperative team working (40 hours) and in-depth interviews of 19 experienced perioperative team members were conducted. Interview participants followed a maximum variation purposive sampling strategy. RESULTS Analysis identified provision of SAP as a process of linked activities; sequenced, yet disconnected in time and space throughout the perioperative phase. Provision of SAP was handled in relation to several interactive factors: preparation and administration, prescription accuracy, diversity of prescription order systems, patient-specific conditions and changes in operating theatre schedules. However, prescription checks were performed either as formal SSC reviews of SAP items or as informal checks of relevant documents. In addition, use of cognitive reminders and clinical experiences were identified as mechanisms used to enable administration of SAP within the 60 min timeframe described in the SSC. CONCLUSION Provision of SAP was identified as a complex process. Yet, a key element in provision of SAP was the given 60 min. timeframe of administration before incision, provided in the SSC. Thus, the SSC seems beneficial in supporting timely SAP administration practice by either being a cognitive tool and/or as a cognitive intervention.
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Affiliation(s)
- Hilde Valen Wæhle
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stig Harthug
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service & Population Research Department, King's College, London, UK
| | - Ingrid Smith
- Department of Essential Medicines and Health Products, World Health Organization, Geneve, Switzerland
| | - Siri Wiig
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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van Dalen ASHM, Legemaate J, Schlack WS, Legemate DA, Schijven MP. Legal perspectives on black box recording devices in the operating environment. Br J Surg 2019; 106:1433-1441. [PMID: 31112294 PMCID: PMC6790687 DOI: 10.1002/bjs.11198] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Background A video and medical data recorder in the operating theatre is possible, but concerns over privacy, data use and litigation have limited widespread implementation. The literature on legal considerations and challenges to overcome, and guidelines related to use of data recording in the surgical environment, are presented in this narrative review. Methods A review of PubMed and Embase databases and Cochrane Library was undertaken. International jurisprudence on the topic was searched. Practice recommendations and legal perspectives were acquired based on experience with implementation and use of a video and medical data recorder in the operating theatre. Results After removing duplicates, 116 citations were retrieved and abstracts screened; 31 articles were assessed for eligibility and 20 papers were finally included. According to the European General Data Protection Regulation and US Health Insurance Portability and Accountability Act, researchers are required to make sure that personal data collected from patients and healthcare professionals are used fairly and lawfully, for limited and specifically stated purposes, in an adequate and relevant manner, kept safe and secure, and stored for no longer than is absolutely necessary. Data collected for the sole purpose of healthcare quality improvement are not required to be added to the patient's medical record. Conclusion Transparency on the use and purpose of recorded data should be ensured to both staff and patients. The recorded video data do not need to be used as evidence in court if patient medical records are well maintained. Clear legislation on data responsibility is needed to use the medical recorder optimally for quality improvement initiatives.
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Affiliation(s)
- A S H M van Dalen
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Legemaate
- Department of Public Health and Health Law, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W S Schlack
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D A Legemate
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Quality in Postoperative Patient Handover: Different Perceptions of Quality Between Transferring and Receiving Nurses. J Nurs Care Qual 2019; 34:E1-E7. [PMID: 29346187 DOI: 10.1097/ncq.0000000000000318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND A safe and efficient patient handover is important to ensure high-quality patient care and reduce the risk of patient harm. Few studies have explored handover activities beyond information transfer. PURPOSE The aims were to assess overall postoperative handover quality and relate quality assessments to handover circumstances, conduct, and teamwork and to compare transferring and receiving nurses' evaluations of handover quality. METHOD This was a cross-sectional study using the Norwegian Handover Quality Rating Form (N-HQRF). In addition, data were collected on nurses' evaluations of the patient condition, handover preparation, and participating nurses' clinical experience. RESULTS Although total perceived handover quality was high in a large majority of cases, there were significant differences between transferring and receiving nurses' evaluations of the same handover. Lower-quality handovers had a higher frequency of time pressure, uncertainty, and patient-related problems. CONCLUSION The findings point to the need to assess handover quality in a wider perspective. Handover circumstances might impact handover quality and should be considered when procedures for handover quality are designed and implemented.
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26
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Medvedev ON, Merry AF, Skilton C, Gargiulo DA, Mitchell SJ, Weller JM. Examining reliability of WHOBARS: a tool to measure the quality of administration of WHO surgical safety checklist using generalisability theory with surgical teams from three New Zealand hospitals. BMJ Open 2019; 9:e022625. [PMID: 30782682 PMCID: PMC6340010 DOI: 10.1136/bmjopen-2018-022625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To extend reliability of WHO Behaviourally Anchored Rating Scale (WHOBARS) to measure the quality of WHO Surgical Safety Checklist administration using generalisability theory. In this context, extending reliability refers to establishing generalisability of the tool scores across populations of teams and raters by accounting for the relevant sources of measurement errors. DESIGN Cross-sectional random effect measurement design assessing surgical teams by the five items on the three Checklist phases, and at three sites by two trained raters simultaneously. SETTING The data were collected in three tertiary hospitals in Auckland, New Zealand in 2016 and included 60 teams observed in 60 different cases with an equal number of teams (n=20) per site. All elective and acute cases (adults and children) involving surgery under general anaesthesia during normal working hours were eligible. PARTICIPANTS The study included 243 surgical staff members, 138 (50.12%) women. MAIN OUTCOME MEASURE Absolute generalisability coefficient that accounts for variance due to items, phases, sites and raters for the WHOBARS measure of the quality of WHO Surgical Safety Checklist administration. RESULTS The WHOBARS in its present form has demonstrated good generalisability of scores across teams and raters (G absolute=0.83). The largest source of measurement error was the interaction between the surgical team and the rater, accounting for 16.7% (95% CI 16.4 to 16.9) of the total variance in the data. Removing any items from the WHOBARS led to a decrease in the overall reliability of the instrument. CONCLUSIONS Assessing checklist administration quality is important for promoting improvement in its use, and WHOBARS offers a reliable approach for doing this.
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Affiliation(s)
- Oleg N Medvedev
- Center for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Carmen Skilton
- Center for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
| | - Derryn A Gargiulo
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Simon J Mitchell
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer M Weller
- Center for Medical and Health Sciences Education, University of Auckland, Auckland, New Zealand
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
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Gutierres LDS, Santos JLGD, Barbosa SDFF, Maia ARC, Koerich C, Gonçalves N. Adherence to the objectives of the Safe Surgery Saves Lives Initiative: perspective of nurses. Rev Lat Am Enfermagem 2019. [PMCID: PMC6358131 DOI: 10.1590/1518-8345.2711.3108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: to measure the adherence to the objectives of the Safe Surgery Saves Lives Initiative in surgical centers from the perspective of nurses. Method: cross-sectional study, developed through an online survey via the Google Forms® platform. The study participants were 220 nurses from surgical centers in different regions of Brazil. The data were collected through a socio-professional characterization form and a questionnaire in which the participants indicated their level of agreement in relation to the fulfillment of the objectives of the Safe Surgery Saves Lives Initiative. Data analysis was performed using descriptive statistics. Results: objective 1, The team will operate on the correct patient at the correct site, presented the highest levels of total agreement (n = 144; 65.5%) and partial agreement (n = 52; 23.6%). Objective 10, Hospitals and the public health systems will establish routine surveillance of surgical capacity, volume and results, obtained the lowest percentages of total (n = 69, 31.4%) and partial agreement (n = 81, 36.8%). Conclusion: adherence to the objectives of the Initiative is adequate, but there are weaknesses, especially in relation to the prevention of never events.
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Ariyanayagam T, Drinkwater K, Cozens N, Howlett D, Malcolm P. UK national audit of safety checks for radiology interventions. Br J Radiol 2018; 92:20180637. [PMID: 30495979 DOI: 10.1259/bjr.20180637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: To reaudit the use of safety checklists in radiology departments in NHS departments throughout the UK. METHODS: This audit was performed on behalf of The Royal College of Radiologists Audit Committee in 2016 and was sent to radiology audit leads at every NHS department in the UK to determine the use of safety checks in various modalities and subspecialties. Free-form text boxes gathered data on problems with checklist implementation. RESULTS: 109/177 (62%) trusts responded. 48% of respondents used safety checklists for all radiological procedures in all modalities. 50% used checklists for some procedures. 2% did not use a checklist. Checklist use had increased since the previous audit (98% 2016, compared to 94% in 2012) but implementation for different procedures remains variable. For example, in ultrasound-guided fine needle and breast stereotactic procedures (49%), use has not increased since 2012. CONCLUSION: Reasons for not using checklists include a perception that intervention suite checklists were not appropriate for minor procedures and the limited flexibility of radiology information systems. The limitations of checklists are discussed. ADVANCES IN KNOWLEDGE: Our reaudit shows that in spite of increased implementation, use of safety checks is variable. Local ownership and radiology information system flexibility are needed to support the culture of safety processes in radiology departments.
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Affiliation(s)
- Timothy Ariyanayagam
- 1 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust , Norfolk , UK
| | | | - Neil Cozens
- 3 Department of Radiology, Derby Teaching Hospitals NHS Foundation Trust , Derby , UK
| | - David Howlett
- 2 Royal College of Radiologists , England , UK.,4 Department of Radiology, Eastbourne District General Hospital , East Sussex , UK
| | - Paul Malcolm
- 1 Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust , Norfolk , UK
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Pal A, Lal R, Frizelle F. Aviation-based teamwork skills work for surgeons: time for an 'aviation bundle'? ANZ J Surg 2018; 88:1231-1235. [PMID: 30306705 DOI: 10.1111/ans.14892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aviation systems were developed to improve safety and have achieved remarkable results. Medicine has looked to replicate these systems; however, the gap in outcomes between the two industries remains vast. Bridging this chasm requires an in-depth analysis of the applicability of the aviation safety model in surgery. This study uses qualitative methods to explore how aviation-based practices may be adapted and applied more effectively in theatre. METHODS Data were collected using multiprofessional focus groups in a single centre. The focus groups involved discussion around teamwork and aviation-based non-technical skills. With consent, audio recordings were anonymized and transcribed. Qualitative (thematic) analysis was used to identify themes. RESULTS Five focus groups were conducted. Eight themes emerged, with a total of 18 sub-themes. Themes were: current practice, customization, applicability, team performance, human factors, analogy, incidents and integration of skills. Extent and limitations of the aviation surgery analogy also emerged. CONCLUSIONS The new insights gained through this qualitative analysis highlight the need to tailor aviation-based practices to the operating theatre. To achieve this, we propose the 'aviation bundle' of non-technical skills. This blueprint aims to promote a culture of safety and efficiency in surgical practice and could be developed into a training programme for theatre staff.
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Affiliation(s)
- Atanu Pal
- Department of Surgery, James Paget University Hospital, Great Yarmouth, UK.,Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
| | - Roshan Lal
- Department of Surgery, James Paget University Hospital, Great Yarmouth, UK
| | - Frank Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.,University of Otago, Christchurch, New Zealand
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Reine E, Rustøen T, Raeder J, Aase K. Postoperative patient handovers-Variability in perceptions of quality: A qualitative focus group study. J Clin Nurs 2018; 28:663-676. [PMID: 30183113 DOI: 10.1111/jocn.14662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/13/2018] [Accepted: 08/30/2018] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES (a) To explore the factors affecting quality in postoperative handovers as perceived by the different professional groups of clinicians involved. (b) To explore possible differences in perceptions of postoperative handover quality across professional groups and level of experience. BACKGROUND High quality patient handovers after surgery and anaesthesia are important to ensure patient safety. There is a paucity of research describing contextual factors related to handover quality and the perspectives of different professional groups involved. DESIGN A qualitative exploratory design was applied. METHOD A total of eight focus group interviews with 37 participants (29 nurses, eight doctors) were conducted. Anaesthesiologists, resident anaesthesiologists, nurse anaesthetists, postoperative care nurses and operating room nurses participated in the study. The interviews were conducted according to profession with two groups per profession: one with experienced clinicians and one with less experienced clinicians. The data were analysed using thematic analysis. The study adheres to the COREQ guidelines. RESULTS The data analysis identified the following factors affecting postoperative handover quality: "timing and concurrency conflicts," "handover structure," "patient conditions," "individual characteristics of clinicians involved" and "team composition." Differences across professional groups and level of experience were related to responsibility, structure and adaptation. CONCLUSION The professional groups involved describe the postoperative patient handover as a complex and variable process that needs to be carefully planned and executed according to the influencing factors. Variability exists across professional groups and level of experience. RELEVANCE TO CLINICAL PRACTICE Health care providers need to be aware that postoperative handovers are affected by a set of factors related to internal (patient conditions, individual characteristics of clinicians involved and team composition) and external (timing and concurrency conflicts, handover structure) characteristics. These issues need to be acknowledged when procedures and routines for handover quality are designed, implemented and used.
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Affiliation(s)
- Elizabeth Reine
- Department of Nurse Anaesthesia, Divisions of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Divisions of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Johan Raeder
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Sendlhofer G, Lumenta DB, Pregartner G, Leitgeb K, Tiefenbacher P, Gombotz V, Richter C, Kamolz LP, Brunner G. Reality check of using the surgical safety checklist: A qualitative study to observe application errors during snapshot audits. PLoS One 2018; 13:e0203544. [PMID: 30188955 PMCID: PMC6126846 DOI: 10.1371/journal.pone.0203544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/22/2018] [Indexed: 12/03/2022] Open
Abstract
Background The WHO Surgical Safety Checklist (SSC) was established to address important safety issues and to reduce the number of surgical deaths. So far, numerous reports have demonstrated sub-optimal implementation of the SSC in practice and limited improvements in patient outcomes. Therefore, the aim of this study was to audit the SSC-practice in a real-world setting in a university hospital setting. Methods From 2015 to 2016, independent observers performed snapshot audits in operating theatres and shadowed the three phases of the SSC. Using a 4-point Likert-scale to rate the compliance on each audit day, we generated a report highlighting possible improvements and provided feedback to the operating team members. Results Audits were performed on 36 operating days (2015: n = 19; 2016: n = 17), in which a total of 136 surgical interventions were observed. Overall, the percentage of “very good compliance” improved from 2015 to 2016: for the sign-in from 52.9% to 81.2% (p = 0.141), for the team-time-out from 33.3% to 58.8% (p = 0.181), and for the sign-out from 21.4% to 41.7% (p = 0.401). The qualitative review revealed inconsistencies when applying the SSC, of which the missing documentation of an actually performed item or the wrong timing for an item was most common. Conclusion Snapshot audits revealed that SSC compliance has improved over the observed period, while its application revealed inconsistencies during the three phases of the SSC. Snapshot audits proved to be a valuable tool in the qualitative analysis of SSC compliance and gave more insight than a mere completeness check of ticks in SSC documents.
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Affiliation(s)
- Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - David Benjamin Lumenta
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Peter Tiefenbacher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Christian Richter
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lars Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
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Procedural Timeout Compliance Is Improved With Real-Time Clinical Decision Support. J Patient Saf 2018; 14:148-152. [DOI: 10.1097/pts.0000000000000185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Besch G, Perrotti A, Salomon du Mont L, Tucella R, Flicoteaux G, Bondy A, Samain E, Chocron S, Pili-Floury S. Long-term compliance with a validated intravenous insulin therapy protocol in cardiac surgery patients: a quality improvement project. Int J Qual Health Care 2018; 30:817-822. [DOI: 10.1093/intqhc/mzy112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 04/30/2018] [Indexed: 01/04/2023] Open
Affiliation(s)
- Guillaume Besch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
| | - Andrea Perrotti
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
- Department of Cardiothoracic Surgery, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Lucie Salomon du Mont
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
- Department of Vascular Surgery, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Raphaelle Tucella
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Guillaume Flicoteaux
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Aline Bondy
- Department of Cardiothoracic Surgery, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Emmanuel Samain
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
| | - Sidney Chocron
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
- Department of Cardiothoracic Surgery, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
| | - Sebastien Pili-Floury
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Besancon, 3 bvd Alexander Fleming, Besancon, France
- EA 3920, Bourgogne Franche-Comte University, Besancon, France
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Ziman R, Espin S, Grant RE, Kitto S. Looking beyond the checklist: An ethnography of interprofessional operating room safety cultures. J Interprof Care 2018; 32:575-583. [PMID: 29630424 DOI: 10.1080/13561820.2018.1459514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Surgical Safety Checklist (SSC) has been adopted in operating rooms (OR) worldwide to reduce medical errors, increase patient safety and improve interprofessional communication. Despite often high compliance rates, recent studies suggested the SSC has not been associated with significant reductions in operative mortality or complications. This ethnographic study sought to understand this disconnection through approximately 50 hours of observation in the OR and 10 in-depth semi-structured interviews with surgeons, nurses, and anaesthesiologists in orthopaedic surgery. Inductive thematic analysis was used to analyse the data. By spending time in the OR and listening to the staff, this study was able to look beyond what "ought" to be happening in the OR and garner a deep understanding of the realities of OR work that acknowledges the complexities of surgical culture in which the SSC is being implemented. This study found SSC compliance was influenced by the perceived (un)importance of individual checklist items within the orthopaedic setting. Additionally, there remains a need to further explore patients' involvement in their operative experience.
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Affiliation(s)
- Roxanne Ziman
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Sherry Espin
- a Daphne Cockwell School of Nursing, Faculty of Community Services , Ryerson University , Toronto , Ontario , Canada
| | - Rachel E Grant
- b Faculty of Education , University of Ottawa , Ottawa , Ontario , Canada
| | - Simon Kitto
- c Department of Innovation in Medical Education , University of Ottawa , Ottawa , Ontario , Canada.,d Office of Continuing Professional Development, Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada
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Willassen ET, Jacobsen ILS, Tveiten S. Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility-Coequal Demands? A Focus Group Study. Glob Qual Nurs Res 2018; 5:2333393618764070. [PMID: 29623287 PMCID: PMC5881961 DOI: 10.1177/2333393618764070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/01/2018] [Accepted: 02/05/2018] [Indexed: 12/22/2022] Open
Abstract
The use of World Health Organization’s (WHO’s) Safe Surgery checklist is an established practice worldwide and contributes toward ensuring patient safety and collaborative teamwork. The aim of this study was to elucidate operating room nurses’ and operating room nursing students’ experiences and opinions about execution of and compliance with checklists. We chose a qualitative design with semistructured focus group discussions. Qualitative content analysis was conducted. Two main themes were identified; the Safe Surgery checklists have varied influence on teamwork and patient safety, and taking responsibility for executing the checks on the Safe Surgery checklist entails practical and ethical challenges. The experiences and opinions of operating room nurses and their students revealed differences of practices and attitudes toward checklist compliance and the intentions of checklist procedures. These differences are related to cultural and professional distances between team members and their understanding of the Safe Surgery checklists as a tool for patient safety.
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Affiliation(s)
| | | | - Sidsel Tveiten
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Gillespie BM, Harbeck E, Lavin J, Gardiner T, Withers TK, Marshall AP. Using normalisation process theory to evaluate the implementation of a complex intervention to embed the surgical safety checklist. BMC Health Serv Res 2018; 18:170. [PMID: 29523148 PMCID: PMC5845378 DOI: 10.1186/s12913-018-2973-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/27/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The surgical Safety Checklist (SSC) was introduced in 2008 to improve teamwork and reduce the mortality and morbidity associated with surgery. Although mandated in many health care institutions around the world, challenges in implementation of the SSC continue. To use Normalisation Process Theory (NPT) to help understand how/why implementation of a complex intervention coined Pass The Baton (PTB) could help explain what facets of the Surgical Safety Checklist use led to its' integration in practice, while others were not. METHODS A longitudinal multi-method study using survey and interviews was undertaken. Implementation of PTB involved; change champions, audit and feedback, education and prompts. Following implementation, surgical teams were surveyed using the NOrmalization MeAsure Development (NoMAD) and subsequently interviewed to explore the impact of PTB on their use of the checklist at 6 and 12 months respectively. Respondents' self-reported perceptions of implementation of PTB was explained using the four NPT constructs; coherence, cognitive participation, collective action, and reflexive monitoring. Survey data were analysed using descriptive statistics. Interview data were coded inductively and content analysed using a framework derived from NPT. RESULTS The NoMAD survey response rate was 59/150 (39.3%). Many (45/59, 77.6%) survey respondents saw the value in PTB, while 50/59 (86.2%) would continue to use it; 45/59 (77.6%) believed that PTB could easily be integrated into existing workflows, and 48/59 (82.8%) thought that feedback could improve PTB in the future. A total of 8 interviews were completed with 26 surgical team members. Nurses and physicians held mixed views towards coherence while buy-in and participation relied on individuals' investment in the implementation process and the ability to modify PTB. Participants generally recognised the benefit and value of using PTB in the ongoing implementation the checklist. CONCLUSIONS Workarounds and flexible co-construction in implementation designed to improve team communications in surgery may facilitate their normalisation in practice.
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Affiliation(s)
- Brigid M. Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
| | - Emma Harbeck
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
| | - Joanne Lavin
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Therese Gardiner
- Nursing & Midwifery Education & Research Unit, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Teresa K. Withers
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
| | - Andrea P. Marshall
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD Australia
- National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast, QLD Australia
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van Daalen FV, Hulscher MEJL, Minderhoud C, Prins JM, Geerlings SE. The antibiotic checklist: an observational study of the discrepancy between reported and actually performed checklist items. BMC Infect Dis 2018; 18:16. [PMID: 29310569 PMCID: PMC5759243 DOI: 10.1186/s12879-017-2878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Checklists are increasingly used to measure quality of care. Recently we implemented an antibiotic checklist in nine Dutch hospitals and showed that use of the checklist resulted in more appropriate antibiotic use. While more appropriate antibiotic use was associated with a reduction in length of stay, use of the checklist in itself was not. In the current study we explored discrepancies between reported and actually performed checklist items at the patient level to test the validity of checklist answers, to evaluate whether discrepancies between reported and actually performed checklist items could explain the lack of effect of checklist use on length of stay, and to identify missed opportunities for performance per checklist item. Methods Checklist answers represented reported performance. Actual performance was assessed by data from the patients’ medical files. Reported and actually performed checklist items could be ‘both YES’; ‘both NO’; ‘YES reported, NOT actually performed’; or ‘NO reported, YES actually performed’. We determined an overall ‘both YES’ score per checklist, and used mixed models to evaluate whether an association existed between this overall score and patient’s length of hospital stay. Finally, we analysed whether the items that were not actually performed, could have been performed. Results Between January and October 2015 physicians filled in 1207 checklists. In total 7881 items were checked. Most items were ‘both YES’ (3392/7881, 43.0%) or ‘both NO’ (2601/7881, 33.0%). The number of ‘YES reported, NOT actually performed’ items was 1628/7881 (20.7%) compared to 260/7881 (3.3%) ‘NO reported, YES actually performed’ items. The level of discrepancy between reported and actually performed items differed per checklist item. The item ‘prescribe antibiotic treatment according to the local guideline’ had the highest percentage of ‘YES reported, NOT actually performed’ items, namely 45.1%. A higher overall ‘both YES’ score of the checklist was significantly associated with a shorter length of hospital stay. Of all checklist items 21.8% were not performed while they could have been performed. Conclusions Checklist answers do not accurately assess actual provided care. As actual performance of the antibiotic checklist items is associated with length of stay, efforts to increase actual performance appear to be justified. Electronic supplementary material The online version of this article (10.1186/s12879-017-2878-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frederike V van Daalen
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Room F4-132, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Marlies E J L Hulscher
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cas Minderhoud
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Room F4-132, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Room F4-132, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Centre, University of Amsterdam, Room F4-132, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Chellan J, Sibiya MN. Perceptions of nursing staff regarding the existence of best practice standards in selected private hospitals in eThekwini district, South Africa. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2018. [DOI: 10.1016/j.ijans.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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de Jager E, McKenna C, Bartlett L, Gunnarsson R, Ho YH. Postoperative Adverse Events Inconsistently Improved by the World Health Organization Surgical Safety Checklist: A Systematic Literature Review of 25 Studies. World J Surg 2017; 40:1842-58. [PMID: 27125680 PMCID: PMC4943979 DOI: 10.1007/s00268-016-3519-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The World Health Organization Surgical Safety Checklist (SSC) has been widely implemented in an effort to decrease surgical adverse events. METHOD This systematic literature review examined the effects of the SSC on postoperative outcomes. The review included 25 studies: two randomised controlled trials, 13 prospective and ten retrospective cohort trials. A meta-analysis was not conducted as combining observational studies of heterogeneous quality may be highly biased. RESULTS The quality of the studies was largely suboptimal; only four studies had a concurrent control group, many studies were underpowered to examine specific postoperative outcomes and teamwork-training initiatives were often combined with the implementation of the checklist, confounding the results. The effects of the checklist were largely inconsistent. Postoperative complications were examined in 20 studies; complication rates significantly decreased in ten and increased in one. Eighteen studies examined postoperative mortality. Rates significantly decreased in four and increased in one. Postoperative mortality rates were not significantly decreased in any studies in developed nations, whereas they were significantly decreased in 75 % of studies conducted in developing nations. CONCLUSIONS The checklist may be associated with a decrease in surgical adverse events and this effect seems to be greater in developing nations. With the observed incongruence between specific postoperative outcomes and the overall poor study designs, it is possible that many of the positive changes associated with the use of the checklist were due to temporal changes, confounding factors and publication bias.
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Affiliation(s)
- Elzerie de Jager
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia.
| | - Chloe McKenna
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4814, Australia
| | - Lynne Bartlett
- College of Public Health, Medical & Veterinary Sciences, The Townsville Hospital, Townsville, QLD, 4814, Australia
| | - Ronny Gunnarsson
- Cairns Clinical School, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,Research and Development Unit, Primary Health Care and Dental Care Narhalsan, Southern Älvsborg County, Region Västra Götaland, Sweden.,Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yik-Hong Ho
- International College of Surgeons, Chicago, IL, USA.,Department of Surgery, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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40
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Havinga J, Dekker S, Rae A. Everyday work investigations for safety. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2017. [DOI: 10.1080/1463922x.2017.1356394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jop Havinga
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
| | - Sidney Dekker
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
| | - Andrew Rae
- School of Humanities, Griffith University, 170 Kessels Road, Brisbane, 4111, Queensland, Australia
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Munn Z, Giles K, Aromataris E, Deakin A, Schultz T, Mandel C, Peters MDJ, Maddern G, Pearson A, Runciman W. Mixed methods study on the use of and attitudes towards safety checklists in interventional radiology. J Med Imaging Radiat Oncol 2017; 62:32-38. [DOI: 10.1111/1754-9485.12633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Zachary Munn
- The Joanna Briggs Institute; The University of Adelaide; Adelaide South Australia Australia
| | - Kristy Giles
- The Joanna Briggs Institute; The University of Adelaide; Adelaide South Australia Australia
| | - Edoardo Aromataris
- The Joanna Briggs Institute; The University of Adelaide; Adelaide South Australia Australia
| | - Anita Deakin
- Australian Patient Safety Foundation; Adelaide South Australia Australia
- Centre for Population Health Research; University of South Australia; Adelaide South Australia Australia
| | - Timothy Schultz
- Australian Patient Safety Foundation; Adelaide South Australia Australia
- Centre for Population Health Research; University of South Australia; Adelaide South Australia Australia
| | - Catherine Mandel
- Radiology Events Register; The University of Melbourne; Melbourne Victoria Australia
- Swinburne University of Technology; Melbourne Victoria Australia
| | - Micah DJ Peters
- The Joanna Briggs Institute; The University of Adelaide; Adelaide South Australia Australia
| | - Guy Maddern
- The Queen Elizabeth Hospital; SA Health; Adelaide South Australia Australia
- The University of Adelaide; Adelaide South Australia Australia
| | - Alan Pearson
- The Joanna Briggs Institute; The University of Adelaide; Adelaide South Australia Australia
| | - William Runciman
- Australian Patient Safety Foundation; Adelaide South Australia Australia
- Centre for Population Health Research; University of South Australia; Adelaide South Australia Australia
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42
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Rydenfält C, Odenrick P, Larsson PA. Organizing for teamwork in healthcare: an alternative to team training? J Health Organ Manag 2017; 31:347-362. [DOI: 10.1108/jhom-12-2016-0233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore how organizational design could support teamwork and to identify organizational design principles that promote successful teamwork.
Design/methodology/approach
Since traditional team training sessions take resources away from production, the alternative approach pursued here explores the promotion of teamwork by means of organizational design. A wide and pragmatic definition of teamwork is applied: a team is considered to be a group of people that are set to work together on a task, and teamwork is then what they do in relation to their task. The input – process – output model of teamwork provides structure to the investigation.
Findings
Six teamwork enablers from the healthcare team literature – cohesion, collaboration, communication, conflict resolution, coordination, and leadership – are discussed, and the organizational design measures required to implement them are identified. Three organizational principles are argued to facilitate the teamwork enablers: team stability, occasions for communication, and a participative and adaptive approach to leadership.
Research limitations/implications
The findings could be used as a foundation for intervention studies to improve team performance or as a framework for evaluation of existing organizations.
Practical implications
By implementing these organizational principles, it is possible to achieve many of the organizational traits associated with good teamwork. Thus, thoughtful organization for teamwork can be used as an alternative or complement to the traditional team training approach.
Originality/value
With regards to the vast literature on team training, this paper offers an alternative perspective on how to improve team performance in healthcare.
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43
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Seamans DP, Louka BF, Fortuin FD, Patel BM, Sweeney JP, Lanza LA, DeValeria PA, Ezrre KM, Ramakrishna H. The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement. Ann Card Anaesth 2017; 19:S6-S11. [PMID: 27762242 PMCID: PMC5100244 DOI: 10.4103/0971-9784.192576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.
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Affiliation(s)
- David P Seamans
- Department of Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - F David Fortuin
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Bhavesh M Patel
- Department of Critical Care, Mayo Clinic Arizona, AZ 85054, USA
| | - John P Sweeney
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Louis A Lanza
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Patrick A DeValeria
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Kim M Ezrre
- Department of Catheterization Laboratory, Mayo Clinic Arizona, AZ 85054, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
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44
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Lockhart JJ, Satya-Murti S. Diagnosing Crime and Diagnosing Disease: Bias Reduction Strategies in the Forensic and Clinical Sciences. J Forensic Sci 2017; 62:1534-1541. [PMID: 28230894 DOI: 10.1111/1556-4029.13453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 01/12/2023]
Abstract
Cognitive effort is an essential part of both forensic and clinical decision-making. Errors occur in both fields because the cognitive process is complex and prone to bias. We performed a selective review of full-text English language literature on cognitive bias leading to diagnostic and forensic errors. Earlier work (1970-2000) concentrated on classifying and raising bias awareness. Recently (2000-2016), the emphasis has shifted toward strategies for "debiasing." While the forensic sciences have focused on the control of misleading contextual cues, clinical debiasing efforts have relied on checklists and hypothetical scenarios. No single generally applicable and effective bias reduction strategy has emerged so far. Generalized attempts at bias elimination have not been particularly successful. It is time to shift focus to the study of errors within specific domains, and how to best communicate uncertainty in order to improve decision making on the part of both the expert and the trier-of-fact.
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Affiliation(s)
- Joseph J Lockhart
- Forensic Services Division, California Department of State Hospitals, 1305 North "H" Street, #117, Lompoc, CA
| | - Saty Satya-Murti
- Health Policy Consultant, 2534 Knightbridge Drive, Santa Maria, CA, 93455
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Jeong EJ, Chung HS, Choi JY, Kim IS, Hong SH, Yoo KS, Kim MK, Won MY, Eum SY, Cho YS. Development of simulation-based learning programme for improving adherence to time-out protocol on high-risk invasive procedures outside of operating room. Int J Nurs Pract 2017; 23. [DOI: 10.1111/ijn.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 11/11/2016] [Accepted: 12/03/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Eun Ju Jeong
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine; Yonsei University College of Medicine; Seoul South Korea
| | - Jeong Yun Choi
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - In Sook Kim
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Seong Hee Hong
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Kyung Sook Yoo
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Mi Kyoung Kim
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Mi Yeol Won
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - So Yeon Eum
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
| | - Young Soon Cho
- Division of Nursing; Yonsei University Gangnam Severance Hospital; Seoul South Korea
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Patial T, Thakur V, Vijhay Ganesun N, Sharma M. Gossypibomas in India - A systematic literature review. J Postgrad Med 2017; 63:36-41. [PMID: 28079043 PMCID: PMC5394815 DOI: 10.4103/0022-3859.198153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose of Review: Gossypibomas remain a dreaded and unwanted complication of surgical practice. Despite significant interest and numerous guidelines, the number of reported cases remains sparse due to various factors, including potential legal implications. Herein, we review related data from India to ascertain if the problem is better or worse than that reported in world literature. Materials and Methods: A literature search was performed on PubMed and Google Scholar, to collect and analyze all case reports and case reviews regarding the condition in India. Results: On analysis of the results, there were 100 publications reporting a total of 126 events. The average patient age was 38.65 years. Average time to discovery was 1225.62 days. Forty-nine percent of reported cases were discovered within the 1st year. The most common clinical features were pain (73.8%), palpable mass (47.6%), vomiting (35%), abdominal distention (26%), and fever (12.6%). Spontaneous expulsion of the gossypiboma was noted in five cases (3.96%). Transmural migration was seen in 36 cases (28.57%). Conclusions: Despite advancements in surgical approaches and preventive measures, gossypibomas continue to be a cause of significant morbidity. A safe working culture, open communication, teamwork, and an accurate sponge count remain our best defence against this often unpredictable complication of surgery.
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Affiliation(s)
- T Patial
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - V Thakur
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - N Vijhay Ganesun
- Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - M Sharma
- Department of Forensic Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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47
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WHO Safety Surgical Checklist implementation evaluation in public hospitals in the Brazilian Federal District. J Infect Public Health 2016; 9:586-99. [DOI: 10.1016/j.jiph.2015.12.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/14/2015] [Accepted: 12/19/2015] [Indexed: 11/22/2022] Open
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48
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Raman J, Leveson N, Samost AL, Dobrilovic N, Oldham M, Dekker S, Finkelstein S. When a checklist is not enough: How to improve them and what else is needed. J Thorac Cardiovasc Surg 2016; 152:585-92. [DOI: 10.1016/j.jtcvs.2016.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/09/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
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49
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Reed S, Ganyani R, King R, Pandit M. Does a novel method of delivering the safe surgical checklist improve compliance? A closed loop audit. Int J Surg 2016; 32:99-108. [PMID: 27343821 DOI: 10.1016/j.ijsu.2016.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 06/05/2016] [Accepted: 06/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In February 2010, the UK National Patient Safety Agency set a mandate that the World Health Organisation's Surgical Safety Checklist (SSC) should be completed for every surgical patient within the NHS in a bid to improve surgical safety. However since its introduction, there have been issues with checklist compliance, staff engagement and surgical serious incidents continue. AIMS This study seeks to explore if an unavoidable pre-recorded audio delivery of the SSC improves compliance and staff engagement with the checklist. METHODS The performance of the time-out and sign-out sections of the SSC were observed in three phases: standard practice, audio prompt and full audio delivery. Two researchers visited operating theatres throughout a three-week period. The outcome measures were occurrence of time-out/sign-out, completion of checklist, and presence, and engagement of staff during checklist administration. Staff feedback on the process was also sought. RESULTS Observation of time-out and sign-out was undertaken for 92 procedures. Time-out and sign-out were performed for 100% of the procedures when using full audio delivery of the SSC, an improvement on findings during the standard practice phase (time out- 97.4%, sign out- 86.8%). The compliance with completion of checklist items also improved with audio delivery of the SSC. However, the presence of all key staff and active participation of team members with the checklist was unaffected by the mode of delivery. Team members' self-reported engagement did not significantly vary across the different practices. CONCLUSION The intervention seems to improve rate of checklist completion, particularly signout. It also brought more consistency on the questions read out during checklist administration. It doesn't necessarily ensure all key staff are present neither does it significantly improve staff engagement in the process.
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Affiliation(s)
- Sophie Reed
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Richard King
- University Hospitals Coventry & Warwickshire NHS Trust, Warwick University, UK
| | - Meghana Pandit
- University Hospitals Coventry & Warwickshire NHS Trust, Institute of Digital Health, Warwick University, UK.
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50
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McDowell DS, McComb S. Surgical Safety Checklists Briefings: Perceived Efficacy and Team Member Involvement. J Perioper Pract 2016; 26:138-44. [PMID: 27498438 DOI: 10.1177/175045891602600603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Researchers have shown inconsistencies in compliance, outcomes and attitudes of surgical team members related to surgical safety checklist briefings. The purpose of this study was to examine surgical circulator and scrub practitioners’ perceptions of safety checklist briefings and team member involvement, and to identify potential improvements in the process based on those perceptions. An anonymous survey was conducted with members of the Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST). Questions focused on perceptions of checklist briefing efficacy and team member involvement in safety practices. From the 346 usable responses, a third respondent group of self-identified perioperative leaders emerged. Significant results were obtained related to leaders’ perceptions, post-procedure briefings and various perceptions of team member involvement. Study results indicate that variances in safety practices continue as perceived by surgical team members thus presenting opportunities for further examination and improvement of processes in reducing surgical errors.
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Affiliation(s)
- DS McDowell
- Indiana University Health North Hospital, Carmel, Indiana, USA
| | - S McComb
- Purdue University, West Lafayette, Indiana, USA
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