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Found 477 results
  1. Content Article
    In this article, Dr Ivan Ramos-Galvez, Consultant in Pain Medicine at the Royal Berkshire Hospital, discusses the physical and psychological issues that can arise following surgery for pelvic mesh implants. Dr Ramoz-Galvez highlights that around a third of reported complications are systemic symptoms such as runny nose, muscle pain, brain fog and lethargy, which may be the result of a chronic inflammatory state within the body. Their link to pelvic mesh implants is suggested by the fact that many women report that these symptoms resolve after their implant is removed. He also discusses the wide-ranging impact of pelvic mesh side effects for women who experience them, highlighting that the consequences are not only physical, but also psychological, social and financial. He calls for the medical profession to recognise this and develop treatments that cover all aspects of pelvic mesh complications.
  2. Content Article
    The national surgical site infection (SSI) surveillance service in England collates and publishes SSI rates that are used for benchmarking and to identify the prevalence of SSIs. However, research studies using high-quality SSI surveillance report rates that are much higher than those published by the national surveillance service. This variance questions the validity of data collected through the national service. The aim of this study from Tanner et al. was to audit SSI definitions and data collection methods used by hospital trusts in England.
  3. Content Article
    As a growing number of hospitals pressed for resources due to the COVID-19 surge suspend elective surgeries, some healthcare professionals want the public to know exactly how important an "elective" procedure can be.  The term "elective surgery" does not describe the acuity of the medical condition or necessity of the procedure. Rather, the use of "elective" distinguishes these surgeries that are scheduled in advance from emergency surgeries, such as trauma cases.  As Americans learn of elective surgeries once again being postponed, physicians are taking to the web to debunk what can be a misnomer.
  4. Content Article
    The purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the care of patients who have NHS-funded surgery in an independent hospital. This was initiated in the context of the COVID-19 pandemic, where because of increased pressure on the NHS, independent hospitals have been providing more care for NHS patients, including urgent elective surgical care and delivery of cancer pathways. The HSIB investigation reviewed the experience of a patient with a diagnosis of bowel cancer, who was booked to undergo laparoscopic (keyhole) surgery to remove part of his bowel in in an independent hospital. Following surgery, the patient made slow progress and on day eight following surgery he started to deteriorate rapidly. He was transferred to the local NHS hospital for investigation and further surgery. He died later the same day as a result of sepsis following a complication of his recent surgery.
  5. Content Article
    Frailty is a condition characterised by loss of biological reserve, failure of physiological mechanisms and vulnerability to a range of adverse outcomes including increased risk of morbidity, mortality and loss of independence in the perioperative period. With the increasing recognition of the prevalence of frailty in the surgical population and the impact on postoperative outcomes, The Centre for Perioperative Care (CPOC) and the British Geriatrics Society (BGS) have worked together to develop a whole pathway guideline on perioperative care for people living with frailty undergoing elective and emergency surgery. The scope of this guideline covers all aspects of perioperative care relevant to adults living with frailty undergoing elective and emergency surgery. It is written for healthcare professionals involved in delivering care throughout the pathway, as well as for patients and their carers, managers and commissioners.
  6. Content Article
    The CPOC Newsletter is for all doctors, nurses and allied health professionals working in or with an interest in the developments of perioperative care. The monthly publication highlights the most up to date information on the workstreams, partner projects, perioperative events, recently published journals, live surveys and successful perioperative initiatives.
  7. Content Article
    Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. This study from MacFadyen et al. reviewd laparoscopic cholecystectomy in the United States from 1989 to 1995. A total of 114,005 cases were analysed and 561 major bile duct injuries (0.50%) and 401 bile leaks from the cystic duct or liver bed (0.38%) were recorded. Based on this review of laparoscopic cholecystectomies, the authors found that the morbidity and mortality rates are similar to open surgery. In addition, the rate of bile duct injuries and leaks is higher than in open cholecystectomy. Furthermore, bile duct injuries can be minimised by lateral retraction of the gallbladder neck and careful dissection of Calot's triangle, the cystic duct-gallbladder junction, and the cystic duct-common bile duct junction.
  8. Content Article
    As Psychology / Human Factors advisor to the UK surgical patient safety learning group (CORESS), and having published on clinical excellence and patient experience issues, Narinder Kapur recently had the unique experience of being a surgical patient. The author discusses the gained insights and learned lessons that could help improve the patient hospital experience and also patient safety.
  9. Content Article
    Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings.
  10. Content Article
    Getting It Right First Time (GIRFT) is designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings.
  11. Content Article
    A group of clinicians and patient group representatives, called the ImPrOve Think Tank, recently convened to address common complication during high-risk surgery they consider to be most urgent and dangerous; haemodynamic instability characterised as significant drops in blood pressure. In this article for The Parliament Magazine, Professor Olivier Huet, Sean Kelly MEP and Ms Luciana Valente discuss why death rates are so high in the 30 days post-surgery, what clinicians can do to improve patient safety and what patients can do to ensure optimal patient safety and care in the perioperative process.
  12. Content Article
    A European Think Tank working to address and propose solutions for an important public health issue – serious complication rates in the 30 days after high-risk surgery remain high. The ImPrOve Initiative aim to improve awareness, monitoring, and management of haemodynamic instability, particularly intraoperative hypotension which refers to the lowering of blood pressure during surgery.
  13. Content Article
    Surgery can be a highly demanding environment, and in pressurised situations we need to prioritise patient safety. Under these circumstances there is a need for clear leadership, but being assertive can sometimes be challenging without coming across as aggressive or intimidating. Training is also an area in which potential issues could arise. Not every trainee will develop at the required rate, and it is important to be able to address concerns with an individual without fearing being labelled as a bully. The following recommendations from the Royal College of Surgeons of Edinburgh may help with workplace relationships.
  14. Content Article
    Previous research suggests that surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study from Molina et al. was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room. They concluded that a large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.
  15. Content Article
    This Healthcare Safety Investigation Branch (HSIB) report highlights a gap between the NHS and other safety-critical industries in identifying and managing barriers to reduce the risk of serious incidents occurring.
  16. Content Article
    A trocar is a hollow device used during minimally invasive surgery that serves as an entry port for optical scopes and surgical equipment. Insertion of this device into the body is determined using anatomical landmarks taking into consideration the patient’s history and physical attributes, e.g., scars or abdominal size. Insertion of the first trocar is the time of highest risk of injury. Intestinal and vascular injuries are two potentially life-threatening injuries that can occur. This is a retrospective review of trocar-related events submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) between 1 January 2014 and 30 June 2020, which identified 268 events.
  17. Content Article
    Amiri et al. analysed the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD). They found that a higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.
  18. Content Article
    During the COVID-19 pandemic, health systems and providers scaled back non-emergency care, including cancelling non-urgent surgeries during the COVID-19. While this cautious approach was necessary early in the pandemic, it limited health systems' and providers' ability to fulfil their mission and deliver needed care to patients. In this article, published by Medpage Today, Beverly Philip, looks at how looks at how we can find a safe way forward.
  19. Content Article
    Many adverse events arise from human factors, such as inefficient teamwork and communication failures, and the incidence of adverse events is greatest in the surgical area. Previous research has shown the effect of team training on patient safety culture and on different areas of teamwork. Limited research has investigated teamwork in surgical wards. The aim of this study, published in BMC Health Services Research, was to evaluate the professional and organizational outcomes of a team training intervention among healthcare professionals in a surgical ward after 6 and 12 months.
  20. Content Article
    Few studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes. In this paper, Alfred et al. we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions.
  21. Content Article
    Patients are more likely to experience preventable harm during perioperative care than in any other type of healthcare encounter. For several decades, a hallmark of surgical quality and safety has been the use of checklists to prevent errors (eg, wrong site surgery) and assure that key tasks have been or will be performed. There are widely disseminated arguments recommending the use of checklists in healthcare but also recognised limitations. In this editorial, Matthew B. Weinger discusses the use of the checklist and its limitations.
  22. Content Article
    In 2009, the World Health Organization (WHO) published the WHO Surgical Safety Checklist, and 3 years later, the Swiss Patient Safety Foundation adapted it for Switzerland. Several meta-analyses and systematic reviews showed ambiguous results on the effectiveness of surgical checklists. Most of them assume that the study checklists are almost identical, but in fact they are quite heterogeneous due to adaptations to local settings. In this study, Fridrich et al. aims to investigate the extent to which the checklists currently used in Switzerland differ and to discuss the consequences of local adaptations.
  23. Content Article
    This study from the COVIDSurg Collaborative and the GlobalSurg Collaborative found that preoperative covid vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritsation by modelling. The authors concluded that as the global roll out of the covid vaccination proceeds, patients needing elective surgery should be prioritised ahead of the general population.
  24. Content Article
    The U.S. Military Health System cares for over 9 million patients and encompasses 63 hospitals and 413 clinics worldwide. Military medicine balances the simultaneous tasks of caring for those patients wounded in military engagements, treating large numbers of families of service men and women, and training the next generation of health care providers and ancillary staff. Similar to civilian health care delivery in the United States, military medicine has also seen increased scrutiny in the areas of cost and quality.  To determine the scope of complication rates, data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) were analysed. The goal of this article from Maturo et al. was to describe the NSQIP surgical outcome data for the U.S. Military's largest medical center from 2009 to 2014 and compare national averages in the areas of mortality, morbidity, cardiac occurrences, pneumonia, unplanned intubation, ventilator use greater than 48 hours, infections, readmissions, and return to operating room. 
  25. Content Article
    Traditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these two methods might not overlap. This is a retrospective observational study from Anderson et al. of all hospitalisations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event identified by surgery faculty and residents for review by departmental M&M conference or administrative data. The authors analysed the degree to which these two processes captured PSI-defined events and reasons for exclusion by each process. The study found that surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.
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