1
|
Sikakulya FK, Muhumuza J, Vivalya BMN, Mambo SB, Kamabu LK, Muteke JK, Lussy JP, Ilumbulumbu MK, Emmanuel T, Kiyaka SM, Kavuyiro A, Mukandirwa C, Lekuya HM, Vahwere BM, Francis Okedi X, Masumbuko CK. Psychosocial impact of surgical complications and the coping mechanisms among surgeons in Uganda and Eastern Democratic Republic of the Congo. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003180. [PMID: 38683841 PMCID: PMC11057973 DOI: 10.1371/journal.pgph.0003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
We aimed to assess the psychosocial impact from postoperative complications on the surgical workforce and the coping mechanisms they use following these complications in Uganda and Eastern Democratic Republic of the Congo (DRC). This was a cross-sectional multi-center study conducted from first February 2022 to 31st March 2022 in the preselected main teaching hospitals of Uganda and Eastern DRC. We surveyed the surgical workforce (practicing surgeons, Obstetrician-Gynecologists, and residents in surgery/ Obstetrics-Gynecology) who had experienced postoperative complications in their career. Data was analysed using SPSS version 23. One hundred ninety-eight participants responded to the questionnaire. Worry about patient and reputation were the commonest psychological impacts in 54.0% and 45.5% of the participants respectively. Majority of the participants (55.1%) used positive coping mechanisms with a positive impact on their practice (94.4%). Being a female doctor (AOR = 2.637, CI 1.065-6.533, P = 0.036), worrying about reputation (AOR = 3.057, CI = 1.573-5.939, P = 0.001) and guilt after a complication (AOR = 4.417, CI = 2.253-8.659, P = <0.001) were predictors of a negative coping mechanism. Postoperative surgical complications continue to cause a huge psychological impact on the operating doctors in Uganda and the Eastern DRC. Female doctors, those that worry about the reputation and those that feel guilty following a complication should be given more support and guidance by peers when surgical complications occur to their patients.
Collapse
Affiliation(s)
- Franck Katembo Sikakulya
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Joshua Muhumuza
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Bives Mutume Nzanzu Vivalya
- Faculty of Clinical Medicine and Dentistry, Department of Psychiatry and Mental Health, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Simon Binezero Mambo
- Youth Alliance for Reproductive Health, Goma, Democratic Republic of the Congo
- Allied Health Sciences Department, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Larrey Kasereka Kamabu
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
- Department of Surgery, Division of Neurosurgery, Makerere University CHS, Kampala, Uganda
| | | | - Justin Paluku Lussy
- Faculty of Medicine, Université de Goma, Goma, Democratic Republic of the Congo
| | | | - Tapem Emmanuel
- Department of Surgery, Makerere University, Kampala, Uganda
| | - Sonye Magugu Kiyaka
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Alpha Kavuyiro
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Claude Mukandirwa
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Hervé Monka Lekuya
- Department of Surgery, Division of Neurosurgery, Makerere University CHS, Kampala, Uganda
- Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Bienfait Mumbere Vahwere
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | - Xaviour Francis Okedi
- Faculty of Clinical Medicine and Dentistry, Department of Surgery, Kampala International University Western Campus, Ishaka-Bushenyi, Uganda
| | | |
Collapse
|
2
|
Oseni AO, Chun JY, Morgan R, Ratnam L. Dealing with complications in interventional radiology. CVIR Endovasc 2024; 7:32. [PMID: 38512496 PMCID: PMC10957835 DOI: 10.1186/s42155-024-00442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/28/2024] [Indexed: 03/23/2024] Open
Abstract
It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.
Collapse
Affiliation(s)
- A O Oseni
- ST6 Interventional Radiology Fellow at St George's Hospital NHS Trust, London, UK.
| | - J-Y Chun
- Consultant Diagnostic and Interventional Radiologist at St Georges Hospital NHS Trust, London, UK
| | - R Morgan
- Consultant Diagnostic and Interventional Radiologist at St Georges Hospital NHS Trust, London, UK
| | - L Ratnam
- ST6 Interventional Radiology Fellow at St George's Hospital NHS Trust, London, UK
| |
Collapse
|
3
|
Kreis AJ, Gower EW, Kropp M, Kello AB, Nouhoum G, Resnikoff S, Talero SL, Solomon AW. The prevention and management of postoperative trachomatous trichiasis: A systematic review. Surv Ophthalmol 2024; 69:93-102. [PMID: 36878359 DOI: 10.1016/j.survophthal.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.
Collapse
Affiliation(s)
- Andreas J Kreis
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Emily W Gower
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martina Kropp
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Amir B Kello
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Guirou Nouhoum
- Techniques and Technologies of Bamako, Institut d'Ophtalmologie Tropicale d'Afrique, University of the Sciences, Bamako, Mali
| | - Serge Resnikoff
- Organisation pour la Prévention de la Cécité, Paris, France; School of Optometry & Vision Science (SOVS), University of New South Wales, Sydney, Australia
| | - Sandra L Talero
- Research Department of Development and Innovation, Superior School of Ophthalmology, Barraquer Institute of America, Bogotá, Colombia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
4
|
Ten Cate O, Khursigara-Slattery N, Cruess RL, Hamstra SJ, Steinert Y, Sternszus R. Medical competence as a multilayered construct. MEDICAL EDUCATION 2024; 58:93-104. [PMID: 37455291 DOI: 10.1111/medu.15162] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/31/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment. THE MODEL Three layers are elaborated. This first is a core layer of canonical knowledge and skill, 'that, which every professional should possess', independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's 'self-actualisation', may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different. IMPLICATIONS The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.
Collapse
Affiliation(s)
- Olle Ten Cate
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Richard L Cruess
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yvonne Steinert
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Robert Sternszus
- Department of Pediatrics, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
5
|
D'Angelo ALD, Rivera M, Rasmussen TE, Nelson MH, Behm KT, Kelley SR, D'Angelo JD. Implementation of a Brief Evidence-Based Intraoperative Coping Curriculum. JOURNAL OF SURGICAL EDUCATION 2023; 80:1737-1740. [PMID: 37679289 DOI: 10.1016/j.jsurg.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND RATIONALE Recent research has called for further resident training in coping with errors and adverse events in the operating room. To the best of our knowledge, there currently exists no evidence-based curriculum or training on this topic. MATERIALS AND METHODS Synthesizing three prior studies on how experienced surgeons react to errors and adverse events, we developed the STOPS framework for handling surgical errors and adverse events (Stop, Talk to your team, Obtain help, Plan, Succeed). This material was presented to residents in two teaching sessions. RESULTS AND CONCLUSION In this paper, we describe the presentation of, and the uniformly positive resident reaction to, the STOPS framework: an empirically based psychological tool for surgeons who experience operative errors or adverse events.
Collapse
Affiliation(s)
| | - Mariela Rivera
- Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Megan H Nelson
- Division of General Surgery, Mayo Clinic, Phoenix, Arizona
| | - Kevin T Behm
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | - Scott R Kelley
- Mayo Clinic, Division of Colon and Rectal Surgery, Rochester, Minnesota
| | | |
Collapse
|
6
|
Köhler TS. The future of penile implants IJIR special edition: 50 th year anniversary on penile implants. Int J Impot Res 2023; 35:593-595. [PMID: 37587367 DOI: 10.1038/s41443-023-00751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
|
7
|
Painter LM, Biggans KA, Turner CT. Risk Management-Obstetrics and Gynecology Perspective. Clin Obstet Gynecol 2023; 66:331-341. [PMID: 37036733 DOI: 10.1097/grf.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
The Obstetrics and Gynecology physician's likelihood to experience medical malpractice claims are higher than in other medical specialties. We will review the basic principles of health care risk management, the role of the risk manager, and the importance of health care risk management in risk mitigation for obstetrics and gynecology physicians. Attention is focused on medical record documentation, disclosure of adverse events, second victim programs, grievance management techniques, alternative dispute resolution concepts, regulatory inquiries including state licensure investigations, product failures, and electronic media strategies. Concluding, health care risk management may be used as a claim avoidance tool and provider protective vehicle for physicians.
Collapse
Affiliation(s)
- Lisa M Painter
- Corporate Risk Management and Disability Services, UPMC, Pittsburgh, Pennsylvania
| | | | | |
Collapse
|
8
|
Zucchelli G, Wang HL, Chambrone L. Complications and treatment errors in periodontal and implant therapy. Periodontol 2000 2023; 92:9-12. [PMID: 35916837 DOI: 10.1111/prd.12442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
The assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the "net benefit ratio" between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.
Collapse
Affiliation(s)
- Giovanni Zucchelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Leandro Chambrone
- Evidence-based Hub, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, CRL, Monte de Caparica, Portugal
- Unit of Basic Oral Investigation (UIBO), School of Dentistry, Universidad El Bosque, Bogota, Colombia
- Department of Periodontics, School of Dentistry, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
9
|
Clavien PA, Ure BM, Madadi-Sanjani O. Discussing Complications after Surgery Consists of Multiple Dimensions. Eur J Pediatr Surg 2023; 33:103-104. [PMID: 36931292 DOI: 10.1055/s-0043-1764454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | | |
Collapse
|
10
|
Waddingham W, Kamran U, Kumar B, Trudgill NJ, Tsiamoulos ZP, Banks M. Complications of diagnostic upper Gastrointestinal endoscopy: common and rare - recognition, assessment and management. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000688. [PMID: 36572454 PMCID: PMC9806027 DOI: 10.1136/bmjgast-2021-000688] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022] Open
Abstract
A clear understanding of the potential complications or adverse events (AEs) of diagnostic endoscopy is an essential component of being an endoscopist. Creating a culture of safety and prevention of AEs should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, periprocedure risk assessments and a team approach, all contribute to reducing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic upper gastrointestinal endoscopy, including their recognition, treatment and prevention.
Collapse
Affiliation(s)
- William Waddingham
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Umair Kamran
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Bhaskar Kumar
- Department of Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Nigel J Trudgill
- Department of gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Matthew Banks
- Gastro-intestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Mahat S, Rafferty AM, Vehviläinen-Julkunen K, Härkänen M. Negative emotions experienced by healthcare staff following medication administration errors: a descriptive study using text-mining and content analysis of incident data. BMC Health Serv Res 2022; 22:1474. [PMID: 36463187 PMCID: PMC9719256 DOI: 10.1186/s12913-022-08818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident. METHOD This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data. RESULTS Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error. CONCLUSION Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice.
Collapse
Affiliation(s)
- Sanu Mahat
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
| | - Anne Marie Rafferty
- grid.13097.3c0000 0001 2322 6764King’s College London: Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK
| | - Katri Vehviläinen-Julkunen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Kuopio, Yliopistonranta 1, 70210 Finland ,grid.410705.70000 0004 0628 207XKuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
| | - Marja Härkänen
- grid.9668.10000 0001 0726 2490Department of Nursing Science, University of Eastern Finland, Yliopistonranta 1c, Kuopio, Finland
| |
Collapse
|
12
|
Montminy SL. Leadership behaviors, attitudes and characteristics to support a culture of safety. J Healthc Risk Manag 2022; 42:31-38. [PMID: 35993351 DOI: 10.1002/jhrm.21521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022]
Abstract
It has been estimated that medical errors are the third highest-ranking cause of death in the United States. A patient safety culture has been touted for many years as best practice to reduce medical error. While there is a general agreement of its importance, it has remained elusive for many. This study sought to learn how strengthening leadership skills within a health care organization could catalyze patient safety culture improvement. The research asked the following to gain an appreciation for that question: How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture? What attitudes, beliefs, and collective efficacy are needed to produce a patient safety culture? What leadership characteristics are needed to create a patient safety culture? The research participants were the employees who make up the patient safety department in a large academic health care system. Information was gathered to capture their view of leadership's role in patient safety culture and to gain knowledge relative to their individual experiences following a medical error.
Collapse
Affiliation(s)
- Susan L Montminy
- American Society for Healthcare Risk Management, Massachusetts Society for Healthcare Risk Management (MSHRM), The Association for Healthcare Risk Management of New York (AHRMNY), Boston, Massachusetts, USA
| |
Collapse
|
13
|
Tsigengagel O, Alchimbayeva M, Khismetova Z, Glushkova N. The public’s views on responsibility for medical errors in Kazakhstan. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2104191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Oxana Tsigengagel
- Department of Public Health, Semey Medical University, Semey, Kazakhstan
| | - Makpal Alchimbayeva
- Department of Medical Law and Ethics, Astana Medical University, Astana, Kazakhstan
| | - Zaituna Khismetova
- Department of Public Health, Semey Medical University, Semey, Kazakhstan
| | - Natalya Glushkova
- Department of Epidemiology, Evidence Medicine and Biostatistics, Kazakhstan’s Medical University ‘Kazakhstan School of Public Health’, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| |
Collapse
|
14
|
STOPS: A Coping Framework for Surgeons Who Experience Intraoperative Error. Ann Surg 2022; 276:288-292. [PMID: 35797637 DOI: 10.1097/sla.0000000000005447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors. BACKGROUND While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being. METHODS We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies. RESULTS Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed. CONCLUSIONS AND RELEVANCE This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike.
Collapse
|
15
|
Lewis J, Shapiro J. Speaking with Frankenstein. THE JOURNAL OF MEDICAL HUMANITIES 2022; 43:267-282. [PMID: 32820412 PMCID: PMC7441016 DOI: 10.1007/s10912-020-09653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring (back) to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated.
Collapse
Affiliation(s)
- Jayne Lewis
- Department of English, University of California, Irvine, 92697, USA.
| | - Johanna Shapiro
- School of Medicine, University of California, Irvine, 92697, USA
| |
Collapse
|
16
|
Surgeons' Perspectives on Intraoperative Gray Area Surgical Complications of Cataract Surgery. J Cataract Refract Surg 2022; 48:954-960. [PMID: 35137694 DOI: 10.1097/j.jcrs.0000000000000905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore surgeons' perspectives and practice patterns in regards to "gray area" surgical complications (GASCs) within cataract surgery. SETTING Tertiary care academic referral center. DESIGN Retrospective observational cross-sectional study. METHODS An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the United States. Demographic data such as gender, experience and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to post-operative complications, as well as their obligation towards patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure. RESULTS A total of 389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety with regard to patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes as compared to attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety in regards to patient outcomes. CONCLUSIONS Significant differences based on gender, practice setting, and level of experience exist in regards to disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may have an impact on patient satisfaction, medico-legal risks, and postoperative surgeon-experienced anxiety.
Collapse
|
17
|
Bhattacharya K, Bhattacharya N. Surgeon’s guilt after postoperative complication. POLISH JOURNAL OF SURGERY 2022; 94:45-48. [DOI: 10.5604/01.3001.0015.6986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surgery is an art, surgical dilemmas are not mathematical problems with rigid, straight cut solutions and the human mind/body is not a perfect science. In such a scenario, unexpected, sudden complications can happen during surgery. While better diagnostic and advanced techniques in surgery, have minimised surgical errors to a great extent, with the risk of post-operative death being as low as 3.6% now, still when complications due occur, the surgeon faces a huge backlash not only from the patient relatives, but from his peers, the hospital management, the social and print media. The surgeon also fears violent retribution, not just consumer issues but a threat of arrest and legal battles. All these make a surgeon the “second victim” in the event of a post-operative complication, leading to changes in practice behaviour, emotional turmoil and even serious mental issues like depression and suicide. In this era of instant judgement by a largely unregulated social media, it is urgently required to address this issue and provide appropriate strength/support to the surgical fraternity.
Collapse
|
18
|
Damin Abukhalil A, Amer NM, Musallam LY, Al-Shami N. Medication error awareness among health care providers in Palestine: a questionnaire based cross-sectional observational study. Saudi Pharm J 2022; 30:470-477. [PMID: 35527828 PMCID: PMC9068552 DOI: 10.1016/j.jsps.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/20/2022] [Indexed: 11/07/2022] Open
Abstract
Background Increased awareness among healthcare professionals regarding medication errors and the establishment of a medication error reporting system can significantly reduce the prevalence of medication errors. Unfortunately, Palestine lacks a regulatory system for the control, reporting, and education of medication errors. Objectives This study aimed to assess the awareness of medication errors and reporting of medication errors in the Palestinian medical community. Methods A cross-sectional observational study was conducted using a self-administered survey involving doctors, nurses, and pharmacists in Palestine. The survey consisted of 20 questions to assess healthcare providers' awareness and course of actions related to medication errors. Data were collected from February 2020 to April 2020. Statistical Package for the Social Sciences (SPSS) was used for data analysis. This study was approved by the ethical committee of Birzeit University. Results A total of 394 participants were included, including 202 nurses, 114 doctors, and 78 pharmacists. 203 (51.5%) had a good awareness level of medication errors, whereas 126 (32%) and 65 (16.5%) had average awareness and poor awareness levels, respectively. In addition, 66.0% of providers did not inform the patients after recognizing the error. Fear of legal or social consequences and being too busy are significant barriers to reporting medication errors. Moreover, 35 % of all providers were not aware of the reporting system in their institutions or the reporting methodology, and only 26% of all participants confirmed that their institutions provided continuous education on medication errors. Conclusion This study revealed differences in healthcare professionals' awareness of medication errors. The study's findings emphasize the urgent need to adopt appropriate measures to raise awareness about medication errors among healthcare providers in Palestine. Furthermore, establishing a regulatory policy and a national medication error reporting system to improve medication safety.
Collapse
|
19
|
Alanizy BA, Masud N, Alabdulkarim AA, Aldihan GA, Alwabel RA, Alsuwaid SM, Sulaiman I. Are patients knowledgeable of medical errors and medical complications? A cross-sectional study at a tertiary hospital, Riyadh. J Family Med Prim Care 2021; 10:2980-2986. [PMID: 34660435 PMCID: PMC8483113 DOI: 10.4103/jfmpc.jfmpc_2031_20] [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: 10/01/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
Background Basic understanding of medical errors and medical complications is essential to ensure patient safety. Our aim in this study was to assess whether patients have sufficient knowledge of medical errors and medical complications and to identify the factors that influence their knowledge. Methods A cross-sectional study was conducted with 400 patients with a scheduled appointment at King Abdulaziz Medical City from 2019 to 2020. A self-administered validated questionnaire was developed by the coinvestigators. The first section focused on demographic information, and the second contained 17 scenarios to assess the knowledge of the patients. The data were analyzed with Chi-square test and logistic regression. Results The sample size realized as 346 (n = 346), with the majority (n = 198, 57%) female, and the mean age 39.5 ± 11 years. The mean scores for the medical errors and complications were 5.5 ± 2.10 and 4.8 ± 2.3, respectively. The participants with secondary education were less likely to have sufficient knowledge of both medical complications (OR 0.52, P = 0.016) and errors (OR 0.52, P = 0.016). In terms of age, the older participants, the 38-47 year age group, were less likely to be knowledgeable about medical complications compared to the younger age groups (OR 0.92, P = 0.046). Conclusion The patients had a higher level of knowledge about medical errors compared to medical complications. The level of education and the employment status significantly predicted the knowledge of both medical errors and complications.
Collapse
Affiliation(s)
- Butoul Alshaish Alanizy
- Medical Students, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Nazish Masud
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Aljawaharah Abdulaziz Alabdulkarim
- Medical Students, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Ghada Abdulaziz Aldihan
- Medical Students, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Reema Abdullah Alwabel
- Medical Students, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Shikah Mohammed Alsuwaid
- Medical Students, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, King Abdullah International Medical Re-Search Center, Riyadh, Saudi Arabia
| | - Ihab Sulaiman
- Department of Car-Diology, Ministry of National Guard Health Affairs- Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
The Medical Malpractice Deposition: A Review for Radiologist Defendants. AJR Am J Roentgenol 2021; 217:1232-1238. [PMID: 34106755 DOI: 10.2214/ajr.21.25724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Please see the Editorial Comment by David M. Yousem discussing this article. Depositions are critical components of any medical malpractice lawsuit and seek to help uncover the facts of the case, to allow justice to be served. Depositions often create considerable anxiety for physician defendants, including radiologists. Defendants unfamiliar with the rules of questioning, or interviewing techniques, used by plaintiff attorneys may fail to appreciate important and nuanced details of the plaintiff attorney's questions, which in turn could impact the outcome of the case. Thorough and informed deposition preparation is thus essential. Highlighting issues relevant to radiologist defendants, we discuss the role and structure of medical malpractice depositions as well as common scenarios, lines of questioning, and attorney strategies.
Collapse
|
21
|
Mok WQ, Chin GF, Yap SF, Wang W. A cross-sectional survey on nurses' second victim experience and quality of support resources in Singapore. J Nurs Manag 2020; 28:286-293. [PMID: 31789437 DOI: 10.1111/jonm.12920] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022]
Abstract
AIM The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore. BACKGROUND The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked. METHODS A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources. RESULTS The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable. CONCLUSION Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon. IMPLICATIONS FOR NURSING MANAGEMENT Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.
Collapse
Affiliation(s)
- Wen Qi Mok
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Guey Fong Chin
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Suk Foon Yap
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
22
|
Medication errors in the care transition of trauma patients. Eur J Clin Pharmacol 2019; 75:1739-1746. [PMID: 31529143 DOI: 10.1007/s00228-019-02757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVE Traumatological patients are vulnerable to medication error given multiple handoffs throughout the hospital since they often require rapid diagnosis and management of multiple concurrent complex conditions. The purpose of this study was to analyze the medication errors (MEs) occurring in the care transition of the traumatological patient. The secondary objectives were to classify the MEs and the level of risk of the pharmacological groups involved. In addition, the causes and contributing factors of those MEs were analyzed. METHODS An observational, descriptive, and prospective study, spanning 4 months, was performed in a tertiary hospital. All patients admitted to the traumatology service were selected for the study. Data were collected in different locations of the hospital stay: Emergency Service, Resuscitation and Post-Anaesthesia Unit, and Traumatology Hospitalization Unit. In each location, data from the different processes (reconciliation, prescription, validation, dispensing, and administration of medicines) were collected. The medication error (ME) was established as a dependent variable. RESULTS A total of 31.3% (132) of the patients analyzed showed some ME. The Traumatology Unit was the location where most errors were detected, followed by the Emergency Service. Having analyzed all the locations, it was observed that 64.2% (172) of the MEs were detected in the reconciliation process, 29.5% (79) in the prescription, 3.7% (10) in the dispensing, 1.5% (4) in the administration, and 1.1% (3) in the validation. In terms of risk weighting, the drugs involved in the MEs detected were 53.8% of medium risk, 20.7% of high risk, and 20.3% of low risk. CONCLUSIONS There is a high prevalence of MEs in the reconciliation process of medication in traumatological patients (64.2%) from our hospital setting. Interestingly, most MEs occurred in this process regardless of the location in the healthcare chain.
Collapse
|
23
|
Sinitsky DM, Gowda SB, Dawas K, Fernando BS. Morbidity and mortality meetings to improve patient safety: a survey of 109 consultant surgeons in London, United Kingdom. Patient Saf Surg 2019; 13:27. [PMID: 31452683 PMCID: PMC6701146 DOI: 10.1186/s13037-019-0207-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/28/2019] [Indexed: 12/26/2022] Open
Abstract
Background Morbidity & Mortality (M&M) meetings are a critical component of clinical governance. They have the potential to improve patient outcomes, quality of care, attitudes towards patient safety and they contribute to the education of clinical staff. This study aimed to evaluate individual surgeons’ experience of these meetings, and to explore their perceived usefulness and barriers to open discussion of adverse outcomes. Methods Consultant general surgeons in London, United Kingdom, were invited to anonymously complete an online survey consisting of 18 key items. Results Invitations were sent to 323 consultant surgeons from 19 NHS Trusts. Responses were received from 109 (33.7%), of which 99 (90.8%) answered all key items. Seventy-two of 104 (69.2%) attend almost all or all M&M meetings. These were rated as being more conducive for learning than for service improvement (p = 0.001). On a scale of 1 to 10 (10 = fearless), 41 of 105 (39.0%) rated as ≤5 the fearfulness of legal or other negative repercussions resulting from open discussion of complications/mortalities. Ninety-eight respondents gave a median rating of 10 (IQR: 8–10) for willingness to talk openly about their complications/mortalities (10 = willing/able). Conclusions Many surgeons in London do not routinely attend M&M meetings, despite these occurring within ‘protected time’. There may be a willingness to talk openly about complications, though there exists a fear of litigation. The nature, content and learning potential of such open M&M discussions should be explored in future research.
Collapse
Affiliation(s)
- Daniel M Sinitsky
- 1Department of Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Siri B Gowda
- 1Department of Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Khaled Dawas
- 1Department of Surgery, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, NW1 2BU UK
| | - Bimbi S Fernando
- 2University Department of Surgery, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK
| |
Collapse
|
24
|
Balogun JA, Adekanmbi A, Balogun FM. Recognition and Disclosure of Medical Errors Among Residents in Surgical Specialties in a Tertiary Hospital in Ibadan. World J Surg 2018; 43:717-722. [DOI: 10.1007/s00268-018-4836-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|