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Content ArticleThis report summarises data submitted by NHS hospitals and independent sector (IS) NHS treatment centres in England to the national SSI Surveillance Service (SSISS) at Public Health England (PHE). The aim of the national surveillance programme is to enhance the quality of patient care by encouraging hospitals to use data obtained from surveillance to compare their rates of SSI over time and against a national benchmark, and to use this information to review and guide clinical practice. The SSISS provides an infrastructure for hospitals to collect data on 17 surgical categories spanning general surgery, cardiothoracic, neurosurgery, gynaecology, vascular, gastroenterology and orthopaedics. Surveillance is targeted at open surgical procedures, which carry a higher risk of infection than minimally invasive (‘keyhole’) procedures.
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Content ArticleSurgical site infections (SSIs) present a considerable challenge for healthcare systems across the world, including in the UK, and have a substantial impact on patients and healthcare professionals. Despite clear evidence and guidelines on how to reduce the risk of these infections on a global, regional and national basis – and the fact that research shows up to 60% of SSIs are preventable – infection rates remain high. Progress has been made in recent years, yet more than 5% of patients undergoing a surgical procedure still develop an SSI, and each infection has been estimated to cost the NHS between £10,0003 and £100,000 per patient. It is now time to act. Collectively we need to reduce the variation in practice across the UK, embed evidence-based examples of best practice, and work collaboratively with the NHS to help reduce the incidence of SSIs to improve patient outcomes. Embedding this guidance and changes to practice cannot take place in silos. It will require action from the whole healthcare community: from policymakers, to trusts, to hospitals, healthcare professionals and medical Royal Colleges, right the way through to the patient themselves. This report, Time to Act: A State of the Nation report on Surgical Site Infections in the UK, will review the available evidence, examples of best practice and reflections from the front line, to make recommendations to each of these groups in order to drive significant improvement in reducing SSI rates in the UK.
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Content ArticleIn response to the coronavirus disease of 2019 (COVID-19) pandemic, healthcare systems worldwide have stepped up their infection prevention and control efforts in order to reduce the spread of the infection. Behaviours, such as hand hygiene, screening and cohorting of patients, and the appropriate use of antibiotics have long been recommended in surgery, but their implementation has often been patchy. The current crisis presents an opportunity to learn about how to improve infection prevention and control and surveillance (IPCS) behaviours. The improvements made were mainly informal, quick and stemming from the frontline rather than originating from formal organisational structures. This paper from Toccafondi et al. aims to illustrate how adopting a human factors and ergonomics perspective can provide insights into how clinical work systems have been adapted and reconfigured in order to keep patients and staff safe.
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Content ArticleGeneral anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study from Odor et al. was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit. If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said.
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Content ArticleInadequate access to anaesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anaesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. In this report, Orser et al. summarises the challenges facing the provision of anaesthesia services in rural and remote regions
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Content ArticleAnesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. Richard Botney reviews the important events in the past 50 years that illustrates the many steps that have contributed to the improvements in anesthesia safety.
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Content ArticleWrong-site surgery (WSS) is a well-known type of medical error that may cause a high degree of patient harm. In Pennsylvania, healthcare facilities are mandated to report WSS events, among other patient safety concerns, to the Pennsylvania Patient Safety Reporting System (PA-PSRS) database.
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Content Article
Surgical Outcome Risk Tool v2 (SORT)
Patient Safety Learning posted an article in Surgery
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. -
Content ArticleNational 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.
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Content Article
Patient Safety Authority: Wrong-site surgery
Patient Safety Learning posted an article in Surgery
Analysis of wrong-site surgery events in Pennsylvania suggests opportunities for prevention. Many steps of preparing the patient for an operation and performing an operation can lead down the path of wrong-site surgery. Preventing wrong-site surgery may require attention at every step of the process. The Patient Safety Authority has provided resources, guidelines and education tools. -
Content ArticleIn this article, published by the Harvard Business Review, authors discuss how to safely tackle the backlog of elective surgeries, created by the initial wave of the pandemic. They highlight the significant role of human factors such as stress or fatigue, and suggest strategies to mitigate them.
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Content ArticleThis report from the Centre for Perioperative Care provides evidence to justify the case for perioperative care, the integrated multidisciplinary care of patients from the moment surgery is contemplated through to full recovery. This report has brought together a wide range of research about the effectiveness of perioperative care. It considered over 27,000 studies in preparing this review. The results show that perioperative care is associated with high quality clinical outcomes, reduced financial cost and better patient satisfaction. A perioperative approach can increase how prepared and empowered people feel before and after surgery. This can reduce complications and the amount of time that people stay in hospital after surgery, meaning that people feel better sooner and are able to resume their day-to-day life. The review highlights the effectiveness of clear perioperative pathways, with an average two-day reduction in hospital stay across multiple types of surgery. Different interventions, including prehabilitation, exercise and smoking cessation can significantly reduce complications by 30% to 80%. This scale of benefits is far greater than many new drugs or treatments launched.
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Content ArticleThe OSIRIS programme is a major project of research, to understand and improve the shared decision making process for patients at high risk of medical complications as they contemplate major surgery. Led by Barts Health NHS Trust & Queen Mary University London and funded by the National Institute for Health Research (NIHR), research will be conducted with patients, doctors and carers to understand the surgical decision making process. The OSIRIS team aim to understand the values and beliefs about long-term outcomes amongst high-risk patients contemplating major surgery, how these differ from doctors’ opinions, how these affect decisions about surgical treatments, and whether patients’ opinions change once they experience surgery. They will co-design with patients and doctors, a decision support intervention, to provide an accurate and individualised forecast of the risks and benefits of surgery for each high-risk patient. You can find out more about the research methodology and the aims of the project through the link below.
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Content ArticleThe Care Quality Commission (CQC) inspected 65 services that provides solely cosmetic surgery and/or hair transplant surgery. This represents just under two thirds of those currently registered. Professor Ted Baker, CQC’s Chief Inspector of Hospitals has written to all independent cosmetic surgery providers. His letter highlights these emerging concerns and clarifies the standards of patient care that CQC expect and patients deserve. It also reminds providers of their responsibility to deliver safe and effective services.
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Content ArticleHealthcare Quarterly is a Canadian publication and this issue, supported by the Canadian Patient Safety Institute (CPSI), focuses on patient safety.
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Content ArticleSince the release of the report Hearing and Responding to the Stories of Survivors of Surgical Mesh in December 2019, the New Zealand Ministry of Health, in collaboration with other health sector agencies, has been working to progress the agreed actions and support those who have been affected and minimise future harm. An update on each of the actions is detailed in the report is provided below.
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Content ArticleChaired by Baroness Julia Cumberlege, the Independent Medicines and Medical Devices Safety Review report, First Do No Harm, examines how the healthcare system in England responds to reports about the harmful side effects from medicines and medical devices. In this blog, Patient Safety Learning reflects on one of the key patient safety themes featured in the Review – informed consent.
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Content ArticleResearch by the British Medical Association (BMA) concludes that over a million planned operations and treatments as well as over twenty thousand cancer treatments have been cancelled or delayed between April and the end of June this year because of the pandemic. The Association’s research also estimates that more than two and a half million first time outpatient appointments were cancelled during the same time period. This paper coincides with the BMA’s latest survey of 5,905 doctors in England and Wales, asking about the impact of the pandemic on their patients and their working lives. As part of the survey, they were asked if, within the last week, they had treated patients with conditions at a later stage (e.g. cancer, heart disease) than they would normally expect. A little over 40% said that they had. Behind this data are the scores of patients whose routine surgery or procedure has been put aside in the rush to reconfigure the NHS to cope with COVID-19. Even worse, doctors know there are those whose illnesses are far more serious than they were, some now beyond cure.
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Content ArticleSafety of patients and surgical teams is paramount when undertaking elective surgery in the initial recovery phase from COVID-19. This tool from the Royal College of Surgeons of England lists key considerations to minimise risks of patients and surgical teams contracting COVID-19 in the hospital.
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Content ArticleHospitals are currently planning to resume or expand surgical services that were cancelled during the recent COVID-19 crisis. While emergency surgery will need to continue to be performed within current restrictions, other operations might now be feasible as resources become available. The following checklist from the Royal College of Surgeons of England introduces some of the main criteria that should be taken into account in the initial stages of resuming planned surgery.
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Content ArticleAccording to the National Institutes of Health (January 2019), more than 130 people in the United States die after overdosing on opioids every day. Among these deaths are patients in the hospital setting, recovering from surgical procedures or undergoing sedation, who are often prescribed opioids such as morphine and oxycodone to manage pain – a necessity for healthy and comfortable recovery. But at certain doses, these drugs can also cause respiratory failure, and, because each patient is different, there is no one dose that is 'right' or 'wrong'. Hospitals must take action to ensure their staff are aware of these risks, and put protocols in place to prevent patient deaths. The authors of this US article, published by Medium, offer recommendations for improving patient safety in this area.
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Content ArticleHelen Marie Bousquet tragically passed away after what has been described by her son as 'a basic routine procedure' for knee surgery. He argues that her tragic and avoidable death highlights the need for better assessment of patients for sleep apnea and for better treatment and monitoring of these patients before, during and after surgery. The recent jury finding that a hospital nurse was negligent in the care of Helen Marie Bousquet raises the question whether negligence can result in safer patient care. In his blog, Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety), looks at this case and the lessons that can be learned.
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Content ArticleThis document sets out Barts Health Local Safety Standards for Invasive Procedures (LocSSIPs) based on the National National Safety Standards for Invasive Procedures (NatSSIPs). It includes eight sequential steps that are reinforced with clear organisational standards. These standards are a minimum, based on national best practice, to improve safety. They apply to all staff and all services that perform invasive procedures at Barts Health NHS Trust.
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Content ArticleThe Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008, presents evidence-based recommendations on the preferred methods for cleaning, disinfection and sterilisation of patient-care medical devices and for cleaning and disinfecting the healthcare environment. This is an American guidance from the Centers for Disease Control and Prevention.
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Content ArticleThe American based ECRI Institute Patient Safety Organization (PSO), identified 234 events in its database pertaining to dirty surgical instruments. This report contains several recommendations based on the findings.
