Perioperative Patient Safety Research Articles

Handoff Mnemonics Used in Perioperative Handoff Intervention Studies: A Systematic Review.

Perioperative handoffs are known to present unique challenges to safe and effective patient care. Numerous national accrediting bodies have called for standardized, structured handoff processes. Handoff mnemonics provide a memory aid and standardized structure, as well as promote a shared mental model. We set out to identify perioperative handoff intervention studies that included a handoff mnemonic; critically assess process and patient outcome improvements that support specific mnemonics; and propose future recommendations. We conducted a systematic review of the English language perioperative handoff intervention literature designed to identify handoff mnemonic interventions. A comprehensive protocol was developed and registered (CRD42022363615). Searches were conducted using PubMed, Scopus, ERIC (EBSCO), Education Full Text (EBSCO), EMBASE (Elsevier), and Cochrane (January 1, 2010 to May 31, 2022). Pairs of trained reviewers were involved in all phases of the search and extraction process. Thirty-seven articles with 23 unique mnemonics met the inclusion criteria. Most articles were published after 2015 (29/37; 78%). Situation, Background, Assessment, Recommendation (SBAR), and SBAR variants were used in over half of all studies (22/37; 59%), with 45% (10/22) reporting at least 1 statistically significant process improvement. Seventy percent of handoff mnemonics (26/37) were expanded into lists or checklists. Fifty-seven percent of studies (21/37) reported using an interdisciplinary/interprofessional team to develop the intervention. In 49% of all studies (18/37) at least 1 measurement tool was either previously published or the authors conducting some form of measurement tool validation. Forty-one percent of process measurement tools (11/27) had some form of validation. Although most studies used training/education as an implementation strategy (36/37; 97%), descriptions tended to be brief with few details and no study used interprofessional education. Twenty-seven percent of the identified studies (10/37) measured perception alone and 11% (4/37) measured patient outcomes. While the evidence supporting one handoff mnemonic over others is weak, SBAR/SBAR variants have been studied more often in the perioperative environment demonstrating some process improvements. A key finding is that 70% of included studies converted their handoff mnemonic to a list or checklist. Finally, given the essential nature of effective handoffs to perioperative patient safety, it is crucial that handoff interventions are well developed, implemented, and evaluated. We propose 8 recommendations for future perioperative handoff mnemonic clinical interventions and research.

Incidence of local anesthetic systemic toxicity in patients receiving bupivacaine infiltration analgesia for total joint arthroplasty under general anesthesia: a retrospective single-center study

BackgroundLocal infiltration analgesia (LIA) is a crucial component of multimodal analgesia that enhances recovery after total hip arthroplasty (THA) and knee arthroplasty (TKA). However, LIA can cause fatal local anesthetic systemic toxicity (LAST). The incidences of LIA-induced LAST in different surgeries and anesthetic agents have not been well investigated.MethodsThis observational study enrolled 1,267 adult patients who received LIA with bupivacaine for primary THA or TKA under general anesthesia at a single medical center between January 2020 and October 2021. LAST incidence was graded by severity: severe (refractory seizure or arrhythmia requiring lipid rescue), major (seizure or arrhythmia requiring prompt medication), and minor (all other) events. Patient demographics, surgical and anesthesia details, recovery profiles, and LAST incidences were recorded and analyzed.ResultsThe incidence of severe LAST events was 2.41 per 1000 in unilateral THA, 0 in TKA, and 3.16 per 1000 in the entire cohort. The odds ratio of developing major LAST events was 4.35 in patients undergoing unilateral THA compared with those undergoing unilateral TKA in a matched comparison. Patients who underwent bilateral THA had the highest risk of developing LIA-induced LAST. Additionally, patients using propofol infusion for anesthesia maintenance had a lower risk of seizures and tremors than those using sevoflurane inhalation. The odds ratio of major LAST events was 0.47 in matched comparisons.ConclusionsLIA was associated with a significantly higher risk of LAST in the THA group than in the TKA group. Propofol maintenance reduces the likelihood of seizures and tremors compared with sevoflurane inhalation. Exploring strategies to reduce the incidence of LIA-induced LAST is essential to improve perioperative patient safety.

The role of human factors engineering in patient safety.

To explore the collaboration between human factors (HFs) experts and clinicians in order to improve perioperative patient safety. Recent recommendations to integrate human factors into anesthesia in the United Kingdom emphasizes the value of applying disciplines outside of medicine to optimize the patient experience. Human factors engineering is underutilized worldwide. Patient safety would benefit from collaboration with HF experts to design resilient systems. Healthcare organizations must consider HF to develop and implement user-centered solutions to improve safety for patients and professionals.

Perspectives on Anesthesia and Perioperative Patient Safety: Past, Present, and Future.

During the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer.

Perioperative Patient Safety Management: The Perspective of Operating Room Nurses

Perioperative patient safety management is a critical aspect of healthcare, requiring a comprehensive understanding of the roles and responsibilities of operating room nurses in ensuring patient safety. This paper emphasizes the significance of nurses' perspectives in enhancing safety protocols during the perioperative phase. It explores the multifaceted responsibilities of operating room nurses, highlighting their pivotal role in patient safety, from preoperative assessment to postoperative care. The challenges faced by nurses in maintaining safety standards are discussed, along with innovative solutions to mitigate these issues. Drawing on insights from contemporary practices, the paper advocates for a proactive approach to safety management, emphasizing continuous education, effective communication, and the implementation of evidence-based guidelines. The conclusions offer a roadmap for future directions in perioperative safety, underscoring the need for collaborative efforts among healthcare professionals to achieve optimal patient outcomes. By integrating the experiences and insights of operating room nurses, this work contributes to a more nuanced understanding of perioperative safety management, aiming to foster a culture of safety in surgical environments.

Impact of progressive chronic kidney disease stage on postoperative outcomes in metabolic surgery—a propensity-matched analysis using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement database

BackgroundMetabolic surgery (MS) is effective in improving renal parameters for individuals with obesity and chronic kidney disease (CKD). Despite recognized benefits, concerns linger about the perioperative safety of patients with CKD undergoing MS. This study aimed to identify the CKD stage associated with the most significant increase in postoperative complications. MethodsThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database (2017–2021) was used to identify patients undergoing laparoscopic gastric sleeve (SG) or Roux-en-Y gastric bypass (RYGB). Propensity matching was used to quantify the risk for adverse outcomes associated with progressive CKD stage. ResultsIn total, 688,583 patients (483,898 without CKD and 204,685 with CKD stages I-V) were examined. Endpoints included length of stay (LOS) >5 days, infection, serious complications, major adverse cardiovascular events (MACE), and death. Both SG and RYGB exhibited a linear increase in risk of infection and death. For SG, patients who were stage IIIa/IIIb demonstrated the greatest risk for LOS >5 days (odds ratio [OR] 1.23; 95% confidence interval [CI] (1.05–1.45); P = .011), serious complications (OR 2.83; 95% CI 1.87–4.30; P < .001), and MACE (OR 2.82; 95% CI 1.81–4.37; P < .001). For RYGB, patients who were stage IIIa/IIIb the exhibited greatest risk of MACE (OR 1.67; 95% CI 1.06–2.62; P = .027). ConclusionsAlthough it is generally accepted that worsening CKD correlates with greater surgical risk, this analysis identified CKD stage III as a major inflection point for risk of LOS >5 days, serious complications, and MACE. These findings are useful for counseling and procedure selection and suggest a need for heightened attention to CKD stage III patients undergoing MS.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Reduction of oxidative stress response and protection of liver and renal cell functions by reduced glutathione in lower limb arterial ischemia–reperfusion in New Zealand white rabbits with high triglyceride levels

ObjectiveAcute liver and kidney injury is the most common complication after aortic surgery, which seriously affects the survival and safety of perioperative patients. The presence of chronic preoperative liver and renal insufficiency, presence of preoperative blood inflammation indicators, duration of intraoperative extracorporeal circulation, and volume of red blood cell transfusion are the main influencing factors for acute postoperative liver and kidney injuries. In recent years, with the research progress on oxidative stress, a growing body of evidence has demonstrated that oxidative stress may cause tissue damage after ischemia–reperfusion (IR). However, the impact of the oxidative stress of distal tissues caused by IR on liver and renal cells after arterial surgeries has not yet been elucidated. MethodsNew Zealand white rabbits were used for the experiments and were divided into three groups. Among them, two groups were fed high-fat feed to establish a white rabbit model of hypertriglyceridemia, whereas the control group was provided with ordinary feed. In the experiment, white rabbits were subjected to occlusion of the infrarenal aorta abdominalis to simulate IR of the lower limbs. The effects of high triglyceride levels after the arterial IR of the lower limbs were investigated using the contents of reactive oxygen species (ROS) and malondialdehyde (MDA), a fat metabolite, in ischemic muscle tissues and blood tissues. One of the groups receiving high-fat feed received intervention with reduced glutathione (GSH) before IR of the lower limbs. Pathological studies were performed to identify the expression levels of inflammatory factors and inflammatory cells in liver and renal cells as well as cell apoptosis. The effects of GSH administration before IR on reducing the oxidative stress in adipose tissues and alleviating liver and kidney damage after stress response were investigated. ResultsAfter IR, the increases in ROS and MDA in ischemic muscle tissues and blood tissues were higher in white rabbits with high triglyceride levels than in those that only received ordinary feed or received intervention with GSH. In addition, for white rabbits with high triglyceride levels, the TNF-α expression levels in the liver increased after IR. Moreover, a considerable increase in the expression of TNF-α, IL-6, macrophages, and T lymphocytes were observed in renal cells. A large number of inflammatory cells and the formation of immune complexes were also noted in the glomeruli; in addition, cell apoptosis was promoted. ConclusionThis study showed that high triglyceride levels enhanced the oxidative stress response and increased ROS production in New Zealand white rabbits after arterial IR of the lower limbs. High ROS levels activated the expression of inflammatory factors and inflammatory cells in the liver and kidney, which affected cell functions and promoted apoptosis. At high triglyceride levels, GSH downregulated ROS production in oxidative stress after IR, thereby protecting liver and kidney functions.

Perioperative patient safety indicators-A Delphi study.

To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. A modified Delphi method. A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. No patient or public contribution.

The Impact of the Comprehensive Unit-Based Safety Program on the Perioperative Efficiency and Patient Safety of Adult Hip and Knee Arthroplasty Procedures: Retrospective Comparative Study

BackgroundThe complexity of health care delivery systems presents a unique challenge for the perioperative space. In the area of arthroplasty procedures, the shift of complex patients into ambulatory surgery centers and reimbursement that is no longer commensurate with the inflated costs of performing these procedures have created difficulties for hospitals and physicians alike. Thus, there is a critical need to optimize perioperative workflows while maintaining high-quality care provision. MethodsOur institution implemented the Comprehensive Unit-based Safety Program (CUSP) to improve the quality and efficiency of total knee and hip arthroplasties (TKAs and THAs). This initiative involved extensive collaboration with clinical and administrative teams, as well as 5 intervention-driven workgroups. First-case on-time start rates and duration of first-case delays, case length, anesthesia preparation, in-room patient preparation, operation, patient exit, and room turnover after CUSP implementation were analyzed using independent samples median testing, Mann-Whitney U testing, and a percentage-point difference calculation. ResultsAfter CUSP arthroplasty implementation, first-case on-time start rates increased from 43 to 81%. Statistically significant decreases were observed in median times for first-case delays, case length, in-room patient preparation, operation, patient exit, and room turnover for TKAs and THAs, but not anesthesia preparation. ConclusionsThe implementation of CUSP arthroplasty for TKAs and THAs resulted in significant improvements in nearly all efficiency metrics, as well as preventions of patient safety missteps. These results exemplify the versatility of CUSP as a quality improvement method that can maintain patient safety and perioperative efficiency in the arthroplasty service of a large-scale medical center. Level of EvidenceIII.

MULTIMODAL ANESTHESIA AS AN IMPORTANT COMPONENT OF ERAS

Introduction. The ideology of Fast Track-Surgery (FTS) and Enhanced Recovery After Surgery (ERAS) represents modern trends in global surgical practice. Anesthesiology aims to provide ideal and universal solutions for protecting patients from surgical aggression. A multimodal approach, which includes multilevel, multifaceted antinociception, is well-founded, where maximum effectiveness is combined with minimal side effects.&#x0D; The aim. To analyze the issue of multimodal pain management as an important component of ERAS (Enhanced Recovery After Surgery) from modern sources of literature for optimizing perioperative care in the minimally invasive surgery department.&#x0D; Materials and methods. Bibliosemantic, comparative, and systemic analysis methods were employed. The proposed recommendations were developed based on an analysis of modern literature, the results of randomized trials and meta-analyses, as well as our own studies dedicated to the study of perioperative pain issues.&#x0D; The results. It has been proven that the use of opioids in anesthesia practice is decreasing. New and modern methods of continuous monitoring of vital organs in patients are being introduced as supplements to classical monitoring protocols. These methods are used to avoid excessive or inadequate dosing of anesthetics, adjust the concentration of substances used, reduce post-anesthesia complications, and improve patient comfort. The method of perioperative energy monitoring significantly complements the "International Standards for Safe Anesthetic Practice", WFSA (2010), and enhances perioperative patient safety by detecting metabolic disturbances and implementing appropriate pathogenetic correction. The importance of regional anesthesia under ultrasound control, nociception-antinociception balance management, and the impact of these methods on opioid consumption, patient satisfaction, and postoperative recovery have been proven.&#x0D; Conclusions. The most commonly used combination of drugs for multimodal analgesia often includes acetaminophen and NSAIDs (strong recommendation). It has been proven that deep and prolonged sedation in intensive care unit (ICU) patients is associated with worse outcomes, longer mechanical ventilation duration, extended ICU and hospital stays, and higher rates of complications, including infections and sometimes even death.

Understanding complex processes better-A case study on increasing patient safety and efficiency in a central operating room

Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in acost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of ahospital. Preoperative preparation is acomplex process with many substeps that are often difficult to manage. Historically, the focus has been on retrospective learning from errors and incidents. More recent approaches take asystemic view. Acentral idea is to consider the mostly positive course of treatment and the adjustments to daily work that are currently required by the people involved (Safety-II). By taking greater account of how the many components of the system interact, processes can be better understood and specific measures derived. This strengthens the system's ability to adapt to changes and disturbances, thus ensuring that goals are achieved. The functional resonance analysis method (FRAM) is an internationally recognized method for modelling work as done compared to work as imagined. This paper presents the application of FRAM to preoperative preparation in a major regional hospital. Is FRAM suitable for improving process understanding in preoperative preparation? An interdisciplinary project team identified relevant functions of preoperative preparation through document analysis and walkthroughs. Based on this, more than 30guided interviews were conducted with functionaries. The results were presented graphically and specific information, such as safety-related statements or reasons for the variability of functions, were also presented textually. In the next phase, statements were evaluated and compared with the target model and the job descriptions. The FRAM revealed the process as acomplex network of relationships. During the modelling process, avarying degree of centrality and variability of certain functions became apparent. From the observations, the project team selected those with high relevance for patient safety and for the efficiency of the overall process in order to prioritize starting points for deriving measures to increase resilience. These starting points relate either to single functions, such as surgical site marking or to multiple functions that are variable in their execution, such as delays due to nonsynchronized duty times. The FRAM conducted provides valuable new insights into the functioning of complex sociotechnical systems that go far beyond classical linear methods. The awareness of operational processes gained and the resulting dynamic view of interactions within the system enable specific measures to be derived that promote resilient behavior and reduce critical variability, thus contributing to increased patient safety and efficiency.

High-flow nasal oxygenation versus face mask oxygenation for preoxygenation in patients undergoing double-lumen endobronchial intubation: protocol of a randomised controlled trial

IntroductionWith the growing emphasis on swift recovery, minimally invasive thoracic surgery has advanced significantly. Video-assisted thoracoscopic surgery (VATS) has seen rapid development, and the double-lumen tube (DLT) remains the most...

Residual Neuromuscular Block Remains a Safety Concern for Perioperative Healthcare Professionals: A Comprehensive Review

Residual neuromuscular block (RNMB) remains a significant safety concern for patients throughout the perioperative period and is still widely under-recognized by perioperative healthcare professionals. Current literature suggests an association between RNMB and an increased risk of postoperative pulmonary complications, a prolonged length of stay in the post anesthesia care unit (PACU), and decreased patient satisfaction. The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade provide guidance for the use of quantitative neuromuscular monitoring coupled with neuromuscular reversal to recognize and reduce the incidence of RNMB. Using sugammadex for the reversal of neuromuscular block as well as quantitative neuromuscular monitoring to quantify the degree of neuromuscular block may significantly reduce the risk of RNMB among patients undergoing general anesthesia. Studies are forthcoming to investigate how using neuromuscular blocking agent reversal with quantitative monitoring of the neuromuscular block may further improve perioperative patient safety.

Comparison of outcomes between warshaw and Kimura techniques for spleen-preserving minimally invasive distal pancreatectomy: with a specific focus on perioperative patient safety

Comparison of outcomes between warshaw and Kimura techniques for spleen-preserving minimally invasive distal pancreatectomy: with a specific focus on perioperative patient safety

Severe and acute hypercapnia, subsequent to the mistaken connection of a carbon dioxide cylinder on the nitrous oxide manifold: a report of three simultaneous cases

Ensuring the delivery of correct gas mixtures during anesthesia is of paramount importance for perioperative patient safety. Accidents resulting from a problem with the supply of medical gases to the operating theater are rare; however, the consequences can be serious. Given the continuous advances in safety measures for the administration of medical gases, it is reasonable to assume that current patients consistently receive the intended gas, as requested by the anesthesiologist. Nevertheless, it is necessary to acknowledge that human error may still occur, despite the automation and safety protocols in place. Simultaneously in three operating rooms, we observed abrupt and sever cases of hypercapnia that occurred during general anesthesia when nitrous oxide was requested. These incidents were due to a carbon dioxide cylinder connected in the place of a nitrous oxide cylinder on the manifold. Patient management, operating theater supervision and factors responsible for this serious adverse event will be discussed in this report. This problem appears to be fairly specific to Belgium where the standard cylinder fittings for the two gasses involved are either the same or close enough to be misconnected on the manifold. Local measures, as well as general recommendations, are proposed to prevent a similar incident in the future.

Peri-operative night-time work of anaesthesiologists: A qualitative study of critical issues and proposals.

Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking. This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks. Qualitative analysis of responses to two open-ended questions. Online platform questionnaire promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC). The survey sample consisted of an international cohort of anaesthesiologists. We identified and classified recurrent themes in the responses to questions addressing perceptions regarding (Q1) peri-operative night-time working conditions, which may affect patient safety and (Q2) potential solutions. We analysed 2112 and 2113 responses to Q1 and Q2, respectively. The most frequently reported themes in relation to Q1 were a perceived reduction in professional performance accompanied by concerns regarding the possible consequences of work with fatigue (27%), and poor working conditions at night-time (35%). The most frequently proposed solutions in response to Q2 were a reduction of working hours and avoidance of 24-h shifts (21%), an increase in human resources (14%) and performance of only urgent or emergency surgeries at night (14%). Overall, the surveyed anaesthesiologists believe that workload-to-staff imbalance and excessive working hours were potential bases for increased peri-operative risk for their patients, partly because of fatigue-related medical errors during night-time work. The performance of nonemergency elective surgical cases at night and lack of facilities were among the reported issues and potential targets for improvement measures. Further studies should investigate whether countermeasures can improve patient safety as well as the quality of life of anaesthesia professionals. Regulations to improve homogeneity, safety, and quality of anaesthesia practice at night seem to be urgently needed.

Technology used to enhance medication awareness/visibility in electronic health record: Multi-disciplinary collaboration and impact on perioperative procedural patient safety.

470 Background: Many patients undergoing procedures at MD Anderson are diagnosed with conditions necessitating anti-coagulant medications taken in the perioperative timeframe. Holding these medications prior to surgery is essential to avoid perioperative complications and procedural delays/cancellations. Failure to hold anti-coagulants could delay necessary cancer treatment. Hypothesis presented: implement a technology solution to enhance the awareness and visibility of these medications within the electronic health record (EHR) to assist in alerting multi-disciplinary care team members. With increased awareness across the perioperative clinical care team, cancellations/delays are expected to improve. Methods: In the fourth quarter of 2020 (* mark in data below), perioperative anesthesia and information technology (IT) teams collaborated to create a visual banner “watch meds” in the EHR. Banner is easily visible above the summary of each patient’s medication list. An institution wide education and awareness campaign highlighting “watch-meds” banner was done by anesthesia/surgical/perioperative teams. Patients meeting the following criteria were identified in the EHR: diagnosis necessitating anticoagulation, anticoagulant use, and scheduled OR procedure. Delays and cancellations on the procedure day for patients meeting criteria from 1/1/2020-12/31/2022 were analyzed, comparing pre and post implementation effects. Results: Case delays and cancellations impact time and labor resources, lead to equipment and material waste, and delay cancer care. Timely surgical completion carries tremendous impact on patient safety, satisfaction, and resource preservation. The number of patients who met criteria for the banner warning was 8% of the total number of cases throughout the three-years recorded. Of those who met criteria, 62% resulted in case delays. Implementation of the banner warning resulted in an immediate 2-fold improvement in cancellations, and ultimately demonstrated a 3-fold stable improvement. Conclusions: Leveraging technology to enhance visual cues in the EHR can be a powerful tool to relay important patient information including medications affecting perioperative care to all care team members, thus enhancing patient safety.[Table: see text]

Development of a Core Outcome Set for Patient Safety in Perioperative Care: Insights from the SAFEST Project

Abstract Although surgical-related adverse effects are among the most common in-hospital adverse events, no set of indicators has yet been defined for a comprehensive and patient-centred analysis of this phenomenon. Thus, it is crucial to standardise a minimum set of indicators, a Core Outcome Set (COS), to allow for monitoring and evaluation of implemented patient safety best practices in perioperative care. The SAFEST project aimed to develop a relevant and feasible COS for patient safety in perioperative care, including patient-relevant data. Following a multimethod approach, an initial list of indicators (ILO) was developed by conducting an umbrella review on patient safety in perioperative care in surgical adult patients. The ILO was prioritised by a diverse group of experts, including patients, through a two-round eDelphi Technique, according to the importance and feasibility of each indicator. Exploring the challenges of measuring specific indicators, the same experts will define the final list of indicators in a consensus conference. From 588 indicators extracted in the umbrella review, 247 indicators were included in the ILO to be independently rated, on a 9-point Likert scale, by participating experts. The indicators were grouped by the perioperative period (preoperative, intraoperative, postoperative and mixed) and further subgrouped by Donabedian's quality of care conceptual model Structure - Process - Outcome. During the eDelphi process, some indicators were reworded, split, merged, added or removed, according to experts’ comments. The final set of indicators results is not yet available as this study is still undergoing. This COS contributes to enhancing standardised reporting in perioperative patient safety, allowing for benchmarking across EU countries and facilitating data comparison across studies.

Reaching Consensus on a core outcome set for patient safety in perioperative care: SAFEST Project

Abstract Background In the European Union, 8 to 12% of patients admitted to hospitals experience adverse events, imposing a considerable burden on the health systems. The lack of standardised indicators to comprehensively analyse perioperative patient safety limits the evaluation of interventions to tackle this public health problem. This study aims to prioritise the most relevant and feasible core indicators to assess patient safety in perioperative care to develop a Core Outcome Set. Methods A two-round eDelphi was conducted. Sixty-seven experts were invited to participate and asked to independently rate indicators in importance and feasibility on a 9-point Likert scale. The indicators were grouped by the perioperative period and subgrouped by Donabedian's quality of care conceptual model Structure - Process - Outcome. Consensus to include was defined as ≥75% of experts scoring an indicator as 7 to 9, and 15% or less scoring 1 to 3. Results Forty-eight experts completed the Round 1 eDelphi survey, and 8 started the survey but did not complete it. Round 1 survey was answered by a diverse range of targeted categories of experts, including healthcare professionals (76.8%) and patients (10.7%). From the 247 indicators included in Round 1, 15.8% reached a consensus to include regarding both importance and feasibility. Across the perioperative period and Donabedian's quality of care conceptual model subgroups, a higher consensus to include was achieved regarding importance than feasibility. The results of Round 2 have yet to be available, as the study is ongoing. Conclusions A consensus of a broad and heterogeneous panel of experts on core indicators for reporting perioperative patient safety was developed. While the experts highly punctuated the indicators' importance, the indicators' feasibility aspect needs to be further explored to implement effective and efficient monitoring and evaluation of surgical-related patient safety systems in clinical practice. Key messages • Prioritising indicators important for patients and the clinical practice is crucial to monitor and evaluate patient safety. • This consensus facilitates benchmarking across EU countries.