Surgical care checklists to optimize patient care following postoperative complications

Pucher, Philip H.; Aggarwal, Rajesh; Almond, M.; Darzi, Ara

doi:10.1016/j.amjsurg.2015.03.018

Cited by 11 publications

(5 citation statements)

References 44 publications

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“…Failure to comply with best practice was found to be the only significant factor in the development of further complications (OR, 6.75; 95% CI, 1.11-41.00) in this study. 35 Another study 36 also showed that failure to adhere to critical management steps in postoperative care significantly predicted the occurrence of a complication, and that each additional management step missed increased the odds of a postoperative complication by 60% (OR, 1.6; 95% CI, 1.2-2.2). 36 Failure to adhere to best practice thus not only occurs in simulation sessions but in clinical practice every day, resulting in preventable morbidity and mortality.…”

Section: Discussionmentioning

confidence: 97%

“…The baseline omission of 33% of critical management steps found in this study corroborates previously reported incidences between 20% to 50%. 21,[32][33][34] A case note review in the care of surgical patients 35 also revealed a noncompliance rate in best practice of 86% in the management of postoperative complications. Failure to comply with best practice was found to be the only significant factor in the development of further complications (OR, 6.75; 95% CI, 1.11-41.00) in this study.…”

Section: Discussionmentioning

confidence: 99%

“…A case note review in the care of surgical patients also revealed a noncompliance rate in best practice of 86% in the management of postoperative complications. Failure to comply with best practice was found to be the only significant factor in the development of further complications (OR, 6.75; 95% CI, 1.11-41.00) in this study . Another study also showed that failure to adhere to critical management steps in postoperative care significantly predicted the occurrence of a complication, and that each additional management step missed increased the odds of a postoperative complication by 60% (OR, 1.6; 95% CI, 1.2-2.2) .…”

Section: Discussionmentioning

confidence: 99%

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Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

et al. 2020

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IMPORTANCE Failure to rescue causes significant morbidity and mortality in the surgical population. Human error is often the underlying cause of failure to rescue. Human error can be reduced by the use of cognitive aids.OBJECTIVES To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in a simulation setting. Surgical teams consisted of 1 surgeon and 2 nurses from a surgical ward from 4 different hospitals in Amsterdam, the Netherlands. Data were analyzed between February 2, 2017, and December 18, 2018.INTERVENTIONS The teams were randomized to manage 3 simulated deteriorating patient scenarios with or without the use of cognitive aids. MAIN OUTCOMES AND MEASURESThe primary outcome of the study was failure to adhere to best practice, expressed as the percentage of omitted critical management steps. The secondary outcome of the study was the perceived usability of the cognitive aids. RESULTSOf the total participants, 93 were women and 51 were men. Twenty-five surgical teams performed 75 patient scenarios with cognitive aids, and 25 teams performed 75 patient scenarios without cognitive aids. Using the cognitive aids resulted in a reduction of omitted critical management steps from 33% to 10%, which is a 70% (P < .001) reduction. This effect remained significant (odds ratio, 0.63; 95% CI, −0.228 to −0.061; P = .001) in a multivariate analysis. Overall usability (scale of 0-10) of the cognitive aids was scored at a median of 8.7 (interquartile range, 8-9). CONCLUSIONS AND RELEVANCEFailure to comply with best practice management of postoperative complications is associated with worse outcomes. In this simulation study, adherence to best practice in the management of postoperative complications improves significantly by the use of cognitive aids. Cognitive aids for deteriorating surgical patients therefore have the potential to reduce failure to rescue and improve patient outcome.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

et al. 2020

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“…[212223] Traditionally, surgical education has been based on the popular “see one, do one, teach one” approach. [24] This approach inadvertently exposes patients to inexperienced trainees that endangers their health and safety.…”

Section: Modalities For Surgical Educationmentioning

confidence: 99%

The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review

Forgione

Guraya²

2017

J Res Med Sci

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Background:Historically, operating room (OR) has always been considered as a stand-alone trusted platform for surgical education and training. However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators to develop more cost-effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeons need to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explore the value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopic surgical training programs in world-class centers across the globe with a view to formulate a blended and unified structured surgical training program.Materials and Methods:Several data sources were searched using MeSH terms “Laparoscopic surgery” and “Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery” and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and by excluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesis and data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles were excluded from the study.Results:Finally, 12 articles were selected for this systematic review. Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators, animal and cadaveric labs, telementoring, telerobotic-assisted surgery, and video games. Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints.Conclusion:The existing world-renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisition of knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.

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“…When standard surgical complication care is compared to evidence-based checklists, only 14% of cases are appropriately managed, precipitating additional morbidity ( p = 0.038) [ 29 ]. A retrospective analysis of surgical checklist use in Europe found an association between checklist use and decreased mortality (adjusted odds ratio ( OR ) 0.71, CI 0.58–0.85, p < 0.001) [ 30 ].…”

Section: The Preeclampsia-eclampsia Checklistmentioning

confidence: 99%

Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist

Nwanodi

2016

Healthcare

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Globally, preeclampsia-eclampsia (PE-E) is a major cause of puerperal intensive care unit admission, accounting for up to 10% of maternal deaths. PE-E primary prevention is possible. Antepartum low-dose aspirin prophylaxis, costing USD $10–24 can cut the incidence of PE-E in half. Antepartum low molecular weight heparin combined with low-dose aspirin prophylaxis can cut the incidence of early onset PE-E and fetuses that are small for their gestational age in half. Despite predictive antepartum models for PE-E prophylaxis, said prophylaxis is not routinely provided. Therefore, magnesium sulfate secondary prevention of eclampsia remains the globally recommended intervention. Implementation of a PE-E checklist is a continuous quality improvement (CQI) tool facilitating appropriate antepartum PE-E prophylaxis and maternal care from the first trimester through the postpartum fourth trimester inter-partum interval. A novel clinical PE-E checklist and implementation strategy are presented below. CQI PE-E checklist implementation and appropriate PE-E prophylaxis provides clinicians and healthcare systems an opportunity to achieve Millennium Development Goals 4 and 5, reducing child mortality and improving maternal health. While CQI checklist implementation may be a tedious ongoing process requiring healthcare team resiliency, improved healthcare outcomes are well worth the effort.

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Surgical care checklists to optimize patient care following postoperative complications

Abstract: Management of complications is highly variable, with failure to adhere to best practice principles significantly associated with an increased risk of further morbidity. This study presents an evidence-based framework for the development of checklists to standardize care.

Cited by 11 publications

References 44 publications

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

The cutting-edge training modalities and educational platforms for accredited surgical training: A systematic review

Preeclampsia-Eclampsia Adverse Outcomes Reduction: The Preeclampsia-Eclampsia Checklist

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