Key Issues in the Development of an Evidence-Based Stratified Surgical Patient Safety Improvement Information System: Experience From a Multicenter Surgical Safety Program

UNSTRUCTURED Surgery is still far from being completely safe and reliable. Surgical safety has, therefore, been the focus of considerable attention over the last few decades, and there are a growing number of national drives to improve it. There are also a number of large surgical complication reporting systems and system-based interventions, both of which have made remarkable progress in the past two decades. These systems, however, have either mainly focused on reporting complications and played a limited role in guiding practice or have provided nonselective interventions to all patients, perhaps imposing unnecessary burdens on frontline medical staff. We have, therefore, developed an evidence-based stratified surgical safety information system based on a multicenter surgical safety improvement program. This study discusses some critical issues in the process of developing this information system, including (1) decisions about data gathering, (2) establishing and sharing knowledge, (3) developing functions for the system, (4) system implementation, and (5) evaluation and continuous improvement. Using examples drawn from the surgical safety improvement program, we have shown how this type of system can be fitted into day-to-day clinical practice and how it can guide medical practice by incorporating inherent patient-related risk and providing tailored interventions for patients with different levels of risk. We concluded that multidisciplinary collaboration, involving experts in health care (including senior staff in surgery, nursing, and anesthesia), data science, health care management, and health information technology, can help build an evidence-based stratified surgical patient safety improvement system. This can provide an information-intensified surgical safety learning platform and, therefore, benefit surgical patients by delivering tailored interventions and an integrated workflow.

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Evaluation of the Post-COVID Patient Prior to Elective Plastic Surgery: Developing an Evidence-Based Framework

Aesthetic Surgery Journal ◽

10.1093/asj/sjab340 ◽

2021 ◽

Author(s):

Thomas Fiala ◽

James Fernau ◽

Robert Singer

Keyword(s):

Patient Safety ◽

Elective Surgery ◽

Relevant Literature ◽

Preoperative Assessment ◽

Screening Tests ◽

Surgical Patient ◽

Evidence Based ◽

Health Issues ◽

Paper Briefly ◽

Surgical Safety

Abstract Preoperative assessment of a potential surgical patient has long been a cornerstone of patient safety. As more patients get, and recover from, COVID-19, plastic surgeons will be faced with the challenge of evaluating the health status and operative risk of convalescent COVID patients who now desire elective surgery. A significant fraction of these patients, however, can have new or persistent health issues as a result of COVID-19, which can affect surgical safety. This paper briefly examines the current relevant literature regarding the post-COVID patient, reviews the waiting period for adequate recovery, and suggests an evidence-based framework for preoperative assessment, based on the severity of the prior COVID-19 episode, ongoing symptoms, and basic screening tests.

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Attitudes and compliance with the WHO surgical safety checklist: a survey among surgeons and operating room staff in 138 hospitals in China

Patient Safety in Surgery ◽

10.1186/s13037-020-00276-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Jie Tan ◽

James Reeves Mbori Ngwayi ◽

Zhaohan Ding ◽

Yufa Zhou ◽

Ming Li ◽

...

Keyword(s):

Patient Safety ◽

Adverse Events ◽

Operating Room ◽

World Health ◽

Surgical Patient ◽

Local Data ◽

Cross Sectional ◽

Surgical Safety Checklist ◽

Surgical Safety ◽

Operating Room Staff

Abstract Background Ten years after the introduction of the Chinese Ministry of Health (MoH) version of Surgical Safety Checklist (SSC) we wished to assess the ongoing influence of the World Health Organisation (WHO) SSC by observing all three checklist components during elective surgical procedures in China, as well as survey operating room staff and surgeons more widely about the WHO SSC. Methods A questionnaire was designed to gain authentic views on the WHO SSC. We also conducted a prospective cross-sectional study at five level 3 hospitals. Local data collectors were trained to document specific item performance. Adverse events which delayed the operation were recorded as well as the individuals leading or participating in the three SSC components. Results A total of 846 operating room staff and surgeons from 138 hospitals representing every mainland province responded to the survey. There was widespread acceptance of the checklist and its value in improving patient safety. 860 operations were observed for SSC compliance. Overall compliance was 79.8%. Compliance in surgeon-dependent items of the ‘time-out’ component reduced when it was nurse-led (p < 0.0001). WHO SSC interventions which are omitted from the MoH SSC continued to be discussed over half the time. Overall adverse events rate was 2.7%. One site had near 100% compliance in association with a circulating inspection team which had power of sanction. Conclusion The WHO SSC remains a powerful tool for surgical patient safety in China. Cultural changes in nursing assertiveness and surgeon-led teamwork and checklist ownership are the key elements for improving compliance. Standardised audits are required to monitor and ensure checklist compliance.

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Engaging junior paediatric trainees in patient safety improvement projects

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-301885.408 ◽

2012 ◽

Vol 97 (Suppl 1) ◽

pp. A174.2-A174

Author(s):

F McHugh ◽

S Robertson ◽

K Pryde ◽

S Williams

Keyword(s):

Patient Safety ◽

Safety Improvement ◽

Patient Safety Improvement

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Point of Care Communication-A Key Strategy for Patient Safety Improvement

American Journal of Infection Control ◽

10.1016/j.ajic.2014.03.060 ◽

2014 ◽

Vol 42 (6) ◽

pp. S18

Author(s):

Dawn R. Major ◽

Bev McFarlane

Keyword(s):

Patient Safety ◽

Point Of Care ◽

Safety Improvement ◽

Patient Safety Improvement

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Leading Quality and Patient Safety Improvement in Norwegian Hospitals

Researching Patient Safety and Quality in Healthcare ◽

10.1201/9781315605609-12 ◽

2016 ◽

pp. 161-175

Author(s):

Inger Johanne Bergerød ◽

Siri Wiig

Keyword(s):

Patient Safety ◽

Safety Improvement ◽

Quality And Patient Safety ◽

Patient Safety Improvement

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Implementation of a multimodal patient safety improvement program “SafetyLEAP” in intensive care units

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-04-2017-0067 ◽

2018 ◽

Vol 31 (2) ◽

pp. 140-149 ◽

Cited By ~ 4

Author(s):

Chantal Backman ◽

Paul C. Hebert ◽

Alison Jennings ◽

David Neilipovitz ◽

Omar Choudhri ◽

...

Keyword(s):

Patient Safety ◽

Intensive Care ◽

Quality Improvement ◽

Intensive Care Units ◽

Audit And Feedback ◽

Improvement Program ◽

Convenience Sample ◽

Content Type ◽

Safety Improvement ◽

Patient Safety Improvement

Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term “LEAP” is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals. Design/methodology/approach A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three (n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases. Findings A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources. Practical implications The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams. Originality/value The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.

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Impact of the Norwegian National Patient Safety Program on implementation of the WHO Surgical Safety Checklist and on perioperative safety culture

BMJ Open Quality ◽

10.1136/bmjoq-2020-000966 ◽

2020 ◽

Vol 9 (3) ◽

pp. e000966

Author(s):

Arvid Steinar Haugen ◽

Eirik Søfteland ◽

Nick Sevdalis ◽

Geir Egil Eide ◽

Monica Wammen Nortvedt ◽

...

Keyword(s):

Patient Safety ◽

Safety Culture ◽

Patient Safety Culture ◽

Operating Theatre ◽

Secondary Outcome ◽

Safety Program ◽

Surgical Safety ◽

Hospital Managers ◽

Culture Dimensions ◽

National Patient

ObjectivesOur primary objective was to study the impact of the Norwegian National Patient Safety Campaign and Program on Surgical Safety Checklist (SSC) implementation and on safety culture. Secondary objective was associations between SSC fidelity and safety culture. We hypothesised that the programme influenced on SSC use and operating theatre personnel’s safety culture perceptions.SettingA longitudinal cross-sectional study was conducted in a large Norwegian tertiary teaching hospital.ParticipantsWe invited 1754 operating theatre personnel to participate in the study, of which 920 responded to the surveys at three time points in 2009, 2010 and 2017.Primary and secondary outcome measuresPrimary outcome was the results of the patient safety culture measured by the culturally adapted Norwegian version of the Hospital Survey on Patient Safety Culture. Our previously published results from 2009/2010 were compared with new data collected in 2017. Secondary outcome was correlation between SSC fidelity and safety culture. Fidelity was electronically recorded.ResultsSurvey response rates were 61% (349/575), 51% (292/569) and 46% (279/610) in 2009, 2010 and 2017, respectively. Eight of the 12 safety culture dimensions significantly improved over time with the largest increase being ‘Hospital managers’ support to patient safety’ from a mean score of 2.82 at baseline in 2009 to 3.15 in 2017 (mean change: 0.33, 95% CI 0.21 to 0.44). Fidelity in use of the SSC averaged 88% (26 741/30 426) in 2017. Perceptions of safety culture dimensions in 2009 and in 2017 correlated significantly though weakly with fidelity (r=0.07–0.21).ConclusionThe National Patient Safety Program, fostering engagement from trust boards, hospital managers and frontline operating theatre personnel enabled effective implementation of the SSC. As part of a wider strategic safety initiative, implementation of SSC coincided with an improved safety culture.

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