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Found 218 results
  1. Content Article
    This article in the Journal of Minimally Invasive Gynaecology provides an interpretation of the 2014 US Food and Drug Administration (FDA) statement on power morcellation, a gynaecological procedure in which a device is used to slice up fibroid tissue for extraction through small incisions. Although use of power morcellation makes surgery less invasive, it has been shown to spread cancer if it exists within the patient's tissues. This article looks at the legal impact of the FDA statement, which warns against using laparoscopic power morcellators in the majority of women undergoing hysterectomy or myomectomy for uterine fibroids.
  2. Content Article
    In this opinion piece, Kath Sansom, founder of the Sling the Mesh campaign, highlights the many issues that women face when trying to get pelvic mesh slings surgically removed. She calls for the NHS to give patients a voice and to develop a robust and consistent plan to tackle the issues faced by patients harmed by surgical mesh.
  3. Content Article
    Surgical fires are a serious a patient safety issue. In this blog, Patient Safety Learning analyses a recent response from Maria Caulfield MP, Minister for Patient Safety and Primary Care, to several questions tabled in the House of Commons about surgical fires in the NHS, and outlines the need for further action to prevent these incidents.
  4. Content Article
    High Reliability Organisations (HRO), including healthcare and aviation, have a common focus on risk management. The human element is a ‘weak link’ which may result in accidents or adverse events taking place. Surgeons and other healthcare professionals can learn from aviation's rigorous approach to the role of human factors (HF) in such events, and how we can minimise them. Air Accident Investigation Branch (AAIB) reports show that fatal accidents are frequently caused by pilots flying outside their own personal limits, those of the aircraft or environment. Similarly, patient morbidity or mortality may occur if surgeons work outside personal their capability, with poor procedure selection and patient optimisation, or with a team or theatre environment not suited to the procedure. The authors of this study introduce the personal limitations checklist – a tool adapted from aviation that allows surgeons to define their limits in advance of any decision to operate, and develop critical self-reflection. It also allows management of patient expectations, shared decision making, and flattening of team hierarchy. The minimum skills, patient characteristics, team and theatre resources for any given procedure to proceed are defined. If the surgeon is ‘out of limits’, redressing these factors, seeking additional assistance, or thorough patient consenting may be required for the safe conduct of the procedure. The authors explore external pressures that could cause a surgeon to exceed both personal and organisational limits.
  5. News Article
    A second “mutilated” patient left with life-changing injuries after botched hospital surgery has described how she was left in urine-soaked bed sheets for days by nurses who called her lazy when she was unable to get out of bed. Lucy Wilson told The Independent she believes she would have been better looked after at a veterinary practice compared to the level of care she received from nurses at Norfolk and Norwich Hospital Trust in January last year. She was one of three patients harmed by surgeon Camilo Valero in the same week and almost died after Dr Valero and other staff failed to recognise her life-threatening injuries following the operation to remove her gall bladder. Dr Valero is under investigation by the General Medical Council but is still practising under supervision at the trust, which has refused to say whether the third patient survived their ordeal. After requests by The Independent, bosses at the NHS trust have now committed to publishing details of a secret review carried out by the Royal College of Surgeons into Dr Valero’s work and the wider surgical services at the trust. Read full story Source: The Independent, 31 May 2021
  6. News Article
    A private healthcare provider has been ordered to pay £20,000 after failing to disclose errors in the treatment of patients under the care of a surgeon. Spire Healthcare was prosecuted today in what the Care Quality Commission (CQC) said was “the first prosecution of its kind against an independent provider of healthcare”. The CQC said concerns around the treatment of four patients were initially raised by Leeds Clinical Commissioning Group, several physiotherapists at the hospital and another surgeon. The patients had surgical procedures carried out by Michael Walsh, a shoulder surgeon who held practising privileges at Spire Leeds until his suspension in April 2018. The procedures resulted in the patients suffering prolonged pain and requiring further remedial surgery. The CQC said it brought the prosecution after Spire failed to share details of what happened to the patients who were being treated by Mr Walsh, in line with their duty of candour responsibilities to be transparent and provide timely apologies when serious incidents occur. Read full story (paywalled) Source: HSJ, 29 April 2021
  7. News Article
    An RAF veteran has been left with life-changing injuries after being “mutilated” by an NHS surgeon during what should have been a routine procedure. Paul Tooth, 64, has been permanently left with tubes going in and out of his body which he needs to continually recycle bile produced by his liver. The previously fit and active father-of-two has lost five stone in weight and can barely leave his house after the surgery last year. It was supposed to be a routine gall bladder removal, but the surgeon inexplicably took out Paul’s bile duct and hepatic duct, which link the liver to the intestines, as well as damaging the liver itself, making a repair impossible. Although he has won his legal battle against the Norfolk and Norwich University Hospital Foundation Trust, Paul believes what happened to him raises bigger safety questions for the trust after he learned he was one of three patients harmed by the same surgeon just days apart. The alarm was first raised by Addenbrooke’s Hospital in Cambridge where the three patients were transferred for specialist care after their initial operations. The Norfolk and Norwich trust has now admitted liability for the errors and standard of care Paul received. Read full story Source: The Independent, 25 April 2021
  8. News Article
    New victims of rogue breast surgeon Ian Paterson are being blocked from using lawyers with experience of the scandal to bring fresh compensation claims against the private hospital where he worked, The Independent has learned. Under the terms of a legal settlement for £37m in 2017, 40 law firms are barred from bringing any new claims against Spire Healthcare for 20 years – meaning that former patients who have learned since then that they were victims of the surgeon, who was jailed for carrying out needless surgeries on women, face having to find lawyers with no prior knowledge of the case. When the deal was signed, it was thought that most of Paterson’s victims had been contacted by the hospital company, but an inquiry published in 2020 heavily criticised its failure to reach affected patients and accused the company of seeking to protect its reputation rather than the interests of patients. In response, Spire Healthcare launched a mass recall of 5,500 former patients, with independent clinicians reviewing their medical records. Some are learning for the first time that they had needless surgery at the hands of the surgeon. Read full story Source: The Independent, 11 April 2021
  9. News Article
    Following the statement from Nadine Dorries MP, Minister for Patient Safety, providing an update on the Paterson Inquiry, Matt James, Chief Executive of the Private Healthcare Information Network, said: “Although we were expecting the Government’s full response by now, it’s reassuring to know that this is still firmly on the agenda. The updates provided today are all welcome, but perhaps most telling is what remains to be addressed – most notably whole-practice information and better information for patients (recommendations one and three). “While it’s disappointing not to see more specifics, it is crucial that the recommendations are implemented properly and with the right consideration, resisting the temptation to create new systems from scratch and instead build on the excellent progress made by organisations such as NHS Digital, GIRFT, NCIP and PHIN. “We will continue to work with our partners across the NHS and private sector to make positive changes which improve transparency, accountability and information for patients. We will continue to liaise with the Department of Health and Social Care when invited to do so.” Press release Source: PHIN, 23 March 2021
  10. Content Article
    This week Nadine Dorries MP, Minister for Patient Safety, Suicide Prevention and Mental Health, provided an update on the Government’s response to the Independent Inquiry into the Issues raised by Paterson.[1] Here, Patient Safety Learning reflects on this statement and the need for the Government to urgently prioritise providing a full response to the Inquiry’s findings.
  11. Content Article
    The non-technical skills of surgeons (NOTSS) play a significant role in patient safety.  The aim of the NOTSS project was to develop and test an educational system for assessment and training of non-technical skills in the intra-operative phase of surgery. NOTSS is a behaviour rating system based on a skills taxonomy that allows valid and reliable observation and assessment of four categories of surgeons' non-technical skill: situation awareness, decision making, communication & teamwork, and leadership. These are the essential non-technical skills surgeons need to perform safely in the operating room and NOTSS allows measurement of several ACGME (Accreditation Council for Graduate Medical Education) competencies, including professionalism, interpersonal and communication skills, and systems-based practice. The skills taxonomy can be used to structure training and assessment in this important area of surgical competence.
  12. Content Article
    In April 2017, Ian Paterson, a surgeon in the West Midlands, was convicted of wounding with intent, and imprisoned. He had harmed patients in his care. The scale of his malpractice shocked the country. There was outrage too that the healthcare system had not prevented this and kept patients safe. At the time of his trial, Paterson was described as having breached his patients’ trust and abused his power. In December 2017, the Government commissioned an independent Inquiry to investigate Paterson’s malpractice and to make recommendations to improve patient safety. The report, outlining a series of recommendations to avoid future harm, was published in February 2020. On 23 March 2021 Nadine Dorries, Minister for Patient Safety, Suicide Prevention and Mental Health, provided an update on the Government’s response to the Independent Inquiry into the Issues raised by Paterson, accessible through the link below.
  13. News Article
    Racism, sexism, and homophobia is widespread in hospital operating theatres across England, according to an independent report. In a damning verdict on the atmosphere in some surgical teams, Baroness Helena Kennedy QC said the ‘old boys’ network of alpha male surgeons was preventing some doctors from rising to the top and had fuelled an oppressive environment for women, ethnic minorities and trainee surgeons. The report was commissioned by the Royal College of Surgeons and lays bare the "discrimination and unacceptable behaviour" taking place in some surgical teams. Baroness Kennedy told The Telegraph the field of surgery was "lagging behind" society, adding: "It is driven by an ethos which is very much alpha male, where white female surgeons are often assumed to be nurses and black women surgeons mistaken for the cleaner. And this is by the management. Read full story Source: The Independent, 18 March 2021
  14. Event
    until
    Join BD this live educational event designed to promote discussions on the following topics: An overview of the latest evidence-based prevention measures of HAI (SSI). Essential bundles of an effective infection prevention and control program management in cardiac surgery. Review of the sustainable change in practice within operating room. The event is designed for cardiac surgeons, infection control and nurses who are interested in learning more about new techniques and methodologies to minimise some of the most challenging post-operative complications, with an opportunity to debate and share opinions with peers through live discussions with internationally renowned faculty. Register
  15. News Article
    NHS England has ordered an independent review into patient safety and governance concerns at an acute trust which had been resisting calls to take this step, HSJ has learned. The intervention at University Hospitals of Morecambe Bay Foundation Trust comes after pressure from staff and local MPs, who believe more extensive investigation is required into cases of patient harm within the trauma and orthopaedics division. The broad issues were first revealed by HSJ in November, with documents suggesting several patients were harmed after leaders failed to act on multiple concerns being raised about a surgeon. The trust has already commissioned one external review. This reported last year and found the service to be riven by “internecine squabbles”. However, the review was overseen by trust executives and the terms of reference were focused on incident reporting and culture within the department. It is understood that some consultants have since been pushing for further investigation into specific cases where patients were harmed, as well as concerns that managers or clinicians who were accused of failing to tackle the issues have since been promoted to more senior positions. Read full story (paywalled) Source: HSJ, 2 March 2021
  16. Content Article
    The Royal College of Surgeons of Edinburgh (RCSEd) has partnered with the anti-smoking charity ASH (Action on Smoking and Health) to support surgeons in encouraging patients to improve their survival chances by quitting smoking ahead of surgery. Fewer postoperative complications, shorter hospital stays and better long-term outcomes are some of the evidence-based benefits the College’s members are being asked to highlight to patients. The campaign urges all surgeons to view patient consultations as ‘teachable moments’, during which patients may be more receptive to intervention and more motivated to quit. As part of the discussion of risks associated with a procedure, surgeons should outline the reduction in risk associated with smoking cessation, with the recommendation to stop at least two months before the operation.
  17. Content Article
    Surgeons' News is a magazine for surgical, dental and allied healthcare professionals. Published quarterly by the Royal College of Surgeons of Edinburgh, it features comment and opinion from leading professionals, plus reviews and reports on subjects relevant to all career levels.
  18. Community Post
    Subject: Looking for Clinical Champions (Patient Safety Managers, Risk Managers, Nurses, Frontline clinical staff) to join AI startup Hello colleagues, I am Yesh. I am the founder and CEO of Scalpel. <www.scalpel.ai> We are on a mission to make surgery safer and more efficient with ZERO preventable incidents across the globe. We are building an AI (artificially intelligent) assistant for surgical teams so that they can perform safer and more efficient operations. (I know AI is vaguely used everywhere these days, to be very specific, we use a sensor fusion approach and deploy Computer Vision, Natural Language Processing and Data Analytics in the operating room to address preventable patient safety incidents in surgery.) We have been working for multiple NHS trusts including Leeds, Birmingham and Glasgow for the past two years. For a successful adoption of our technology into the wider healthcare ecosystem, we are looking for champion clinicians who have a deeper understanding of the pitfalls in the current surgical safety protocols, innovation process in healthcare and would like to make a true difference with cutting edge technology. You will be part of a collaborative and growing team of engineers and data scientists based in our central London office. This role is an opportunity for you to collaborate in making a difference in billions of lives that lack access to safe surgery. Please contact me for further details. Thank you Yesh yesh@scalpel.ai
  19. Content Article
    National audits, such as the National Emergency Laparotomy Audit (NELA), are a powerful tool. They allow us to see what is happening to our ‘real-life’ patients, to identify gaps in our local services, to see which hospitals are doing best and to share best practice. This learning informs guidelines and pathways such as ‘The High-Risk Surgical Patient’ and the forthcoming international enhanced recovery programmes for emergency laparotomy. The linking of good practice with a financial incentive, the Best Practice Tariff, has also acted as a carrot for hospitals to support funding for new models of care. Previously we have seen how audit, linked with guidelines and associated financial incentives, has improved outcomes in hip fracture and now it is encouraging to observe similar results in emergency laparotomy. In this blog, Dr Jugdeep Dhesi, Consultant Geriatrician and Deputy Director for the Centre of Perioperative Care, discusses NELA and older patients, and how we must deliver patient-centred rather than surgical-speciality based pathways and to ensure the best outcomes for all of our patients.
  20. Content Article
    Some patients die after major surgery. Risk prediction tools can help shared decision making with the patient, aiding decisions on whether to operate, how to prepare and use of critical care. An international multi-centre prospective observational cohort study in 274 sites with 22,631 patients compared risk prediction with 30-day mortality. In 88.7% of cases clinicians exclusively used subjective assessment. The best predictions were from the SORT tool combined with clinical assessment. P-POSSUM Surgical Risk Scale, SRS and SORT all over-predicted risk, with SORT performing best. This 10-question SORT model has been updated including clinician assessment and provides an accurate means of predicting perioperative risk.
  21. News Article
    Several patients were harmed after leaders at an acute trust failed to act on multiple concerns being raised about a surgeon, documents obtained by HSJ suggest. The documents reveal a catalogue of governance and safety concerns over the trauma and orthopaedics department at University Hospitals of Morecambe Bay Foundation Trust in the last three years. They include an external review which described the process for investigating clinical incidents as akin to “marking your own homework” and found the T&O department at Royal Lancaster Infirmary driven by “internecine squabbles”. It comes as the trust, which is widely known for a patient safety scandal within its maternity department, also faces a major investigation into whistleblowing concerns over its urology services. Read full story (paywalled) Source: HSJ, 17 November 2020
  22. News Article
    Keyhole surgery can allow complicated procedures to be carried out with just a few access cuts, helping to reduce patient recovery times and potential risk of infection. But the remote controlled robots that can perform this type of surgery are often very large, expensive and not widely available. Now a new robo-surgeon with a modular design could be about to change that. View video Source: BBC News, 9 November 2020
  23. Content Article
    The latest ECRI and the Institute for Safe Medication Practices PSO Deep Dive explores one of the areas that accounts for a large portion of healthcare volume: surgical care. Annually, surgery accounts for 7 million inpatient hospital stays and 36 million procedures in the outpatient setting. Although surgical safety has been the subject of guidelines, patient safety and quality improvement projects, and attention in the literature, adverse events continue to occur with relative frequency, putting patients at risk.
  24. Content Article
    In this blog for the Guardian, a well respected surgeon tells of the time they were admitted to the intensive care unit of the hospital where they worked following a suicide attempt. The surgeon explains how depression is a lot more common in medicine than realised but how it is still stigmatised, even within the medical profession. Many medical staff often display signs of depression differently to others and keep working right up until they break; work brings comfort from the feelings of hopelessness and worthlessness. Very few have the opportunity to attend counselling, since this would require taking time off work.  "I would be smiling and laughing on the outside, but on the inside was a continuous mantra of self-loathing that kept getting louder. I pushed myself harder, took extra shifts, tried to put my head down and just get through it. One day, I had had enough. The pain had become physical as well as mental, and the idea of having to live any longer was unbearable."
  25. Content Article
    The objective of this review from Alani et al. is to draw attention to the risk factors, causes and prevention of surgical fires in facial plastic and reconstructive surgery performed under local anaesthesia and sedation using a review of the literature.
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