Article

Patient Safety in Surgery

Department of Surgery, John Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Annals of Surgery (Impact Factor: 7.19). 05/2006; 243(5):628-32; discussion 632-5. DOI: 10.1097/01.sla.0000216410.74062.0f
Source: PubMed

ABSTRACT Improving patient safety is an increasing priority for surgeons and hospitals since sentinel events can be catastrophic for patients, caregivers, and institutions. Patient safety initiatives aimed at creating a safe operating room (OR) culture are increasingly being adopted, but a reliable means of measuring their impact on front-line providers does not exist.
We developed a surgery-specific safety questionnaire (SAQ) and administered it to 2769 eligible caregivers at 60 hospitals. Survey questions included the appropriateness of handling medical errors, knowledge of reporting systems, and perceptions of safety in the operating room. MANOVA and ANOVA were performed to compare safety results by hospital and by an individual's position in the OR using a composite score. Multilevel confirmatory factor analysis was performed to validate the structure of the scale at the operating room level of analysis.
The overall response rate was 77.1% (2135 of 2769), with a range of 57% to 100%. Factor analysis of the survey items demonstrated high face validity and internal consistency (alpha = 0.76). The safety climate scale was robust and internally consistent overall and across positions. Scores varied widely by hospital [MANOVA omnibus F (59, 1910) = 3.85, P < 0.001], but not position [ANOVA F (4, 1910) = 1.64, P = 0.16], surgeon (mean = 73.91), technician (mean = 70.26), anesthesiologist (mean = 71.57), CRNA (mean = 71.03), and nurse (mean = 70.40). The percent of respondents reporting good safety climate in each hospital ranged from 16.3% to 100%.
Safety climate in surgical departments can be validly measured and varies widely among hospitals, providing the opportunity to benchmark performance. Scores on the SAQ can serve to evaluate interventions to improve patient safety.

Full-text

Available from: John Bryan Sexton, May 28, 2015
0 Followers
 · 
228 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Introduction: Positive safety and a teamwork climate in the training environment may be a precursor for successful teamwork training. This pilot project aimed to implement and test whether a new interdisciplinary and team-based approach would result in a positive training climate in the operating theatre. Method: A 3-day educational module for training the complete surgical team of specialist nursing students and residents in safe teamwork skills in an authentic operative theatre, named Co-Op, was implemented in a university hospital. Participants' (n = 22) perceptions of the 'safety climate' and the 'teamwork climate', together with their 'readiness for inter-professional learning', were measured to examine if the Co-Op module produced a positive training environment compared with the perceptions of a control group (n = 11) attending the conventional curriculum. Results: The participants' perceptions of 'safety climate' and 'teamwork climate' and their 'readiness for inter-professional learning' scores were significantly higher following the Co-Op module compared with their perceptions following the conventional curriculum, and compared with the control group's perceptions following the conventional curriculum. Conclusion: The Co-Op module improved 'safety climate' and 'teamwork climate' in the operating theatre, which suggests that a deliberate and designed educational intervention can shape a learning environment as a model for the establishment of a safety culture.
    Medical Teacher 09/2014; 37(3):1-10. DOI:10.3109/0142159X.2014.947927 · 2.05 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is being used more frequently for the treatment of peritoneal surface malignancies. There are a paucity of data regarding safety and quality outcomes in this group of patients. The aim of this study was to evaluate safety events and quality measures in a group of patients who underwent CRS + HIPEC. Methods All patients who underwent CRS + HIPEC procedures between December 2007 and March 2014 were included. All safety-related events and quality outcomes were reviewed. Major events were defined as occurrences in which there was harm to patient or healthcare personnel. Minor events were defined as quality or safety events in which there was potential for damage. Results A total of 72 patients were included. The mean Peritoneal Cancer Index for the study group was 20.5. One hundred percent compliance for informed consent, patient identification and surgical site marking, and antibiotic and venous thromboembolism prophylaxis guidelines was identified. The incidence of major safety events was 37.5 %. Minor events occurred in 47.2 % of patients. There was a 2.78 % 30-day mortality in the study group. Conclusions One in three patients undergoing CRS + HIPEC procedures experienced a major safety or quality event before, during, or after surgery. Adequate surgical care alone is not sufficient to prevent these occurrences. Active surveillance of safety events and quality leads to early detection and development of improvement plans. New CRS + HIPEC centers need to adhere to strict safety and quality guidelines to ensure excellent patient outcomes.
    Annals of Surgical Oncology 09/2014; 22(5). DOI:10.1245/s10434-014-4064-0 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. Quality of surgical teamwork was assessed with observational teamwork assessment for surgery (OTAS-D). It evaluates five dimensions of OT teamwork: communication, coordination, cooperation/backup behaviour, leadership, and team monitoring/situation awareness. Each dimension is evaluated for each profession (surgical, nursing, and anaesthesia team) as well for each phase of the procedure (pre-, intra-, and post-operative). We observed n = 63 procedures, mainly in abdominal/general and orthopaedic surgery. Additionally, all OT team members scored their individual evaluation of the intra-operative teamwork (standardised 1-item questions). The OTAS-D evaluations showed meaningful results and differences for the OT professions as well as across the different phases of the procedures. Overall, a medium to good level of the OT teamwork was observed. There were no differences in regard to type of surgery (minimally invasive vs. open) or surgical specialties. With an increased coordination of the surgical team we observed a significantly increased cooperation of the nursing team (r = 0.36, p = 0.004). Concerning the OT staffs self-reports, the surgical and nursing teams reported higher scores for quality of surgical teamwork during the procedure than their anaesthesia team members. No significant relationships between observed quality of OT teamwork and self-reports were found. The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed. Georg Thieme Verlag KG Stuttgart · New York.
    Zentralblatt für Chirurgie 12/2014; 139(6):648-56. DOI:10.1055/s-0034-1383233 · 1.19 Impact Factor