A qualitative content analysis of retained surgical items: learning from root cause analysis investigations

Objective To describe incidents of retained surgical items, including their characteristics and the circumstances in which they occur. Design A qualitative content analysis of root cause analysis investigation reports. Setting Public health services in Victoria, Australia, 2010–2015. Participants Incidents of retained surgical items as described by 31 root cause analysis investigation reports. Main Outcome Measure(s) The type of retained surgical item, the length of time between the item being retained and detected and qualitative descriptors of the contributing factors and the circumstances in which the retained surgical items occurred. Results Surgical packs, drain tubes and vascular devices comprised 68% (21/31) of the retained surgical items. Nearly one-quarter of the retained surgical items were detected either immediately in the post-operative period or on the day of the procedure (7/31). However, about one-sixth (5/31) were only detected after 6 months, with the longest period being 18 months. Contributing factors included complex or multistage surgery; the use of packs not specific to the purpose of the surgery; and design features of the surgical items. Conclusion Retained drains occurred in the post-operative phase where surgical counts are not applicable and clinician situational awareness may not be as great. Root cause analysis investigation reports can be a valuable means of characterizing infrequently occurring adverse events such as retained surgical items. They may detect incidents that are not detected by other data collections and can inform the design enhancements and development of technologies to reduce the impact of retained surgical items.

Temporal variations in the rooting ability of cuttings of Populusbalsamifera and Salixplanifolia from natural clones–populations of subarctic Quebec

Temporal variations in the rooting ability of cuttings from five clones of Populusbalsamifera L. and five populations of Salixplanifolia Pursh from the Great Whale River valley in subarctic Quebec were determined. Cuttings were sampled monthly from May through October and rooted in a greenhouse. Root number and length of the longest root per cutting were determined 35 days after planting. There were significant variations among the six sampling dates in the rooting potential of cuttings of both species. A higher percentage of cuttings formed adventitious roots in May and June before or shortly after bud break than later, during the growing season; root number and length followed a similar trend. There was an increase in the rooting ability of cuttings of both species towards the fall period. Salixplanifolia produced more roots per cutting than P. balsamifera early in the season (i.e., May and June), but later in the season the differences between the two species were not great; root length showed no such trend. Differences among clones–populations in the rooting potential of cuttings were large for both species. Coefficients of variation for root number were lower in spring than later, during the growing season, for both P. balsamifera and S. planifolia. Seasonal trends in coefficients of variation for root length were not as evident as for root number. These results have significant implications for site restoration in the Subarctic. To optimize the rooting ability of cuttings and minimize the differences among clones–populations in rooting potential, cuttings should be sampled early in the season before bud break or shortly thereafter.