Inadvertent returns to theatre within 30 days (IRT30) of surgery

2015 ◽  
Vol 20 (4) ◽  
pp. 208-214
Author(s):  
Anisha Sukha ◽  
Elizabeth Li ◽  
Tim Sykes ◽  
Anthony Fox ◽  
Andrew Schofield ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Clinical Governance ◽  
Operating Theatre ◽  
Consecutive Series ◽  
Surgical Performance ◽  
Content Type ◽  
Emergency Procedures ◽  
Surgical Subspecialty ◽  
Surgeon Performance ◽  
Learning Points

Purpose – When a patient unexpectedly has to go back to the operating theatre, there is often a perceived problem with the primary operation. An IRT30 is defined as any patient returning to the operating theatre within 30 days of the index procedure. IRT30 has been suggested to be a useful quality indicator of surgical standards and surgeon performance. The purpose of this paper is to evaluate the usefulness of this validated tool, by assessing all IRT30 over a 12-month period. Learning points for individual surgeons, surgical subspecialty units and the clinical governance leads were reviewed. Design/methodology/approach – Consecutive series of general and vascular surgical patients undergoing elective and emergency procedures between July 2012 and 2013. Prospective data collection of all IRT30s classified as Types 1-5 by a single-rater and in-depth discussion of Types 3-5 cases at the clinical governance meetings. The individual case learning points were recorded and the collective data monitored monthly. Findings – There were 134 IRT30s. In total 84 cases were discussed: Type 3 (n=80), Type 4 (n=4) and Type 5 (n=0). In total 50 cases were not discussed: Type 1 (n=27), Type 2 (n=23). Originality/value – It is crucial that surgeons continue to learn throughout their surgical career by reflecting on their own and their colleague’s results, complications and surgical performance. Analysing Types 3 and 4 IRT30s within the governance meetings has identified learning points related to both surgical technique and surgical decision making. By embracing these learning points, surgical technique and individual as well as group surgeon performance can be modified and opportunities for training and focused supervision created.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Clinical governance in Australia

2015 ◽  
Vol 20 (2) ◽  
pp. 56-73 ◽  
Author(s):  
Allan D Spigelman ◽  
Shane Rendalls
Keyword(s):  
Web Sites ◽  
Service Providers ◽  
Service Level ◽  
Clinical Governance ◽  
Success Factor ◽  
Quality And Safety ◽  
Funding Policy ◽  
Content Type ◽  
Health Service Providers ◽  
Governance Systems

Purpose – The purpose of this paper is to overview, background and context to clinical governance in Australia, areas for further development and potential learnings for other jurisdictions. Design/methodology/approach – Commentary; non-systematic review of clinical governance literature; review of web sites for national, state and territory health departments, quality and safety organisations, and clinical colleges in Australia. Findings – Clinical governance in Australia shows variation across jurisdictions, reflective of a fragmented health system with responsibility for funding, policy and service provision being divided between levels of government and across service streams. The mechanisms in place to protect and engage with consumers thus varies according to where one lives. Information on quality and safety outcomes also varies; is difficult to find and often does not drill down to a service level useful for informing consumer treatment decisions. Organisational stability was identified as a key success factor in realising and maintaining the cultural shift to deliver ongoing quality. Research limitations/implications – Comparison of quality indicators with clinical governance systems and processes at a hospital level will provide a more detailed understanding of components most influencing quality outcomes. Practical implications – The information reported will assist health service providers to improve information and processes to engage with consumers and build further transparency and accountability. Originality/value – In this paper the authors have included an in depth profile of the background and context for the current state of clinical governance in Australia. The authors expect the detail provided will be of use to the international reader unfamiliar with the nuances of the Australian Healthcare System. Other studies (e.g. Russell and Dawda, 2013; Phillips et al., n.d.) have been based on deep professional understanding of clinical governance in appraising and reporting on initaitives and structures. This review has utilised resources available to an informed consumer seeking to understand the quality and safety of health services.

Acute subdural hematoma

1982 ◽  
Vol 57 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Henry A. Shenkin
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Neurological Status ◽  
Neurological Dysfunction ◽  
Acute Subdural Hematoma ◽  
Consecutive Series ◽  
Content Type ◽  
Subdural Hematomas ◽  
Fine Print

✓ In a consecutive series of 39 cases of acute subdural hematoma (SDH), encountered since computerized tomography diagnosis became available, 61.5% were found to be the result of bleeding from a small cortical artery, 25.6% were of venous origin, 7.7% resulted from cerebral contusions, and 5% were acute bleeds into chronic subdural hematomas. Craniotomy was performed promptly on admission, but there was no difference in survival (overall 51.3%) between patients with arterial and venous bleeds. The only apparent factor affecting survival in this series was the preoperative neurological status: 67% of patients who were decerebrate and had fixed pupils prior to operation died. Of patients with less severe neurological dysfunction, only 20% failed to survive.

The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies

1994 ◽  
Vol 80 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Toyohiko Isu ◽  
Kyosuke Kamada ◽  
Nobuaki Kobayashi ◽  
Shoji Mabuchi
Keyword(s):  
Surgical Technique ◽  
Donor Site ◽  
Bone Grafts ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Disc Disease ◽  
Nerve Roots ◽  
Content Type ◽  
Vertebral Bodies

✓ The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

The role of craniectomy in the treatment of chronic subdural hematomas

1980 ◽  
Vol 52 (6) ◽  
pp. 776-781 ◽  
Author(s):  
George Tyson ◽  
W. Ellis Strachan ◽  
Peter Newman ◽  
H. Richard Winn ◽  
Albert Butler ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Chronic Subdural Hematoma ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Consecutive Series ◽  
Content Type ◽  
Significant Clinical Improvement ◽  
Acute Neurological Deterioration ◽  
Fine Print

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

scholarly journals Self-regulation and medical direction

2018 ◽  
Vol 23 (3) ◽  
pp. 233-242 ◽  
Author(s):  
Peter O’Meara ◽  
Gary Wingrove ◽  
Michael McKeage
Keyword(s):  
Quality Management ◽  
North America ◽  
Self Regulation ◽  
Clinical Governance ◽  
Independent Practice ◽  
Content Type ◽  
Study Approach ◽  
Regulatory Systems ◽  
Regulatory Frameworks ◽  
Professional Self

Purpose The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America. Design/methodology/approach A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis. Findings Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession. Originality/value In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

An action framework for compliance and governance

2014 ◽  
Vol 19 (4) ◽  
pp. 342-359 ◽  
Author(s):  
Allen O’Neill
Keyword(s):  
Data Privacy ◽  
Design Methodology ◽  
State Of The Art ◽  
Clinical Governance ◽  
Healthcare Organisation ◽  
Privacy Risk ◽  
Content Type ◽  
Starting Point ◽  
Governance Risk ◽  
Education Process

Purpose – The purpose of this paper is to propose a framework for clinical governance, in particular, the compliance of data privacy in a healthcare organisation. Design/methodology/approach – The approach of the research was to highlight problem areas in compliance and governance risk management (governance, risk and compliance (GRC)) in general, and then identify knowledge in other domains that could be combined and applied to improve GRC management, and ultimately improve governance outcomes. Findings – There is a gap in the literature is respect of systems and frameworks to assist organisations in managing the complex minutiae associated with compliance. This paper addresses this gap by proposing a “compliance action framework” which builds on work existing in other domains in relation to education, process control and governance. Research limitations/implications – The present research provides a starting point for an implementation of the framework within a number of organisations, and opens questions for further research in the field. Originality/value – The GRC framework proposed in this paper contributes to the state of the art, by proposing processes for improving the governance capability and compliance outcomes within an organisation for governance of data privacy risk and data protection.

Trigeminal schwannoma

1988 ◽  
Vol 69 (6) ◽  
pp. 850-860 ◽  
Author(s):  
Paul C. McCormick ◽  
Jacqueline A. Bello ◽  
Kalmon D. Post
Keyword(s):  
Trigeminal Nerve ◽  
Surgical Approach ◽  
Csf Leak ◽  
Symptom Duration ◽  
Consecutive Series ◽  
Nerve Function ◽  
Content Type ◽  
Trigeminal Schwannoma ◽  
Cranial Nerve Palsies ◽  
Fine Print

✓ A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients. The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months). The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.

Endoscopic treatment of colloid cysts of the third ventricle

1998 ◽  
Vol 89 (6) ◽  
pp. 1062-1068 ◽  
Author(s):  
M. Samy Abdou ◽  
Alan R. Cohen
Keyword(s):  
Surgical Technique ◽  
Endoscopic Resection ◽  
Endoscopic Treatment ◽  
Third Ventricle ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
The Third ◽  
Endoscopic Evacuation ◽  
Colloid Cysts ◽  
Fine Print

✓ The surgical technique for the endoscopic evacuation of colloid cysts of the third ventricle in 13 patients is described. The authors conclude that endoscopic resection of these lesions is a useful addition to the current surgical repertoire and a viable alternative to stereotactic aspiration or open craniotomy.

Lean Six Sigma in policing services

2018 ◽  
Vol 67 (5) ◽  
pp. 935-940 ◽  
Author(s):  
Jiju Antony ◽  
Bryan Rodgers ◽  
Inness Coull ◽  
Vijaya Sunder M.
Keyword(s):  
Six Sigma ◽  
Design Methodology ◽  
Single Case ◽  
Lean Six Sigma ◽  
Single Case Study ◽  
Content Type ◽  
The Public ◽  
Study Approach ◽  
Learning Points

Purpose This paper is based on a single case study carried out as part of a change programme but is used as a reflective tool to draw on some of the wider organisational learning which can be considered when implementing, reviewing or re-energise a Lean Six Sigma (LSS) Programme. The paper aims to discuss this issue. Design/methodology/approach A case study approach has been used and referenced throughout the paper with references to literature to support the wider learning points drawn which are then applied to any continuous improvement (CI) programmes. Findings The paper presents a range of learning points which are drawn from a successful deployment of LSS within a change project carried out as part of an overall programme in Scottish policing services. Research limitations/implications The points are drawn from a single case study which was deployed within a wider change programme and is supported by wider literature but is used as a vehicle for informing strategic considerations within an organisation. Originality/value This case study is drawn from policing services in the public sector which alone is an area that has not been significantly studied. It is used to explore wider implications in terms of strategic alignment, organisational performance and project management and presents the argument that the design of a CI programme is much wider than the implementation of LSS itself.

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