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Sichong Q, Hong L, Shipan W, Yuan X, Haiyang L, Hongjia Z. Night-time surgery for type a aortic dissection: Immediate or delaying? Perfusion 2023:2676591231164879. [PMID: 37078919 DOI: 10.1177/02676591231164879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES This study aims to investigate whether surgery performed during night compared with daytime were associated with an increased risk of operative mortality of type A aortic dissection (TAAD) patients. METHODS A total of 2015 TAAD patients who underwent surgical repair were collected from two cardiovascular centers from Jan 2015 to Jan 2021. According to the start time of surgery, patients were divided into daytime group (06:01 a.m. to 06:00 p.m.) and night-time group (06:01 p.m. to 06:00 a.m.), and retrospective analyses were performed between them. RESULTS The operative mortality of night-time group (12.2%, 43/352) was dramatically higher than daytime group (6.9%, 115/1663; p = 0.001). There was significant difference between night-time and daytime groups in terms of 30-days mortality (5.8% vs 10.8%; p = 0.001) and in-hospital mortality (3.5% vs 6.0%; p = 0.03). The night-time group had a longer duration of intensive care unit stay (4 vs two; days; p < 0.001) and ventilation support (34 vs 19; hours; p < 0.001), compared with daytime group. The risk factors for operative mortality were night-time surgery (odds ratio [OR], 1.545; p = 0.027), age (odds ratio, 1.152; p < 0.001), total arch replacement (OR, 2.265; p < 0.001) and previous aortic surgery (OR, 2.376; p = 0.003). CONCLUSION Night-time surgical repair may be associated with higher operative mortality of patients with TAAD. Nevertheless, it is reasonable to offer emergency surgery at night-time for such patients who were more likely to present disastrous complications with delayed surgical intervention, as outcomes indicate acceptable operative mortality.
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Affiliation(s)
- Qian Sichong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Liu Hong
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Wang Shipan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xue Yuan
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Li Haiyang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Zhang Hongjia
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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2
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Cavallone LF, Duggan EW, Berger JS. A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology. Anesth Analg 2022; 135:728-731. [DOI: 10.1213/ane.0000000000006169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Weigel WA, Lyons AB, Liberman JS, Blackmore CC. Using Lean tools to improve the efficiency of awake fibreoptic intubation setup. BMJ Open Qual 2021; 10:bmjoq-2021-001432. [PMID: 34862239 PMCID: PMC8647560 DOI: 10.1136/bmjoq-2021-001432] [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: 02/22/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background Awake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. In our institution, the awake intubation setup process was highly variable and error prone. Methods We deployed Lean methods to improve the efficiency and accuracy of the awake fibreoptic intubation setup process. A 2-day improvement event with a multidisciplinary team addressed the setup process, tested solutions and created standard work documents. Twenty awake fibreoptic intubation simulations were conducted before and after the intervention to quantify gains in setup efficiency and error reduction. Results Variability in the setup process, including clinical locations visited, was reduced through creating a standardised process. The average time to for an awake fibreoptic intubation setup was reduced by approximately 50%, from 23 min to 11 min (p<0.001). In addition, awake fibreoptic intubation equipment set out without error increased in the postintervention simulations from 59% to 85% (p=0.003). Conclusion Using Lean tools, we were able to make the setup of awake fibreoptic intubation not only more efficient, but also more accurate. A similar methodological approach may have value for other complex anaesthesia procedures.
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Affiliation(s)
- Wade A Weigel
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew B Lyons
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA.,Anesthesiology, Gallatin Valley Anesthesia Associates, Bozeman, Montana, USA
| | - Justin S Liberman
- Anesthesiology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - C Craig Blackmore
- Center for Health Care Improvement Science, Virginia Mason Medical Center, Seattle, Washington, USA
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4
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Brenner MJ, Boothman RC, Rushton CH, Bradford CR, Hickson GB. Honesty and Transparency, Indispensable to the Clinical Mission-Part I: How Tiered Professionalism Interventions Support Teamwork and Prevent Adverse Events. Otolaryngol Clin North Am 2021; 55:43-61. [PMID: 34823720 DOI: 10.1016/j.otc.2021.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
At the foundation of clinical medicine is the relationship among patients, families, and health care professionals. Implicit to that social contract, professionals pledge to bring clinical excellence to advance their patients' wellness and healing-and to prevent harm. Patients trust that those privileged to deliver care will do so unwaveringly in service of patients' best interests; however, the incentives and infrastructure surrounding health care delivery can promote or undermine individual performance, teamwork, and patient safety. Modeling professionalism and identifying slips and lapses supports pursuit of high reliability. Part 1, Promoting Professionalism, introduces the first of 3 pillars of advancing the clinical mission.
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Affiliation(s)
- Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan School of Medicine, 1500 East Medical Center Drive SPC 5312, 1904 Taubman Center, Ann Arbor, MI 48109-5312, USA; GTC Quality Improvement Collaborative, Durham, NC, USA.
| | - Richard C Boothman
- Boothman Consulting Group, LLC, Ann Arbor, MI, USA; Department of Surgery, University of Michigan Medical School, Ann Arbor; Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cynda Hylton Rushton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carol R Bradford
- The College of Medicine and James Cancer Hospital and Solove Research Institute; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus
| | - Gerald B Hickson
- Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, TN, USA
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5
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Zhou P, Li M, Wei X, Zhu H, Xue D. Patient Safety Climate in General Public Hospitals in China: A Multiregion Study. J Patient Saf 2021; 17:522-530. [PMID: 28968298 DOI: 10.1097/pts.0000000000000427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to analyze the potential difference in patient safety climate by region (Shanghai vs Hubei Province vs Gansu Province) and general public hospital level (tertiary vs secondary) in China. METHODS Using a stratified sampling method, employees from 54 public general hospitals in Shanghai, Hubei Province, and Gansu Province in China were surveyed in 2015. The Patient Safety Climate in Health Care Organizations tool and the percentage of "problematic responses" (PPRs) were used to measure and analyze the patient safety climate. A χ2 test and hierarchical linear modeling were applied for the analysis. RESULTS In the study, 4121 valid questionnaires were collected. The psychometric analysis supported the validity and reliability of our Chinese version of the Patient Safety Climate in Health Care Organizations. The overall patient safety climate was relatively good and exhibited no significant differences among the surveyed hospitals by various regions (Shanghai vs Hubei Province vs Gansu Province) and diverse hospital levels (tertiary vs secondary) using hierarchical linear models. "Fear of blame and punishment" and "fear of shame" had the highest PPRs and were prevalent in various types of hospitals. "Provision of safe care" and "organizational resources for safety" also had notably high PPRs. There were 4 dimensions varied by region and hospital level in this survey. CONCLUSIONS Fear of shame and fear of blame are the most important barriers to the improvement of patient safety in the hospitals of China. Facility characteristics contributed somewhat to hospital patient safety climate in some dimensions. The initiatives to improve hospital patient safety climate are necessary and its implementation strategies needs to be shared.
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Affiliation(s)
- Ping Zhou
- From the Key Laboratory of Health Technology Assessment (MOH); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fu Dan University, Shanghai
| | - Minqi Li
- From the Key Laboratory of Health Technology Assessment (MOH); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fu Dan University, Shanghai
| | - Xuefeng Wei
- Health and Family Planning Commission of Gansu Province, Lanzhou
| | - Hongbo Zhu
- Health and Family Planning Commission of Hubei Province, Wuhan, People's Republic of China
| | - Di Xue
- From the Key Laboratory of Health Technology Assessment (MOH); Collaborative Innovation Center of Social Risks Governance in Health; School of Public Health, Fu Dan University, Shanghai
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Assessment of Workplace Safety Climate among Healthcare Workers during the COVID-19 Pandemic in Low and Middle Income Countries: A Case Study of Nigeria. Healthcare (Basel) 2021; 9:healthcare9060661. [PMID: 34206111 PMCID: PMC8228704 DOI: 10.3390/healthcare9060661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
The COVID-19 pandemic has presented several organizations with the opportunity to review their operational strategies, as well as the existing safety climate within their establishments. The healthcare sector is not an exception, especially those in Low and Middle Income Countries (LMICs), where most safety systems are not robust when compared with developed countries. The study aim is to assess the occupational safety climate among healthcare workers (HCWs) in LMICs using Nigeria as a case study. A cross-sectional study was adopted to measure safety climate perception among professionals working in healthcare establishment during the COVID-19 pandemic using a validated Nordic Safety Climate Questionnaire (NOSACQ-50). At the end of the survey period, 83% (433) of the responses were adjudged to have met the threshold criteria and were used to inform the study outcome. Worker safety commitment within the healthcare facilities (M = 3.01, SD = 0.42) was statistically significantly higher than management safety priority, commitment, and competence (M = 2.91, SD = 0.46), t(130.52), p < 0.001. A significant effect of the management role was found in regards to management safety priority, commitment, and competence (F(1, 406) = 3.99, p = 0.046, η2 = 0.010). On the contrary, the managerial position does not have a significant effect on worker safety commitment (F(1, 417) = 0.59, p = 0.440, η2 = 0.001). The outcome from the study showed that, where there is active promotion of a positive safety climate in healthcare sectors in LMICs, employees are more likely to engage in positive safety behaviour. To help address the identified gaps, there is the need for more effort to be made towards promoting an effective and positive safety climate across the establishment, including management and healthcare worker commitments.
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7
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Naito Y, Kawanishi H, Kayashima M, Okamoto S, Imamura T, Furuya H, Egawa J, Kawaguchi M. Current Status of Clinical Engineer Anesthesia Assistants and Their Effect on Labor Task Shifting in Japan: A Prospective Observational Study in a Single Institute. JMA J 2021; 4:129-134. [PMID: 33997446 PMCID: PMC8119214 DOI: 10.31662/jmaj.2020-0100] [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: 11/09/2020] [Accepted: 02/03/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Anesthesiologists are in short supply across the world, resulting in perpetually long working hours. To reduce the burden on anesthesiologists, tasks that can be performed by non-physicians must be shifted to other medical staff. In hospitals, clinical engineers can work as anesthesia assistants and perform some of the duties of anesthesiologists. This study aimed to evaluate the effect of task shift performed by clinical engineer anesthesia assistants (CEAAs). Methods: This was a 1-month prospective observational study that included 33 anesthesiologists (11 fellows and 22 certified anesthesiologists) and 11 CEAAs. The total activity and anesthesia times were extracted from the attendance record as indices of the anesthesiologists' work status. The CEAAs recorded the duration of work performed on behalf of the anesthesiologists as task shift time. The task shift rate was evaluated as follows: task shift time/(task shift time + total activity time) and task shift time/(task shift time) + (total anesthesia time). Results: The study period consisted of 19 weekdays. The average daily activity time of the anesthesiologists was 10.1 h, and the average anesthesia time was 8.5 h. The CEAAs performed a total of 546.8 h of task shift. The defined task shift rate was 20.1% when the total activity time was the denominator and 23.1% when the anesthesia time was the denominator. Conclusions: CEAAs might be effective in reducing the working hours of anesthesiologists through task shift. Their taking over a portion of the anesthesiologists' duties may allow the anesthesiologists to work more efficiently.
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Affiliation(s)
- Yusuke Naito
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Hideaki Kawanishi
- Department of Medical Technology, Nara Medical University, Kashihara, Japan
| | | | - Sawako Okamoto
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Nara Medical University, Kashihara, Japan
| | - Hitoshi Furuya
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
| | - Junji Egawa
- Department of Anesthesiology, Nara Medical University, Kashihara, Japan
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8
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Tremey B, Squara P, De Labarre H, Ma S, Fischler M, Lawkoune JD, Le Guen M. Hands-free induction of general anesthesia: a randomised pilot study comparing usual care and high-flow nasal oxygen. Minerva Anestesiol 2020; 86:1135-1142. [DOI: 10.23736/s0375-9393.20.14456-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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9
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DeVido JJ, Epson MF. Clinical Update: What is Old is New Again: Rediscovering Narrative in Healthcare and Charting a Future for Addiction Specialists. Am J Addict 2020; 29:418-425. [DOI: 10.1111/ajad.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/17/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jeffrey J. DeVido
- Marin County California Health and Human Services, Department of Behavioral Health & Recovery Services; San Rafael California
- Partnership HealthPlan of California; Fairfield California
- Department of Psychiatry and Behavioral Sciences; Weill Institute for Neurosciences; University of California, San Francisco; San Francisco California
| | - Martin F. Epson
- Marin County California Health and Human Services, Department of Behavioral Health & Recovery Services; San Rafael California
- Department of Psychiatry and Behavioral Sciences; Weill Institute for Neurosciences; University of California, San Francisco; San Francisco California
- San Francisco Veterans Administration Health Care System; San Francisco California
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10
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Evaluation of Methods to Measure Production Pressure. J Nurs Care Qual 2020; 35:E14-E19. [DOI: 10.1097/ncq.0000000000000411] [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]
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11
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Abbaspour A, Saremi M, Alibabaei A, Moghanlu PS. Determining the optimal human reliability analysis (HRA) method in healthcare systems using Fuzzy ANP and Fuzzy TOPSIS. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043519900431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose As one of the leading causes of deaths and injuries, medical errors constitute a veritable threat to patient safety. Despite this fact, no unique method has yet been established to identify and evaluate medical errors. This study was conducted to select an optimal human reliability analysis method compatible with healthcare systems from available methods. Design/methodology/approach: In order to select the optimal method for the identification and evaluation of medical errors, different criteria and sub-criteria were determined by reviewing the literature and based on experts’ opinions. Next, weights of criteria and sub-criteria were specified by using the fuzzy analytical network process (ANP). Finally, fuzzy technique for order preference by similarity to ideal solution method was used to prioritize the methods. Findings Six criteria and 21 sub-criteria for choosing the optimal method were determined. The utility, usability, and structure of a method had the highest influence with weights of 0.262, 0.191, and 0.187, respectively. Based on the results of fuzzy technique for order preference by similarity to ideal solution, the Human Error Assessment and Reduction Technique method with a closeness coefficient of 0.576 was selected as the optimal method for identifying medical errors. The Human Factors Analysis and Classification System and Systematic Human Error Reduction and Prediction Approach methods ranked second and third, respectively. Originality/value: To date, no studies have attempted to determine the optimal methods for identification and assessment of medical errors. This paper aimed to fill this gap by using fuzzy analytical network process and fuzzy technique for order preference by similarity to ideal solution techniques.
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Affiliation(s)
- Asghar Abbaspour
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahnaz Saremi
- Workplace Health Promotion Research Center and School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Alibabaei
- School of Management and Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pedram S Moghanlu
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Viswanath O, Simpao AF, Garcia G. The Expected Role of the Anesthesiologist in Delivering Bad News. Anesth Analg 2019; 126:1774-1776. [PMID: 28759490 DOI: 10.1213/ane.0000000000002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Omar Viswanath
- From Miami Beach Anesthesiology Associates, Inc, Miami Beach, Florida.,Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, Florida
| | - Allan F Simpao
- Department of Anesthesiology & Critical Care, Perelman School of Medicine at the Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Guillermo Garcia
- From Miami Beach Anesthesiology Associates, Inc, Miami Beach, Florida.,Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, Florida
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13
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Wong LR, Flynn-Evans E, Ruskin KJ. Fatigue Risk Management: The Impact of Anesthesiology Residents' Work Schedules on Job Performance and a Review of Potential Countermeasures. Anesth Analg 2019; 126:1340-1348. [PMID: 29049076 DOI: 10.1213/ane.0000000000002548] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Long duty periods and overnight call shifts impair physicians' performance on measures of vigilance, psychomotor functioning, alertness, and mood. Anesthesiology residents typically work between 64 and 70 hours per week and are often required to work 24 hours or overnight shifts, sometimes taking call every third night. Mitigating the effects of sleep loss, circadian misalignment, and sleep inertia requires an understanding of the relationship among work schedules, fatigue, and job performance. This article reviews the current Accreditation Council for Graduate Medical Education guidelines for resident duty hours, examines how anesthesiologists' work schedules can affect job performance, and discusses the ramifications of overnight and prolonged duty hours on patient safety and resident well-being. We then propose countermeasures that have been implemented to mitigate the effects of fatigue and describe how training programs or practice groups who must work overnight can adapt these strategies for use in a hospital setting. Countermeasures include the use of scheduling interventions, strategic naps, microbreaks, caffeine use during overnight and extended shifts, and the use of bright lights in the clinical setting when possible or personal blue light devices when the room lights must be turned off. Although this review focuses primarily on anesthesiology residents in training, many of the mitigation strategies described here can be used effectively by physicians in practice.
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Affiliation(s)
- Lily R Wong
- From the San Jose State University Research Foundation, San Jose, California.,Human Factors Research Division, NASA Ames Research Center, Moffett Field, California
| | - Erin Flynn-Evans
- Human Factors Research Division, NASA Ames Research Center, Moffett Field, California
| | - Keith J Ruskin
- Department of Anesthesia and Critical Care, University of Chicago School of Medicine, Chicago, Illinois
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14
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Yang N, Elmatite WM, Elgallad A, Gajdos C, Pourafkari L, Nader ND. Patient outcomes related to the daytime versus after-hours surgery: A meta-analysis. J Clin Anesth 2019; 54:13-18. [DOI: 10.1016/j.jclinane.2018.10.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/25/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
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15
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Sinskey JL, Chang JM, Shibata GS, Infosino AJ, Rouine-Rapp K. Applying Conflict Management Strategies to the Pediatric Operating Room. Anesth Analg 2019; 129:1109-1117. [PMID: 30633050 DOI: 10.1213/ane.0000000000003991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Effective communication is essential in today's health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas-Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one's own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.
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Affiliation(s)
- Jina L Sinskey
- From the Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California
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16
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Abstract
STATEMENT Improving healthcare safety is a worthwhile and important endeavor. Simulation-based activities can help with such a goal through research and training. In this manner, it can focus on education and training, assessment and metrics, process improvement, and culture change to help move forward both patient safety and quality of care.This article will address the following three main topics: (1) designing simulation-based activities to promote high reliability in healthcare, (2) developing simulation-based activities to foster resilience in healthcare systems, and (3) evaluating the impact of adverse events in healthcare and how simulation-based activities can be used to determine and potentially to prevent their cause. These topics will be treated sequentially, providing synopses of concepts and giving examples of research currently being undertaken. It will then highlight current priorities for simulation-based research in this domain by drawing from insights obtained and a targeted literature review.
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17
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The impact of the patient's initial NACA score on subjective and physiological indicators of workload during pre-hospital emergency care. PLoS One 2018; 13:e0202215. [PMID: 30092090 PMCID: PMC6084954 DOI: 10.1371/journal.pone.0202215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/29/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians' protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload. RESULTS In contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57). CONCLUSIONS Patients' initial NACA scores are associated with subjective workload. Workload was highest during CPR.
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18
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Stuetzle KV, Pavlin BI, Smith NA, Weston KM. Survey of occupational fatigue in anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2018; 46:414-423. [PMID: 29966116 DOI: 10.1177/0310057x1804600411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational fatigue in anaesthetists is recognised as a patient safety risk. Better understanding of the issues surrounding their fatigue is needed. This study aimed to ascertain the sources and effects of occupational fatigue amongst anaesthetists in Australia and New Zealand. An anonymous online survey was sent to 979 anaesthetists. The response rate was 38.0%. Most participants reported regularly working over 40 hours per week; men reported five more hours per week than women. Stated contributors to fatigue included long work hours, mental strain at work, and personal and family demands. Fatigue-related behaviour was reported more by men (OR [odds ratio]=2.6) and less by respondents reporting eight or more hours of sleep before work (OR=0.6). Reporting at least one instance of less than five hours off between shifts was predictive of falling asleep while administering an anaesthetic (OR=1.6). More data are required to support practices and policies that promote more time off between work periods and increased time for sleep to reduce risk of fatigue.
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Abstract
INTRODUCTION Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore. METHODS A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure. RESULTS Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively. CONCLUSION Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.
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Affiliation(s)
- Jia Xin Chai
- SingHealth Anaesthesiology Residency Programme, Singapore
- Department of Anaesthesiology, Singapore General Hospital, Singapore
| | - Shin Yuet Chong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Zhou P, Bai F, Tang HQ, Bai J, Li MQ, Xue D. Patient safety climate in general public hospitals in China: differences associated with department and job type based on a cross-sectional survey. BMJ Open 2018; 8:e015604. [PMID: 29666125 PMCID: PMC5905765 DOI: 10.1136/bmjopen-2016-015604] [Citation(s) in RCA: 5] [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: 11/03/2022] Open
Abstract
OBJECTIVE This study analysed differences in the perceived patient safety climate among different working departments and job types in public general hospitals in China. DESIGN Cross-sectional survey. SETTING Eighteen tertiary hospitals and 36 secondary hospitals from 10 areas in Shanghai, Hubei Province and Gansu Province, China. PARTICIPANTS Overall, 4753 staff, including physicians, nurses, medical technicians and managers, were recruited from March to June 2015. MAIN OUTCOME MEASURE The Patient Safety Climate in Healthcare Organisations (PSCHO) tool and the percentages of 'problematic responses' (PPRs) were used as outcome measures. Multivariable two-level random intercept models were applied in the analysis. RESULTS A total of 4121 valid questionnaires were collected. Perceptions regarding the patient safety climate varied among departments and job types. Physicians responded with relatively more negative evaluations of 'organisational resources for safety', 'unit recognition and support for safety efforts', 'psychological safety', 'problem responsiveness' and overall safety climate. Paediatrics departments, intensive care units, emergency departments and clinical auxiliary departments require more attention. The PPRs for 'fear of blame and punishment' were universally significantly high, and the PPRs for 'fear of shame' and 'provision of safe care' were remarkably high, especially in some departments. Departmental differences across all dimensions and the overall safety climate primarily depended on job type. CONCLUSIONS The differences suggest that strategies and measures for improving the patient safety climate should be tailored by working department and job type.
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Affiliation(s)
- Ping Zhou
- Key Laboratory of Health Technology Assessment, NHFPC (Fudan University), Shanghai, China
- Department of Hospital Management, School of Public Health, Fudan University, Shanghai, China
| | - Fei Bai
- Department of Hospital management, National Center for Medical Service Administration, Beijing, China
| | - Hui-qin Tang
- Department of Hospital management, Health and Family Planning Commission of Hubei Province, Wuhan, China
| | - Jie Bai
- Key Laboratory of Health Technology Assessment, NHFPC (Fudan University), Shanghai, China
- Department of Hospital Management, School of Public Health, Fudan University, Shanghai, China
| | - Min-qi Li
- Key Laboratory of Health Technology Assessment, NHFPC (Fudan University), Shanghai, China
- Department of Hospital Management, School of Public Health, Fudan University, Shanghai, China
| | - Di Xue
- Key Laboratory of Health Technology Assessment, NHFPC (Fudan University), Shanghai, China
- Department of Hospital Management, School of Public Health, Fudan University, Shanghai, China
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Li H, Zuo M, Gelb AW, Zhang B, Zhao X, Yao D, Xia D, Huang Y. Chinese Anesthesiologists Have High Burnout and Low Job Satisfaction. Anesth Analg 2018; 126:1004-1012. [DOI: 10.1213/ane.0000000000002776] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
STUDY OBJECTIVE Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures. DESIGN A prospective, observational, longitudinal, comparison study was conducted. SETTING An academic tertiary hospital's main operating room suite staffed by attending anesthesiologists, anesthesiology residents, anesthesiologist assistants and nurse anesthetists. PATIENTS Subjects were 30 anesthesiology residents working daytime shifts and 30 peers working overnight call shifts from the University of Texas Health Science Center at Houston. INTERVENTIONS Before and after their respective work shifts, residents completed the Stanford Sleepiness Scale (SSS) and the ProPoint and AntiPoint tablet-based tasks. These latter tasks are designed to measure sensorimotor and executive functions, respectively. MEASUREMENTS The SSS is a self-reported measure of sleepiness. Response times (RTs) are measured in the pointing tasks. MAIN RESULTS Call residents exhibited increased RTs across their shifts (post-pre) on both ProPoint (p=0.002) and AntiPoint (p<0.002) tasks, when compared to Routine residents. Increased stress was associated with decreases in AntiPoint RT for Routine (p=0.007), but with greater increases in sleepiness for Call residents (p<0.001). Further, whether or not a Call resident consumed caffeine habitually was associated with ProPoint RT changes; with Call residents who habitually drink caffeine having a greater Pre-Post difference (i.e., more slowing, p<0.001) in ProPoint RT. CONCLUSIONS These results indicate that (1) overnight Call residents demonstrate both sensorimotor and cognitive slowing compared to routine daytime shift residents, (2) sensorimotor slowing is greater in overnight Call residents who drink caffeine habitually, and (3) increased stress during a shift reduces (improves) cognitive RTs during routine daytime but not overnight call shifts.
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Hopping M, Merry AF, Pandit JJ. Exploring performance of, and attitudes to, Stop- and Mock-Before-You-Block in preventing wrong-side blocks. Anaesthesia 2017; 73:421-427. [DOI: 10.1111/anae.14167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Hopping
- School of Medicine; Faculty of Medical and Health Sciences; The University of Auckland; New Zealand
- Nuffield Department of Anaesthetics; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - A. F. Merry
- School of Medicine; Faculty of Medical and Health Sciences; The University of Auckland; New Zealand
- Department of Anaesthesia; Auckland City Hospital; Auckland New Zealand
| | - J. J. Pandit
- Nuffield Department of Anaesthetics; Oxford University Hospitals NHS Foundation Trust; Oxford UK
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Göras C, Unbeck M, Nilsson U, Ehrenberg A. Interprofessional team assessments of the patient safety climate in Swedish operating rooms: a cross-sectional survey. BMJ Open 2017; 7:e015607. [PMID: 28864690 PMCID: PMC5588952 DOI: 10.1136/bmjopen-2016-015607] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A positive patient safety climate within teams has been associated with higher safety performance. The aim of this study was to describe and compare attitudes to patient safety among the various professionals in surgical teams in Swedish operating room (OR) departments. A further aim was to study nurse managers in the OR and medical directors' estimations of their staffs' attitudes to patient safety. METHODS A cross-sectional survey with the Safety Attitudes Questionnaire (SAQ) was used to elicit estimations from surgical teams. To evoke estimations from nurse managers and medical directors about staff attitudes to patient safety, a short questionnaire, based on SAQ, was used. Three OR departments at three different hospitals in Sweden participated. All licensed practical nurses (n=124), perioperative nurses (n=233), physicians (n=184) and their respective manager (n=22) were invited to participate. RESULTS Mean percentage positive scores for the six SAQ factors and the three professional groups varied, and most factors (safety climate, teamwork climate, stress recognition, working conditions and perceptions of management), except job satisfaction, were below 60%. Significantly lower mean values were found for perioperative nurses compared with physicians for perceptions of management (56.4 vs 61.4, p=0.013) and working conditions (63.7 vs 69.8, p=0.007). Nurse managers and medical directors' estimations of their staffs' ratings of the safety climate cohered fairly well. CONCLUSIONS This study shows variations and some weak areas for patient safety climate in the studied ORs as reported by front-line staff and acknowledged by nurse managers and medical directors. This finding is a concern because a weak patient safety climate has been associated with poor patient outcomes. To raise awareness, managers need to support patient safety work in the OR.
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Affiliation(s)
- Camilla Göras
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Anesthesia, Intensive Care Unit, Falu Lasarett, Sweden
- Centre for Clinical Research, Falun, Dalarna, Sweden
| | - Maria Unbeck
- Department of Orthopedics, Danderyd Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ulrica Nilsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Ehrenberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Greig P, Higham H, Darbyshire J, Vincent C. Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists. Br J Anaesth 2017; 118:740-746. [DOI: 10.1093/bja/aew444] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
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Saadat H, Bissonnette B, Tumin D, Raman V, Rice J, Barry N, Tobias J. Effects of partial sleep deprivation on reaction time in anesthesiologists. Paediatr Anaesth 2017; 27:358-362. [PMID: 27900800 DOI: 10.1111/pan.13035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fatigue in anesthesiologists may have implications that extend beyond individual well-being. AIM The aim of the present study was to evaluate the impact of sleep deprivation on the reaction time in anesthesiologists either after an overnight call or regular working hours. Moderation of this effect by coping strategies was observed. METHODS Psychomotor vigilance test was used to assess reaction time in 23 anesthesiologists at two time-points: (i) on a regular non-call day and (ii) after a 17-h in-house call. Student's paired t-test was used to compare Psychomotor Vigilance Task data at these two moments. Change score regression was performed to determine the association between coping strategies, assessed using the Coping Strategy Indicator instrument, and decline in reaction time after night call. RESULTS Twenty-one colleagues completed the psychomotor vigilance test measurements after two decided to end their participation for personal reasons. Post-call psychomotor vigilance test mean reaction time decreased by an average of 31.2 ms (95% CI: 0.5, 61.9; P = 0.047) when compared to regular day. Reliance on specific coping mechanisms, indicated by Coping Strategy Indicator scale scores, included problem-solving (28 ± 4), followed by seeking social support (23 ± 5) and avoidance (19 ± 4). The change score regression model (r2 = 0.48) found that greater reliance on avoidance was associated with greater increase in reaction time after night call. CONCLUSION Reaction time increased considerably in anesthesiologists after a night call duty. Greater subjective reliance on avoidance as a coping strategy was associated with greater deterioration in performance.
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Affiliation(s)
- Haleh Saadat
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT, USA
| | - Bruno Bissonnette
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Anesthesia and Critical Care Medicine, The University of Toronto, Toronto, ON, Canada
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Vidya Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie Rice
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - N'Diris Barry
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA
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Stock GN, McFadden KL. Improving service operations: linking safety culture to hospital performance. JOURNAL OF SERVICE MANAGEMENT 2017. [DOI: 10.1108/josm-02-2016-0036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.
Design/methodology/approach
Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.
Findings
The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.
Practical implications
Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.
Originality/value
This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.
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A Retrospective Study of Success, Failure, and Time Needed to Perform Awake Intubation. Anesthesiology 2016; 125:105-14. [DOI: 10.1097/aln.0000000000001140] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Awake intubation is the standard of care for management of the anticipated difficult airway. The performance of awake intubation may be perceived as complex and time-consuming, potentially leading clinicians to avoid this technique of airway management. This retrospective review of awake intubations at a large academic medical center was performed to determine the average time taken to perform awake intubation, its effects on hemodynamics, and the incidence and characteristics of complications and failure.
Methods
Anesthetic records from 2007 to 2014 were queried for the performance of an awake intubation. Of the 1,085 awake intubations included for analysis, 1,055 involved the use of a flexible bronchoscope. Each awake intubation case was propensity matched with two controls (1:2 ratio), with similar comorbidities and intubations performed after the induction of anesthesia (n = 2,170). The time from entry into the operating room until intubation was compared between groups. The anesthetic records of all patients undergoing awake intubation were also reviewed for failure and complications.
Results
The median time to intubation for patients intubated post induction was 16.0 min (interquartile range: 13 to 22) from entrance into the operating room. The median time to intubation for awake patients was 24.0 min (interquartile range: 19 to 31). The complication rate was 1.6% (17 of 1,085 cases). The most frequent complications observed were mucous plug, endotracheal tube cuff leak, and inadvertent extubation. The failure rate for attempted awake intubation was 1% (n = 10).
Conclusions
Awake intubations have a high rate of success and low rate of serious complications and failure. Awake intubations can be performed safely and rapidly.
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Sarotti D, Rabozzi R, Franci P. Impact evaluation of two different general anesthesia protocols (TIVA with propofol vs isoflurane) on the total number of interventions to treat cardiovascular depression or arousal/movement episodes in dogs undergoing orthopedic surgery receiving an intrathecal anesthesia. J Vet Med Sci 2016; 78:1549-1555. [PMID: 27334295 PMCID: PMC5095623 DOI: 10.1292/jvms.15-0661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this prospective, randomized clinical trial was to compare the total number of anesthetic interventions (TNAI) performed by the anesthetist to treat
cardiovascular depression or arousal/movement episodes in dogs receiving intrathecal and general anesthesia (GA), maintained using propofol-based TIVA (group P)
or isoflurane (group I). Mean arterial pressure (MAP) before (T0) and 12 min after intrathecal anesthesia (T1) and intraoperative
vasoactive consumption were also compared. The TNAI to deepen the anesthetic plane or to treat hemodynamic depression in the pre-surgical and intra-surgical
period was calculated in forty-two client-owned dogs randomly assigned to group P or I. Ten dogs for each group complied with the inclusion criteria and were
analyzed. In pre-surgical period, the TNAI was higher in Group I [2 (0–5)] than Group P [0 (0–2)] (P=0.022), and ephedrine consumption was also
higher in Group I [75 (0–200) µg/kg)] than Group P [(0 (0–50)] (P=0.016). MAP (mmHg) in Group P was 79 (66–95) at
T0 and 65 (59–86) at T1 and 67.5 (50–73) and 57 (53–66) in Group I, respectively. At T0 and T1, MAP was higher in
Group P (P=0.005 and P=0.006, respectively). No differences were found between the two groups in the intrasurgical period
(P>0.05). This study shows that the GA protocol can have a relevant impact on the TNAI performed by the anesthetist in the pre-surgical
period of anesthesia, to treat cardiovascular depression or arousal/movement episodes in dogs receving intrathecal anesthesia.
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Staff Turnover in Assertive Community Treatment (Act) Teams: The Role of Team Climate. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 44:258-268. [DOI: 10.1007/s10488-016-0740-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wetmore D, Goldberg A, Gandhi N, Spivack J, McCormick P, DeMaria S. An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting. BMJ Qual Saf 2015; 25:739-46. [DOI: 10.1136/bmjqs-2015-004707] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/28/2015] [Indexed: 11/04/2022]
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Kim SE, Kim CW, Lee SJ, Oh JH, Lee DH, Lim TH, Choi HJ, Chung HS, Ryu JY, Jang HY, Choi YH, Kim SJ, Jung JH. A questionnaire survey exploring healthcare professionals' attitudes towards teamwork and safety in acute care areas in South Korea. BMJ Open 2015; 5:e007881. [PMID: 26209120 PMCID: PMC4521544 DOI: 10.1136/bmjopen-2015-007881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Although human factors are important in terms of patient safety, there have been very few reports on the attitudes of healthcare professionals working in acute care settings in South Korea. In the present study, we investigated the attitudes of such professionals, their cultures and their management systems. DESIGN A questionnaire survey with 65 items covering nine themes affecting patient safety. Nine themes were compared via a three-or-more-way analysis of variance, with interaction, followed by multiple comparisons among several groups. SETTING Intensive care units, emergency departments and surgical units of nine urban hospitals. PARTICIPANTS 592 nurses and 160 physicians. INTERVENTION None. OUTCOME MEASURES Mean scores using a five-point scale and combined response scores for each of the nine themes. RESULTS The mean score for information-sharing was the highest (3.78±0.49) and that for confidence/assertion was the lowest (2.97±0.34). The mean scores for teamwork, error management, work value, organisational climate, leadership, stress and fatigue level, and error/procedural compliance were intermediate. Physicians showed lower scores in leadership and higher scores in information-sharing than nurses. Respondents with 24 months or less of a clinical career showed higher scores in leadership, stress and fatigue, and error scores and lower scores in work value than more experienced respondents. CONCLUSIONS Our results suggest that medical personnel in Korea are relatively reluctant to disclose error or assert their different opinions with others. Many did not adequately recognise the negative effects of fatigue and stress, attributed errors to personal incompetence, and error-management systems were inadequate. Discrepancies in leadership and information-sharing were evident between professional groups, and leadership, stress, fatigue level, work value and error scores varied with the length of work experience. These can be used as baseline data to establish training programmes for patient safety in Korea.
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Affiliation(s)
- Sung Eun Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chan Woong Kim
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Jin Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yeong Ryu
- Department of Emergency Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, Seoul, Korea
| | - Hye Young Jang
- Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Yoon Hee Choi
- Department of Emergency Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Su Jin Kim
- Department of Emergency Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Hee Jung
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul Metropolitan Boramae Medical Center, Seoul, Korea
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Amte R, Munta K, Gopal PB. Stress levels of critical care doctors in India: A national survey. Indian J Crit Care Med 2015; 19:257-64. [PMID: 25983431 PMCID: PMC4430743 DOI: 10.4103/0972-5229.156464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Doctors working in critical care units are prone to higher stress due to various factors such as higher mortality and morbidity, demanding service conditions and need for higher knowledge and technical skill. Aim: The aim was to evaluate the stress level and the causative stressors in doctors working in critical care units in India. Materials and Methods: A two modality questionnaire-based cross-sectional survey was conducted. In manual mode, randomly selected delegates attending the annual congress of Indian Society of Critical Care Medicine filled the questionnaire. In the electronic mode, the questionnaires were E-mailed to critical care doctors. These questionnaires were based on General Health Questionnaire-12 (GHQ-12). Completely filled 242 responses were utilized for comparative and correlation analysis. Results: Prevalence of moderate to severe stress level was 40% with a mean score of 2 on GHQ-12 scale. Too much responsibility at times and managing VIP patients ranked as the top two stressors studied, while the difficult relationship with colleagues and sexual harassment were the least. Intensivists were spending longest hours in the Intensive Care Unit (ICU) followed by pulmonologists and anesthetists. The mean number of ICU bed critical care doctors entrusted with was 13.2 ± 6.3. Substance abuse to relieve stress was reported as alcohol (21%), anxiolytic or antidepressants (18%) and smoking (14%). Conclusion: Despite the higher workload, stress levels measured in our survey in Indian critical care doctors were lower compared to International data. Substantiation of this data through a wider study and broad-based measures to improve the quality of critical care units and quality of the lives of these doctors is the need of the hour.
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Affiliation(s)
- Rahul Amte
- Department of Critical Care, Yashoda Hospital, Somajiguda, Hyderabad, Telangana, India
| | - Kartik Munta
- Department of Critical Care, Yashoda Hospital, Somajiguda, Hyderabad, Telangana, India
| | - Palepu B Gopal
- Department of Critical Care, Care Hospital, Nampally, Hyderabad, Telangana, India
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Survey on patient safety climate in public hospitals in China. BMC Health Serv Res 2015; 15:53. [PMID: 25890169 PMCID: PMC4326494 DOI: 10.1186/s12913-015-0710-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022] Open
Abstract
Background Patient safety climate has been recognized as a core determinant for improving safety in hospitals. Describing workforce perceptions of patient safety climate is an important part of safety climate management. This study aimed to describe staff’s perceptions of patient safety climate in public hospitals in Shanghai, China and to determine how perceptions of patient safety climate differ between different types of workers in the U.S. and China. Methods Survey of employees of 6 secondary, general public hospitals in Shanghai conducted during 2013 using a modified version of the U.S. Patient Safety Climate in Health Care Organizations (PSCHO) tool. The percentage of “problematic responses” (PPRs) was used to measure safety climate, and the PPRs were compared among employees with different job types, using χ2 tests and multivariate regression models. Results Perceptions of patient safety climate were relatively positive among hospital employees and similar to those of employees in U.S. hospitals along most dimensions. For workers in Chinese hospitals, the scales of “fear of blame” and “fear of shame” had the highest PPRs, whereas in the United States the scale of “fear of shame” had among the lowest PPRs. As in the United States, hospital managers in China perceived a more positive patient safety climate overall than other types of personnel. Conclusions “Fear of shame” and “fear of blame” may be important barriers to improvement of patient safety in Chinese hospitals. Research on the effect of patient safety climate on outcomes is necessary to implement effective polices to improve patient safety and quality outcomes in China. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0710-x) contains supplementary material, which is available to authorized users.
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Megeus V, Nilsson K, Karlsson J, Eriksson BI, Andersson AE. Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room. Antimicrob Resist Infect Control 2015; 4:5. [PMID: 25685334 PMCID: PMC4328079 DOI: 10.1186/s13756-015-0042-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room. METHODS Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization's observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery. RESULTS A total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean = 10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%). CONCLUSIONS There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.
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Affiliation(s)
- Veronika Megeus
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- />Department of Anesthesia, Surgery and Intensive Care, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85 Gothenburg, Sweden
| | - Kerstin Nilsson
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
| | - Jon Karlsson
- />Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- />The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bengt I Eriksson
- />Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- />The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- />The Swedish Institute for Health Science, Lund, Sweden
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Wacker J, Steurer J, Manser T, Leisinger E, Stocker R, Mols G. Perceived barriers to computerised quality documentation during anaesthesia: a survey of anaesthesia staff. BMC Anesthesiol 2015; 15:13. [PMID: 25971791 PMCID: PMC4429922 DOI: 10.1186/1471-2253-15-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 01/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Underreporting of intraoperative events in anaesthesia is well-known and compromises quality documentation. The reasons for such omissions remain unclear. We conducted a questionnaire-based survey of anaesthesia staff to explore perceived barriers to reliable documentation during anaesthesia. METHODS Participants anonymously completed a paper-based questionnaire. Predefined answers referred to potential barriers. Additional written comments were encouraged. Differences between physician and nurse anaesthetists were tested with t-tests and chi-square tests. RESULTS Twenty-five physician and 30 nurse anaesthetists (81% of total staff) completed the survey. The reported problems referred to three main categories: (I) potential influences related to working conditions and practices of data collection, such as premature entry of the data (indicated by 85% of the respondents), competing duties (87%), and interfering interruptions or noise (67%); (II) problems referring to institutional management of the data, for example lacking feedback on the results (95%) and lacking knowledge about what the data are used for (75%); (III) problems related to specific attitudes, e.g., considering these data not useful for quality improvement (47%). Physicians were more sceptical than nurses regarding the relevance of these data for quality and patient safety. CONCLUSIONS The common perceived difficulties reported by physician and nurse anaesthetists resemble established barriers to incident reporting and may similarly act as barriers to quality documentation during anaesthesia. Further studies should investigate if these perceived obstacles have a causal impact on quality reporting in anaesthesia. TRIAL REGISTRATION ClinicalTrials.gov identifier is NCT01524484. Registration date: January 21, 2012.
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Affiliation(s)
- Johannes Wacker
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic, Witellikerstrasse 40, CH-8032, Zürich, Switzerland.
| | - Johann Steurer
- Horten Center for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Pestalozzistrasse 24, CH-8091, Zürich, Switzerland.
| | - Tanja Manser
- Institute for Patient Safety, Faculty of Medicine, University of Bonn, Stiftsplatz 12, D-53111, Bonn, Germany.
| | - Elke Leisinger
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic, Witellikerstrasse 40, CH-8032, Zürich, Switzerland.
| | - Reto Stocker
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic, Witellikerstrasse 40, CH-8032, Zürich, Switzerland.
| | - Georg Mols
- Department of Anaesthesia & Surgical Intensive Care Medicine, Hospital Lahr-Ettenheim, Klostenstr. 19, D-77933, Lahr, Germany.
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Green-McKenzie J, Shofer FS. Duration of Time on Shift Before Accidental Blood or Body Fluid Exposure for Housestaff, Nurses, and Technicians. Infect Control Hosp Epidemiol 2015; 28:5-9. [PMID: 17230381 DOI: 10.1086/510568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 04/14/2006] [Indexed: 11/04/2022]
Abstract
Background.Shift work has been found to be associated with an increased rate of errors and accidents among healthcare workers (HCWs), but the effect of shift work on accidental blood and body fluid exposure sustained by HCWs has not been well characterized.Objectives.To determine the duration of time on shift before accidental blood and body fluid exposure in housestaff, nurses, and technicians and the proportion of housestaff who sustain a blood and body fluid exposure after 12 hours on duty.Methods.This retrospective, descriptive study was conducted during a 24-month period at a large urban teaching hospital. Participants were HCWs who sustained an accidental blood and body fluid exposure.Results.Housestaff were on duty significantly longer than both nursing staff (P = .02) and technicians (P < .0001) before accidental blood and body fluid exposure. Half of the blood and body fluid exposures sustained by housestaff occurred after being on duty 8 hours or more, and 24% were sustained after being on duty 12 hours or more. Of all HCWs, 3% reported an accidental blood and body fluid exposure, with specific rates of 7.9% among nurses, 9.4% among housestaff, and 3% among phlebotomists.Conclusions.Housestaff were significantly more likely to have longer duration of time on shift before blood and body fluid exposure than were the other groups. Almost one-quarter of accidental blood and body fluid exposures to housestaff were incurred after they had been on duty for 12 hours or more. Housestaff sustained a higher rate of accidental blood and body fluid exposures than did nursing staff and technicians.
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Abstract
OBJECTIVES An estimated 7.4% of patients admitted to acute care facilities in Canada experience injury or death due to health care mishaps, and 38% of these events are deemed preventable. Commitment of executive leaders to a culture of safety is important for the reduction of risk to Canadian patients. The purpose of this study was to examine the safety climate from a leader's perspective in 2 Canadian acute care settings, with attention paid to high reliability organization (HRO) principles. METHODS The Patient Safety Culture in Healthcare Organizations questionnaire was administered to leaders in 2 acute care hospitals in Ontario between June and January 2009. The primary outcome measures were senior leadership support for safety and supervisory leadership support for safety. Misalignment between the safety climate and HRO principles was defined as greater than 10% of respondents reporting problematic or neutral leadership support for safety. RESULTS Of the 142 respondents (67% response rate), both medical/nursing leaders and tertiary care clinical leaders were significantly more likely than board/administrative leaders to report problematic/neutral responses. Overall, executive leadership perceptions of the safety climate were not aligned with HRO principles. CONCLUSIONS The significant differences in response between board/administrative leaders and those involved in frontline patient care suggest that a weak safety culture exists in these 2 health care organizations. The cultivation of a stronger organizational safety culture, in alignment with HRO principles, could lead to lower rates of preventable mishaps and support risk identification and mitigation in perioperative settings.
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Cardiopulmonary resuscitation guidance improves medical students' adherence to guidelines in simulated cardiac arrest: a randomised cross-over study. Eur J Anaesthesiol 2014; 30:752-7. [PMID: 23702601 DOI: 10.1097/eja.0b013e328362147f] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The 2010 Resuscitation Guidelines require high-quality chest compression and rapid defibrillation for patients with ventricular fibrillation with rhythm analysis and defibrillation repeated every 2 min. A lack of adherence to the guidelines by medical students was observed during simulated resuscitation training. OBJECTIVES To assess whether real-time cardiopulmonary resuscitation guidance, including an audiovisual countdown timer, a metronome, a display of the chest compression quality and voice prompts, might improve adherence to the guidelines by medical students. DESIGN Randomised cross-over simulation study. SETTING Studienhospital Münster, Faculty of Medicine University Münster, Germany PARTICIPANTS One hundred and forty-one medical students (fifth year) in 47 teams. INTERVENTION Simulated resuscitation with and without real-time cardiopulmonary resuscitation guidance. MAIN OUTCOME MEASURES The preshock pause, postshock pause, fraction of time without chest compression and defibrillation intervals. Observed quality parameters were chest compression depth and chest compression rate. RESULTS With real-time cardiopulmonary resuscitation guidance, there were improved mean (SD) chest compression rates (105 ± 8 vs. 121 ± 12 bpm; P < 0.005), fewer inappropriate shock intervals [median (interquartile range) 0 (1 to 5) vs. 4 (1 to 7); P < 0.005], a smaller fraction of time without chest compression (18.9 ± 4.4 vs. 22.5 ± 7.0%; P < 0.005) and shorter postshock pauses (2.3 ± 0.9 vs. 3.4 ± 1.2 s; P < 0.005). CONCLUSION Real-time cardiopulmonary resuscitation guidance significantly increased adherence to the guidelines by medical students treating simulated out-of-hospital cardiac arrest. Using a simple tool such as a countdown timer makes it possible to reduce the number of inappropriate shock intervals and time without chest compression.
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Dexter F, Wachtel RE. Strategies for Net Cost Reductions with the Expanded Role and Expertise of Anesthesiologists in the Perioperative Surgical Home. Anesth Analg 2014; 118:1062-71. [DOI: 10.1213/ane.0000000000000173] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wang JO, Li CY, Kao S, Yeh TC, Arens JF, Ho ST. Factors associated with Taiwan anesthesiologists' intention to leave anesthesia practice. J Formos Med Assoc 2013; 114:509-16. [PMID: 24373937 DOI: 10.1016/j.jfma.2013.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/11/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/PURPOSE Anesthesiologists in Taiwan had the heaviest workload compared with other Taiwanese specialists. In a previous study, anesthesia-related mortality was >12 times the rate reported in the USA, UK, and Japan. Nine percent of Taiwanese anesthesiologists left their jobs to work as general practitioners in clinics. This study aims to assess the current working conditions of anesthesiologists in Taiwan and their satisfaction with their occupation, and to identify the factors associated with the intentions of anesthesiologists in Taiwan to leave anesthesia practice. METHODS A self-reported questionnaire was completed by 474 attending anesthesiologists in Taiwan. The Chi-square test was used for categorical variables and the t test for continuous variables. Multivariate logistic regression was conducted to identify the factors significantly associated with the willingness of anesthesiologists to continue in anesthesiology. RESULTS The sample anesthesiologists worked 59.9 hours/week, however a reasonable length of time to work is 49.6 hours/week. They simultaneously covered four operating rooms daily, but three rooms is considered reasonable. Surprisingly, 54.9% of them expressed their unwillingness to practice clinical anesthesia. Those anesthesiologists dissatisfied with their overall working conditions had a substantially increased odds ratio (6.96) of deterring continuing to practice in anesthesia. Furthermore, an inability to take care of the family and a low salary significantly decreased the willingness to practice in anesthesia (odds ratio: 0.42 and 0.38, respectively). CONCLUSION Unfavorable working conditions were considered to lower the satisfaction of anesthesiologists in Taiwan. In particular, an inability to take care of the family and a low salary were major factors in deterring anesthesiologists in Taiwan from continuing in anesthesia.
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Affiliation(s)
- Ju-O Wang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan; Division of Public Affairs, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Senyeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Te-Chun Yeh
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - James F Arens
- University of Texas Medical Branch in Galveston, Galveston, TX, USA
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital/National Yang-Ming University, Taipei, Taiwan; Department of Anesthesiology, National Defense Medical Center, Taipei, Taiwan.
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Hehir MP, Walsh JM, Higgins S, Mahony R. Maternal and neonatal morbidity during off peak hours in a busy obstetric unit. Are deliveries after midnight more complicated? Acta Obstet Gynecol Scand 2013; 93:189-93. [PMID: 24266619 DOI: 10.1111/aogs.12307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to compare maternal and neonatal outcomes in deliveries occurring overnight with those in daylight hours. DESIGN Prospective observational study. SETTING Large national tertiary referral center. POPULATION All singleton laboring nulliparous parturients delivering infants >500 g over a 2-year period, 1 January 2008 to 31 December 2009. METHODS Details of intrapartum characteristics and neonatal outcomes of deliveries occurring between midnight and 08.00 h were compared with deliveries occurring outside of these hours. MAIN OUTCOME MEASURES Maternal and neonatal morbidity. RESULTS During the study period there were 8450 nulliparous deliveries. 2668 (31.6%) delivered between midnight and 08.00 h, and 5782 (68.4%) outside of these hours. There was a significant difference between the time periods in the number of babies born with a cord pH <7.1: 10.8% (44/406) of babies were born between midnight and 08.00 h, and 6.3% (63/1007) of babies were born outside these hours (p = 0.003). There was no significant difference in terms of Apgar score <7 at 5 min (p = 0.17). There was a trend toward a larger number of anal sphincter injuries occurring between midnight and 08.00 h (3% vs. 2.3%; p = 0.05). CONCLUSION Our findings suggest that infants are more likely to be born with a pH <7.1 and there was a trend toward an increased rate of anal sphincter injury during time periods when staffing levels are low and clinician fatigue may play a role in decision-making and patient management. This may play a role in service provision planning and staff recruitment.
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Epstein RH, Dexter F. Rescheduling of Previously Cancelled Surgical Cases Does Not Increase Variability in Operating Room Workload When Cases Are Scheduled Based on Maximizing Efficiency of Use of Operating Room Time. Anesth Analg 2013; 117:995-1002. [DOI: 10.1213/ane.0b013e3182a0d9f6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Medical error, disclosure and patient safety: a global view of quality care. Clin Biochem 2013; 46:1161-9. [PMID: 23578740 DOI: 10.1016/j.clinbiochem.2013.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022]
Abstract
Medical errors are a prominent issue in health care. Numerous studies point at the high prevalence of adverse events, many of which are preventable. Although there is a range of severity in errors, they all cause harm, to the patient, to the system, or both. While errors have many causes, including human interactions and system inadequacies, the focus on individuals rather than the system has led to an unsuitable culture for improving patient safety. Important areas of focus are diagnostic procedures and clinical laboratories because their results play a major role in guiding clinical decisions in patient management. Proper disclosure of medical errors and adverse events is also a key area for improvement. Globally, system improvements are beginning to take place, however, in Canada, policies on disclosure, error reporting and protection for physicians remain non-uniform. Achieving a national standard with mandatory reporting, in addition to a non-punitive system is recommended to move forward.
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Abstract
Universally, anesthesiologists are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthesiologist is the consequence of cumulative acuity, manifesting as decreased motor and cognitive powers. This results in impaired judgement, late and inadequate responses to clinical changes, poor communication and inadequate record keeping. With rising expectations and increased medico-legal claims, anesthesiologists work round the clock to provide efficient and timely services, but are the "sleep provider" in a sleep debt them self? Is it the right time to promptly address these issues so that we prevent silent perpetuation of problems pertinent to anesthesiologist's health and the profession. The implications of sleep debt on patient safety are profound and preventive strategies are quintessential. Anesthesiology governing bodies must ensure requisite laws to prevent the adverse outcomes of sleep debt before patient care is compromised.
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Affiliation(s)
- Ashish Sinha
- Professor and Vice Chairman for Research, Director of Clinical Research, Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, USA
| | - Avtar Singh
- Department of Anesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mulana, Ambala, India
| | - Anurag Tewari
- Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, India
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Lim SM, Park JC, Lee H, Shin SK, Lee SK, Lee YC. Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm. Surg Endosc 2012; 27:1397-403. [PMID: 23233016 DOI: 10.1007/s00464-012-2643-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/29/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) can be technically demanding and requires great attention to detail and prolonged concentration. We assumed that clinical outcomes of ESDs may be affected by cumulative time, and we aimed to compare complete resection rates and adverse events according to cumulative ESD time. METHODS This study involved 1,328 consecutive patients with 1,461 gastric tumors who underwent ESD from January 2008 to July 2011 in a tertiary-care academic medical center. The main outcome measurements were en bloc resection rate, complete resection rate, bleeding rate and perforation rate. RESULTS Patients were divided into three groups according to cumulative time intervals (<2 h vs. 2-4 h vs. ≥ 4 h). Complete resection rate did not differ among the three groups, but early post-ESD bleeding (EPEB) rate was significantly different among the three groups (2.5 vs. 3.5 % vs. 6.6 %, P = 0.040). In multivariate analysis, cumulative time period was an independent predictor of EPEB (2-4 h odds ratio [OR] 2.29, 95 % confidence interval [CI] 1.05-5.01, P = 0.038; ≥ 4 h OR 3.99; 95 % CI, 2.15-7.65, P < 0.001). The rate of perforation was higher in ESDs performed after completing prior endoscopies or outpatient clinic session compared to those performed without prior work (3.8 vs. 1.6 %, P = 0.004). Moreover, prior workload before ESD was an independent predictor of perforation in multivariate analysis (OR 2.77, 95 % CI, 1.37-5.60, P = 0.005). CONCLUSIONS Our data suggest that cumulative ESD time did not influence en bloc or complete resection rate of ESD, but increased the rate of acute bleeding. Moreover, prior workload before ESDs may increase the risk of perforation.
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Affiliation(s)
- Sun Min Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Whitson MJ, Bodian CA, Aisenberg J, Cohen LB. Is production pressure jeopardizing the quality of colonoscopy? A survey of U.S. endoscopists' practices and perceptions. Gastrointest Endosc 2012; 75:641-8. [PMID: 22341109 DOI: 10.1016/j.gie.2011.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 10/22/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fatigue is an underestimated cause of underperformance among physicians. There is evidence that fatigue or other byproducts of production pressure may negatively influence the quality of colonoscopy. OBJECTIVE To investigate the practices and perceptions of U.S. endoscopists regarding the effect of production pressure on the performance of colonoscopy. DESIGN We conducted a 40-question online survey to assess endoscopists' practices and perceptions concerning production pressure. SETTING A total of 5030 U.S. American Society for Gastrointestinal Endoscopy members. MAIN OUTCOME MEASUREMENTS The proportion of endoscopists responding positively to questions pertaining to the impact of production pressure on colonoscopy practice. RESULTS Ninety-two percent of respondents indicated that production pressure influenced one or more aspects of their endoscopic practices. Examples of production pressure included (1) postponing polypectomy for a subsequent session (2.8%), (2) reducing the length of time spent inspecting the colon (7.2%), and (3) proceeding with colonoscopy in a patient with an unfavorable risk/benefit ratio (69.2%). Forty-eight percent of respondents reported witnessing the effects of production pressure on a colleague. Respondents working fee-for-service and those with >10 years since completion of fellowship were more likely to describe their weekly workloads as excessive compared with those who were salaried (81.3% vs 71.3%; P = .01) and <10 years out of training (81% vs 72.7%; P = .01). LIMITATIONS Nonresponse bias due to low response rate (22.3%). CONCLUSION Production pressure influences the conduct of colonoscopy for many endoscopists and could have an adverse effect on the outcome of colorectal cancer screening. ( CLINICAL TRIAL REGISTRATION NUMBER RE:GIE D 11-01288R1.) The study was an Internet study and did not involve human subjects.
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Affiliation(s)
- Matthew J Whitson
- Department of Medicine, Division of Gastroenterology, Mount Sinai Medical Center, New York City, New York, USA
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Professional stress in anesthesiology: a review. J Clin Monit Comput 2011; 26:329-35. [DOI: 10.1007/s10877-011-9328-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
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Enquête comparative sur le syndrome d’épuisement professionnel chez les anesthésistes réanimateurs et les autres praticiens des hôpitaux publics en France (enquête SESMAT). ACTA ACUST UNITED AC 2011; 30:782-94. [DOI: 10.1016/j.annfar.2011.05.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 05/19/2011] [Indexed: 11/21/2022]
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Shidhaye R, Divekar D, Dhulkhed V, Goel G, Gupta A, Shidhaye R. Evaluation of stressors and coping strategies for stress in Indian anaesthesiologists. Indian J Anaesth 2011; 55:193-8. [PMID: 21713218 PMCID: PMC3106399 DOI: 10.4103/0019-5049.79871] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several studies have been done to assess job satisfaction and quantify effects of stressors on anaesthesiologists in different regions and countries. Studies related to stress in Indian anaesthesiologists are very limited, which prompted us to design this study not only to identify the stressors but also to find out how anaesthesiologists react to stress and devise means to minimize it to increase their job satisfaction levels. A set of questions was handed over personally to 200 anaesthesiologists at the national- and state-level anaesthesiology conferences and continuing medical educations with a request to return them duly filled in, with an assurance that confidentiality and anonymity would bemaintained. Main outcome measures were demographics, factors causing stress, how the responding anaesthesiologists and their colleagues react to it and methods they adopt to reduce stress at their workplace. Response rate was 96%. The total number of respondents was 192 (54% males and 46% females; juniors, 76%; and seniors, 24%). Identified stressors were as follows: time constraints (34%), medicolegal concerns (24%), interference with home life (22%), clinical problems (20%) and communication problems (9%). Different strategies for coping with stress were identified. This survey is just a beginning. Indian Society of Anaesthesiologists is requested to look into the matter and take it further on a larger scale by multicentric studies to lay down standards related to number of working hours, number of night-call duties per week, proper assistance, medicolegal protection, etc., which would not only reduce occupational stress but also improve efficiency and job satisfaction among anaesthesiologists.
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Affiliation(s)
- Rv Shidhaye
- Department of Anaesthesiology and Critical Care, Pravara Institute of Medical Sciences, Loni, India
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