Analysis of errors reported by surgeons at three teaching hospitals

Gawande, Atul A.; Zinner, Michael J.; Studdert, David M.; Brennan, Troyen A.

doi:10.1067/msy.2003.169

Cited by 922 publications

(582 citation statements)

References 50 publications

(42 reference statements)

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“…Indirect effects on cost may result from the fact that trainees commit significantly more errors due to lack of technical competence or knowledge than do their non-trainee counterparts, and trainee errors are more complex than non-trainee errors (Singh et al 2007). Gawande et al (2003) reported that the most commonly cited system factor contributing to errors at the three teaching hospitals studied was inexperience or lack of competence in a surgical task.…”

Section: Discussionmentioning

confidence: 99%

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

Hagen

Holom

Amayu

2017

HEPL

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Abstract:Setting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals' lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals. Cambridge University Press AbstractSetting prices for elective patient treatments in private for-profit (PFP) hospitals in traditional tax-funded health systems is challenging since both the organisation of these hospitals and the tasks they perform differ considerably from what we find in public hospitals. From the year 2000, Norway became one of a few countries to gradually implement a procurement system based on competitive tendering when outsourcing elective surgery. In this study we analyse the effect of introducing competitive tendering on the prices paid to PFP hospitals. Pricing data were collected from the formal contracts awarded to PFP hospitals and defined in terms of both absolute and relative prices. We found that PFP hospitals performed day surgeries at markedly lower prices than public hospitals and that competitive tendering triggered the price reduction. We speculate that the PFP hospitals' lack of acute services, less severe patient population, reduced teaching responsibilities and ability to streamline production, as well as other factors, explain the lower prices at PFP hospitals.

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Section: Discussionmentioning

confidence: 99%

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

Hagen

Holom

Amayu

2017

HEPL

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“…This plot shows the score constantly underpredicted major complications and as such is insufficiently accurate to serve as a comprehensive risk stratification tool. 3 of surgical adverse events occur [9,10,20]. Patients with low scores should be recognized to be at an elevated risk for major complications, even patients whose baseline characteristics would suggest they otherwise are at low risk.…”

Section: Discussionmentioning

confidence: 99%

The Surgical Apgar Score in Hip and Knee Arthroplasty

Wuerz

Regenbogen

Ehrenfeld

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background A 10-point Surgical Apgar Score, based on patients' estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery, was developed to rate patients' outcomes in general and vascular surgery but has not been tested for patients having orthopaedic surgery. Questions/purposes For patients undergoing hip and knee arthroplasties, we asked (1) whether the score provides accurate risk stratification for major postoperative complications, and (2) whether it captures intraoperative variables contributing to postoperative risk based on the three parameters independent of preoperative risk. Patients and MethodsWe retrospectively reviewed the electronic records for all 3511 patients who underwent a hip or knee arthroplasty from March 2003 to August 2006 and extracted data to calculate a Surgical Apgar Score. We evaluated the relationship between scores and likelihood of major postoperative in-hospital complications and assessed its discrimination and calibration. Results Complication rates increased monotonically as the score decreased. Even after controlling for preoperative risk, each 1-point decrease in the score was associated with a 34.0% increase (95% confidence interval, 0.66-0.84) in the odds of a complication. The overall discriminatory performance of the score was a c-statistic of 0.61. Seventysix percent of all major complications occurred in patients classified as low risk with scores of 7 or greater.

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“…Communication and teamwork failures are often cited as the most common cause of adverse events [1][2][3][4][5] . The Joint Commission identified communication as a critical factor in more than 65% of reported sentinel events 6 .…”

Section: Introductionmentioning

confidence: 99%

A Multidisciplinary Teamwork Training Program: The Triad for Optimal Patient Safety (TOPS) Experience

et al. 2008

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Analysis of errors reported by surgeons at three teaching hospitals

Abstract: Subjective incident reports gathered through interviews allow identification of characteristics of surgical errors and their leading contributing factors, which may help target research and interventions to reduce such errors.

Cited by 922 publications

References 50 publications

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

Outsourcing day surgery to private for-profit hospitals: the price effects of competitive tendering

The Surgical Apgar Score in Hip and Knee Arthroplasty

A Multidisciplinary Teamwork Training Program: The Triad for Optimal Patient Safety (TOPS) Experience

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