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Content Article
Impact of adverse events on surgeons (April 2022)
Patient Safety Learning posted an article in Surgery
Surgeons are affected negatively when things go wrong. They may experience guilt, anxiety and reduced confidence following adverse events, which may lead to formal investigation and sanction. Medical errors have been linked with burnout, depression, suicidal ideation and reduced quality of life. This research from Turner et al. explores the impact of adverse events on UK surgeons’ health and wellbeing. Surgeons completed an online survey that involved recalling an error-based or complication-based event and answering questions regarding health, wellbeing and support seeking. -
Content Article
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We’re looking for patients to help raise awareness of the damaging impact that surgical infections can have on people, and guide improvements. Have you ever been in surgery and contracted an infection? Do you want to share your experience anonymously and help create change? Take part in this survey: Experiences of Surgical Infections -
Content Article
Human factors - Safer surgery checklist (June 2022)
Patient-Safety-Learning posted an article in Surgery
This literature review in The Operating Theatre Journal looks at 'How industry has helped healthcare better understand human factors'. The author, Nigel Roberts, Theatre Lead at the University Hospitals of Derby and Burton, looks at this question in relation to teamwork, leadership, situational awareness, communication and culture. -
Content Article
Waiting Lists Tracker
Patient Safety Learning posted an article in Suggest a useful website
Get information on waiting times for treatment at NHS Trusts in England. This data is sourced from NHS England, and is published two months in arrears. Please note that some data may not be available. This could be because a) the Trust does not provide treatment for the selected condition, b) data has not been submitted, or c) some services (e.g. mental health) are not covered in the source data. -
Content ArticleThis ITV documentary tells the story of how surgeon Ian Paterson duped his patients into believing they had cancer and performed unnecessary surgeries on them, before he was caught and jailed for 20 years in 2017. It features personal accounts of patients who were harmed by Paterson while he worked in NHS and private practice. Further reading: Report of the independent Inquiry into the issues raised by Paterson (4 February 2020) Patient Safety Learning’s response to the Paterson Inquiry (11 February 2020) Government response to the independent inquiry report into the issues raised by former surgeon Ian Paterson (16 December 2021)
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Content ArticleShared decision making and regular communication throughout a patient’s surgery pathway would, a recent HSJ webinar argued, help the NHS move from the concept of waiting lists to one of preparation lists – and to a better way of dealing with the backlog. Claire Read reports.
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Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation aims to improve patient safety in relation to the decontamination of surgical instruments. It focuses on the work of sterile services departments (SSDs) in hospitals, where reusable medical equipment is cleaned, disinfected and sterilised to make it safe before it is used again. The investigation looked at the regulatory framework which SSDs work within, and their use of assurance models, which provide evidence that a service is running according to the relevant policies and procedures. These mechanisms are designed to keep patients safe and enable NHS trusts to manage risk within their organisations. For its reference case, the investigation used the case of a 56 year-old woman who underwent surgery to remove a kidney stone in her right kidney. During the procedure, 'black stuff' came out of one of the instruments being used, which was later analysed and found to be dried blood. The surgeon stopped the surgery immediately and proceeded with an alternative procedure to remove the kidney stone, for which the patient had already consented. The patient was tested for blood-borne viruses as she had been exposed to another person's dried blood, but tests did not show any evidence that she had contracted any.
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Content ArticleDespite its success in other industries, process standardisation in healthcare has been slow to gain traction or to demonstrate a positive impact on the safety of care. The High 5s project is a global patient safety initiative of the World Health Organization (WHO) to facilitate the development, implementation and evaluation of Standard Operating Protocols (SOPs) within a global learning community to achieve measurable, significant and sustainable reductions in challenging patient safety problems. The project seeks to answer two questions: (i) Is it feasible to implement standardized health care processes in individual hospitals, among multiple hospitals within individual countries and across country boundaries? (ii) If so, what is the impact of standardization on the safety problems that the project is targeting? Three SOPs—correct surgery, medication reconciliation, concentrated injectable medicines—have been developed and are being implemented and evaluated in multiple hospitals in seven participating countries. Nearly 5 years into the implementation, it is clear that this is just the beginning of what can be seen as an exercise in behaviour management, asking whether healthcare workers can adapt their behaviours and environments to standardise care processes in widely varying hospital settings.
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Content ArticleSurgical smoke or surgical plume is the smoke created by electrical and cauterisation devices used in surgery. When surgical staff are exposed to this smoke, it may cause harm, with some studies finding that exposure increased cancer risk for surgeons. This study in the journal Scientific Reports aimed to compare the concentration of surgical smoke produced by different tissues and electric diathermy modes, and to measure the effectiveness of different local exhaust ventilations. The authors found that: there were varying levels of particulates given off by different devices and different tissues. in the cutting setting, all three smoke extractors had more than 96% efficiency in clearing surgical smoke. adapting an electric diathermy device with a urethral catheter is a simple and effective way to exhaust smoke in surgical operations. They highlight the need for more research to ensure surgical staff are well protected from the risks of surgical smoke.
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Content ArticleThis study in BMC Infectious Diseases aimed to determine whether there is an association between Covid-19 infection and acute appendicitis. The authors performed a single institution retrospective review of pre-procedure Covid-19 testing and indications for surgical intervention. They found a high prevalence of Covid-19 in both all testing and pre-procedure testing during the enrolment period and observed a high prevalence of acute appendicitis among patients identified to be Covid-positive during pre-procedure testing and without recognised symptoms of Covid-19.
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Content ArticleThese tools and resources from the National Institute for Health and Care Excellence (NICE) accompany the NICE guidance on Hypothermia: prevention and management in adults having surgery. Resources available for download include: Audit and service improvement baseline assessment tool Implementation support advice document Education information Shared learning information Practical steps to improving the quality of care and services using NICE guidance
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Content ArticleIn order to prevent hypothermia during or after surgery, patients can be warmed before or during the induction of anaesthesia. If the patient is warmed before, this is known as prewarming, and if they are warmed at the same time that anaesthetics are given, this is known as cowarming. This study in the Journal of Anaesthesiology and Clinical Pharmacology aimed to investigate whether cowarming is as good as prewarming in preventing the occurrence of intraoperative hypothermia.
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Content ArticleHypothermia is a common problem in the operating theatre, and it contributes to many poor outcomes including rising costs, increased complications and higher morbidity rates. This literature review in the Journal of PeriAnesthesia Nursing aimed to determine the best method and time to prewarm a patient in order to prevent hypothermia during or after surgery. The authors suggest that forced-air warming is most effective in preventing perioperative hypothermia. Eighty-one percent of the experimental studies reviewed found that there was a significantly higher temperature throughout surgery and in the post-operative care unit for patients who received forced-air prewarming.
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Content ArticleThis article looks at the benefits and process of prewarming patients before surgery, in order to maintain normothermia (a normal, safe temperature) throughout the peri-operative process. Increasing the patient's core temperature helps prevent hypothermia later on in surgery, reducing the need to deal with temperature issues during and after surgery. The author highlights the link between warming and patient safety and describes different approaches that can be taken for different lengths and types of surgical procedure.
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Content ArticleIn this article in the Patient Safety Journal, Mayher Profita, a third-year surgical resident in Pennsylvania, describers her residency and the burnout she experienced. "The burnout was making us care less about our patients and the care they received and more about whether we made the right career choice."
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Content ArticleThis guideline covers preventing and managing inadvertent hypothermia in people aged 18 and over having surgery. It offers advice on assessing patients’ risk of hypothermia, measuring and monitoring temperature, and devices for keeping patients warm before, during and after surgery.
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Content ArticleAn HSJ roundtable, supported by Edwards Lifesciences, looked at how trusts can find solutions to the complex challenges of improving patient safety in operating theatres and intensive care units.
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Content ArticleThe pandemic has had an enormous impact on health and care services in the UK. In this article, Nuffield Trust fellows Jessica Morris and Sarah Reed take a closer look at access and waiting times before and after the start of the Covid-19 pandemic. They highlight that before the pandemic, pressure on the system was already reducing access to NHS services and making waiting times longer. Covid-19 has made the situation significantly worse due to the need for heightened infection control practices, rising levels of staff sickness and burnout, the cancellation of routine care and redirection of staff. Enabling services to recover will be challenging given these ongoing pressures and real-term budget cuts for the NHS this year. The article examines the impact of the pandemic on waiting times relating to: General practice Elective (planned) care Diagnostic testing Cancer care A&E Ambulance
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Content ArticleThis prospective study aimed to determine the surgical site infection (SSI) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro. A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study. All four surgical wound categories were included. Primary closure was employed in all cases. Patients were followed up to 30th day postoperatively. All cases were evaluated for postoperative fever, redness, swelling of wound margins and collection of pus. Cultures were taken from all the cases with any of the above finding. The overall rate of surgical site infection was 13·0%. The rate of wound infection was 5·3% in clean operations, 12·4% in clean‐contaminated, 36·3% in contaminated and 40% in dirt‐infected cases. Age, use of surgical drain, duration of operation and wound class were significant risk factors for increased surgical site infection.. Postoperative hospital stay was double in cases who had surgical site infection. Sex, haemoglobin level and diabetes were not statistically significant risk factors. In conclusion, surgical site infection causes considerable morbidity and economic burden. The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended.
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Content Article
In this blog, Nigel Roberts, who is a registered Allied Health Professional theatre lead at the University Hospitals of Derby and Burton (which has in excess of 50 operating theatres and performs over 50,000 procedures annually), considers the current challenges facing all operating theatre staff post pandemic. Nigel looks at how human factors may influence the delivery of the surgical safety checklist, and discusses whether Local Safety Standards for Invasive Procedures (LocSSIPs) are making a difference in terms of the number of intra-operative Never Events being reported.- Posted
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Content ArticleThis literature review in The Operating Theatre Journal examines why the decision was made not to class surgical fires as a 'Never Event', even though research has identified them as a preventable hazard. The author also examines steps that could be taken to further reduce the risk of surgical fires in the NHS and other health systems. You will need to create a free online account to view this article.
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Content ArticleCompensation claims are a useful source of information on patient safety research. This study in The Journal of Patient Safety aimed to determine the main causes of surgical compensation claims and their financial impact on the health system. The authors analysed the frequency, causes, consequences, locations and surgical settings of compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. The study found that the most frequent causes for claims were surgical error (42.4%) and treatment error (30.9%), and that the main surgical settings involved were orthopaedic surgery and traumatology (27.4%), gynaecology and obstetrics (25.7%) and “general surgery” (17.2%).
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Content ArticleAcross multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occur in the hands of both inexperienced and experienced practitioners. Current evidence shows that unrecognised oesophageal intubation occurs sufficiently frequently to be a major concern and to merit a co-ordinated approach to address it. Harm from unrecognised oesophageal intubation is avoidable through reducing the rate of oesophageal intubation, combined with prompt detection and immediate action when it occurs. These guidelines provide recommendations for preventing unrecognised oesophageal intubation that are relevant to all airway practitioners independent of geography, clinical location, discipline or patient type.
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Content ArticleClinicians at Guy's & St Thomas' Foundation Trust in London are preparing to publish the results of 15 one-day HIT lists between February 2021 and August 2022, involving 300 patients across eight different specialties, in which they claim they have been able to carry out four times as many operations as they would normally expect to complete in a month using conventional lists.
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Content ArticleProven patient safety solutions such as the World Health Organization’s Surgical Safety Checklist can be difficult to implement at scale. This article looks at a voluntary initiative launched in South Carolina hospitals in 2010 to encourage use of the checklist in all operating rooms. Hospitals that implemented the checklist by 2017 had higher levels of CEO and physician participation than comparison hospitals, and engaged more in activities such as in-person meetings and teamwork skills trainings. The authors suggest three considerations for hospital, state and national policy makers: Successful programs must be designed to engage all stakeholders (CEOs, physicians, nurses, surgical technologists, and others) Offering a variety of program activities—both lower-touch and higher-touch—over the duration of the program allows more hospital and individual participation Change takes time and resources
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