Perioperative Patient Safety Research Articles

Advances in studies on imaging and artificial intelligence technology-assisted difficult airway assessment

: Endotracheal intubation is an indispensable part to ensure oxygen supply for patients who undergo general anesthesia in surgeries. However, despite great progress and improvement in intubation technology and equipment, the incidence of perioperative complications and disabilities caused by difficult airway has not been well improved, especially for unpredictable difficult airway. At present, the accuracy of the difficult airway assessment methods are not high and the process is complex, so it is our focus to optimize the difficult airway prediction process and improve the prediction accuracy. At present, imaging and artificial intelligence (AI) face recognition technology as an aid to the assessment of difficult airways is significantly better than the traditional assessment methods. However, imaging techniques such as X-ray, CT, MRI, and ultrasound have their own clinical application value, while at the same time have many limitations, such as radiation, medical costs, equipment requirements, and medical staff burden, which prevent them from being widely used in clinical practice. On the other hand, AI technology in difficult airway identification is still in the sprouting stage, with the technology being immature and lacks sufficient research evidence to support it. For this reason, we have reviewed the literature on imaging technology and AI technology-assisted assessment of difficult airway in recent years, and we hope to provide new ideas for further research and to shed light on the emergence of a convenient and accurate method for difficult airway early warning, thus optimizing the clinical workflow, reducing the risk of misclassification, and ensuring the perioperative life safety of patients.

Composition and risk assessment of perioperative patient safety incidents reported by anesthesiologists from 2009 to 2019: a single\u2010center retrospective cohort study

BackgroundPatient safety incident (PSI) reporting has been an important means of improving patient safety and enhancing organizational quality control. Reports of anesthesia-related incidents are of great value for analysis to improve perioperative patient safety. However, the utilization of incident data is far from sufficient, especially in developing countries such as China.MethodsAll PSIs reported by anesthesiologists in a Chinese academic hospital between September 2009 and August 2019 were collected from the incident reporting system. We reviewed the freeform text reports, supplemented with information from the patient medical record system. Composition analysis and risk assessment were performed.ResultsIn total, 847 PSIs were voluntarily reported by anesthesiologists during the study period among 452,974 anesthetic procedures, with a reported incidence of 0.17%. Patients with a worse ASA physical status were more likely to be involved in a PSI. The most common type of incident was related to the airway (N = 208, 27%), followed by the heart, brain and vascular system (N = 99, 13%) and pharmacological incidents (N = 79, 10%). Those preventable incidents with extreme or high risk were identified through risk assessment to serve as a reference for the implementation of more standard operating procedures by the department.ConclusionsThis study describes the characteristics of 847 PSIs voluntarily reported by anesthesiologists within eleven years in a Chinese academic hospital. Airway incidents constitute the majority of incidents reported by anesthesiologists. Underreporting is common in China, and the importance of summarizing and utilizing anesthesia incident data should be scrutinized.

Sex and gender differences in anesthesia: Relevant also for perioperative safety?

Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. Sex-related differences in physiology, as well as in pharmacokinetics and pharmacodynamics of anesthetic drugs may influence the anesthesia plan, the management of pain, postoperative recovery, adverse effects, patient satisfaction, and outcomes. Further studies are needed to characterize outcome differences between men and women in non-cardiac, cardiac, and transplantation surgery in order to individualize perioperative management and improve patient safety. Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.

Open-label, single-centre, cluster-randomised controlled trial to Evaluate the Potential Impact of Computerisedantimicrobial stewardship (EPIC) on the antimicrobial use after cardiovascular surgeries: EPIC trial study original protocol

IntroductionInappropriate antimicrobial use increases the prevalence of antimicrobial-resistant bacteria. Surgeons are reluctant to implement recommendations of guidelines in clinical practice. Antimicrobial stewardship (AMS) is effective in antimicrobial management, but it...

Adult Cranioplasty and Perioperative Patient Safety: Does Plastic Surgery Facility Volume Matter?

Cranioplasty lies at the intersection of neurosurgery and plastic surgery, though little is known about the impact of plastic surgery involvement. The authors hypothesized that adult cranioplasty patients at higher volume plastic surgery facilities would have improved inpatient outcomes. Adult cranioplasty encounters were extracted from the National Inpatient Sample from 2012 to 2014 based on International Classification of Diseases, Ninth Revision (ICD-9) codes. Regression models included the following variables: age, gender, race/ethnicity, Elixhauser Comorbidity Index, payer, hospital size, region, and urban/teaching status. Outcomes included odds of receiving a flap, perioperative patient safety indicators, and mortality. The weighted sample included 49,305 encounters with diagnoses of neoplasm (31.2%), trauma (56.4%), infection (5.2%), a combination of these diagnoses (3.9%), or other diagnoses (3.2%). There were 1375 inpatient mortalities, of which 10 (0.7%) underwent a flap procedure. On multivariable regression, higher volume plastic surgery facilities and all diagnoses except uncertain neoplasm were associated with an increased likelihood of a flap procedure during the admission for cranioplasty, using benign neoplasm as a reference (P < 0.001). Plastic surgery facility volume was not significantly associated with likelihood of a patient safety indicator event. The highest volume plastic surgery quartile was associated with lower likelihood of inpatient mortality (P = 0.008). These findings support plastic surgery involvement in adult cranioplasty and suggest that these patients are best served at high volume plastic surgery facilities.

Measuring and monitoring perioperative patient safety: a basic approach for clinicians.

Purpose of reviewRecent research points to considerable rates of preventable perioperative patient harm and anaesthesiologists’ concerns about eroding patient safety. Anaesthesia has always been at the forefront of patient safety improvement initiatives. However, factual local safety improvement requires local measurement, which may be afflicted by barriers to data collection and improvement activities. Because many of these barriers are related to mandatory reporting, the focus of this review is on measurement methods that can be used by practicing anaesthesiologists as self-improvement tools, even independently from mandatory reporting, and using basic techniques widely available in most institutions.Recent findingsFour mutually complementary measurement approaches may be suited for local patient safety learning: incident and rate-based measurements, staff surveys and patient surveys. Reportedly, individual methods have helped to tailor problem solutions and to reduce patient harm, morbidity, and mortality.SummaryConsidering the potential for perioperative patient safety measurements to improve patient outcomes, the absence of a generally accepted measurement standard and manifold barriers to reporting, a pragmatic approach to locally measuring patient safety appears advisable.

The Anesthesia Patient Safety Foundation Stoelting Conference 2019: Perioperative Deterioration-Early Recognition, Rapid Intervention, and the End of Failure-to-Rescue.

The Anesthesia Patient Safety Foundation Stoelting Conference 2019: Perioperative Deterioration-Early Recognition, Rapid Intervention, and the End of Failure-to-Rescue.

&lt;p&gt;Peri-Operative Patient Safety – An Interactive Workshop for Section 3 CPD Credits Developed in Collaboration with the CMPA&lt;/p&gt;

BackgroundThe Royal College of Physicians and Surgeons of Canada requires physicians to collect credit in continuing professional development courses including Section 3 credits which require feedback and self-assessment. This study aims to examine the effectiveness of offering Section 3 credits in a conference setting using an interactive workshop on peri-operative patient safety developed in collaboration with the Canadian Medical Protective Association (CMPA). Both the knowledge gained and the attitudes towards the conference were analysed.MethodsThis was a pre/post-test study design. An interactive case studies workshop was implemented on medicolegal issues for patient care, before, during, and after surgery at the Canadian Society of Otolaryngology Head and Neck Surgery annual meeting. The workshop used small group and large interactive group educational strategies to gauge knowledge of both pre and post cases. Participants completed a questionnaire at the end of the workshop comparing their attitudes before and after the workshop.ResultsThere were 22 participants in the workshop. A little over half knew the requirements for Section 3 CPD credits (58%) but only 36% knew how to obtain them. The data demonstrated with 95% confidence intervals, statistically significant improvement in how participants felt about their ability to identify at-risk behaviours in surgical practice (2.10 to 2.90, 3-point Likert, p<0.001), to analyze the impact of at-risk behaviour on patient care (1.95 to 2.65, p<0.001), and to develop strategies to address at-risk behaviours in surgical practice and improve patient care (1.95 to 2.80, p<0.001). One hundred percent of participants felt similar workshops should be included in future annual meetings, and 94% felt that future meetings should include more opportunities to obtain Section 3 credits.ConclusionThis study demonstrates the effectiveness of an interactive workshop in a conference setting to fulfill the need for Section 3 continuing professional development credits.

Ten years of the Helsinki Declaration on patient safety in anaesthesiology: An expert opinion on peri-operative safety aspects.

: Patient safety is an activity to mitigate preventable patient harm that may occur during the delivery of medical care. The European Board of Anaesthesiology (EBA)/European Union of Medical Specialists had previously published safety recommendations on minimal monitoring and postanaesthesia care, but with the growing public and professional interest it was decided to produce a much more encompassing document. The EBA and the European Society of Anaesthesiology (ESA) published a consensus on what needs to be done/achieved for improvement of peri-operative patient safety. During the Euroanaesthesia meeting in Helsinki/Finland in 2010, this vision was presented to anaesthesiologists, patients, industry and others involved in health care as the 'Helsinki Declaration on Patient Safety in Anaesthesiology'. In May/June 2020, ESA and EBA are celebrating the 10th anniversary of the Helsinki Declaration on Patient Safety in Anaesthesiology; a good opportunity to look back and forward evaluating what was achieved in the recent 10 years, and what needs to be done in the upcoming years. The Patient Safety and Quality Committee (PSQC) of ESA invited experts in their fields to contribute, and these experts addressed their topic in different ways; there are classical, narrative reviews, more systematic reviews, political statements, personal opinions and also original data presentation. With this publication we hope to further stimulate implementation of the Helsinki Declaration on Patient Safety in Anaesthesiology, as well as initiating relevant research in the future.

CURRENT POSSIBILITIES OF USE OF INDIRECT CALORIMETRY IN PERIOPERATIVE ENERGY MONITORING

The purpose of the study is to develop a method of perioperative energy monitoring and to implement it in clinical practice.&#x0D; Material and methods. The study involved 125 patients who underwent various surgical interventions under general anesthesia using sevoflurane (inhalation anesthetics) and fentanyl (narcotic analgesics) in low-flow artificial lung ventilation. Methods of perioperative monitoring (International Standards for a Safe Practice of Anesthesia 2010, WFSA) were supplemented using indirect calorimetry.&#x0D; Results. Analyzing the literature data, a close correlation was found between the energy equivalent of oxygen (EEE2) and the respiratory factor (RQ). The authors obtained the corresponding one-factor linear regression formula, which had the form: EEE2 = 1.157 × RQ + 4,037. Using the basic principles of gas exchange in the lungs of Bohr-Engoff, a method of perioperative energy monitoring was developed, based on indirect calorimetry, taking into account the real values ​​of the energy equivalent of patients' oxygen. The universal formula for determining the level of metabolism of the patient (MR, cal / min) in the form of:&#x0D; MR = [0,863 × VE × (PECO2 / PaCO2) × (FiO2 - FeO2)] (1,157 × RQ + 4,037)&#x0D; where, VE - total ventilation of the lungs per minute (ml / min), PECO2, PaCO2 - partial pressure, respectively, in a mixture of gases, which is exhaled and in the arterial blood (mm Hg). FiO2 and FEO2 are the oxygen fraction in the gas mixture that is inhaled and exhaled in units (% / 100). The method is implemented as a computer program created on the basis of the developed formula. The methods of intensive perioperative therapy taking into account the level of metabolism are presented.&#x0D; Conclusion. The method of perioperative energy monitoring substantially complements the "International Standards for Safe Anesthesiology Practice", WFSA (2010) enhances the perioperative safety of patients by detecting metabolic disorders and conducting appropriate pathogenetic correction.

Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

BackgroundTo improve perioperative patient safety, guidelines for the preoperative, peroperative, and postoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation of these guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guideline adherence and to explore what can be learned for future implementation projects in complex organizations.MethodsWe developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. for classifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument for measuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviews with quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. The target group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on a five-point Likert scale (which were classified into the seven categories of the framework: factors relating to the intervention, society, implementation, organization, professional, patients, and social factors), respondents were invited to rank their three most important barriers in a separate, extra open-ended question.ResultsNinety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered to be barriers, relating to social factors (N = 5), the organization (N = 4), the professional (N = 4), the patient (N = 1), and the intervention (N = 1). An integrated information system was considered an important facilitator (70.4%) as well as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly all categories. The most frequently reported barriers were as follows: time pressure (16% of the total number of barriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%).ConclusionsWe identified a wide range of barriers that are believed to hinder the use of the perioperative safety guidelines, while an integrated information system and local data collection and feedback will also be necessary to engage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementation strategies. These results may also be of relevance for guideline implementation in general in complex organizations.Trial registrationDutch Trial Registry: NTR3568.

Implementation Analysis of a Perioperative Patient Safety Program in Guatemala.

The implementation of programs to improve patient safety remains challenging in low- and middle-income countries. The goal of our study was to define the barriers and facilitators to implementation of a perioperative patient safety program in Guatemala. We conducted semi-structured interviews with 16 staff pre-intervention and a follow-up focus group discussion 1year later in the perioperative department at the Roosevelt Hospital in Guatemala. We performed qualitative thematic analysis to identify barriers and facilitators to the implementation process, with analysis guided by the Consolidated Framework for Implementation Research. We found several dominant themes affecting implementation of a patient safety program. Implementation facilitators included strong prioritization of patient needs, program compatibility with existing workflow, and staff attributes. Barriers included a lack of knowledge about patient safety, limited resources, limited leadership engagement, and lack of formal implementation leaders. Several program modifications were made to enhance successful implementation iteratively during the implementation process. Our analysis highlights several dominant themes which affect the implementation of a perioperative safety program in Guatemala. Understanding the barriers and facilitators to implementation during program deployment allows for program modification and improvement of the implementation process itself.

The Mechanisms Responsible for Improved Information Transfer in Avatar-Based Patient Monitoring: Multicenter Comparative Eye-Tracking Study.

BackgroundPatient monitoring is central to perioperative and intensive care patient safety. Current state-of-the-art monitors display vital signs as numbers and waveforms. Visual Patient technology creates an easy-to-interpret virtual patient avatar model that displays vital sign information as it would look in a real-life patient (eg, avatar changes skin color from healthy to cyanotic depending on oxygen saturation). In previous studies, anesthesia providers using Visual Patient perceived more vital signs during short glances than with conventional monitoring.ObjectiveWe aimed to study the deeper mechanisms underlying information perception in conventional and avatar-based monitoring.MethodsIn this prospective, multicenter study with a within-subject design, we showed 32 anesthesia providers four 3- and 10-second monitoring scenarios alternatingly as either routine conventional or avatar-based in random sequence. All participants observed the same scenarios with both technologies and reported the vital sign status after each scenario. Using eye-tracking, we evaluated which vital signs the participants had visually fixated (ie, could have potentially read and perceived) during a scenario. We compared the frequencies and durations of participants’ visual fixations of vital signs between the two technologies.ResultsParticipants visually fixated more vital signs per scenario in avatar-based monitoring (median 10, IQR 9-11 versus median 6, IQR 4-8, P<.001; median of differences=3, 95% CI 3-4). In multivariable linear regression, monitoring technology (conventional versus avatar-based monitoring, difference=−3.3, P<.001) was an independent predictor of the number of visually fixated vital signs. The difference was less prominent in the longer (10-second) scenarios (difference=−1.5, P=.04). Study center, profession, gender, and scenario order did not influence the differences between methods. In all four scenarios, the participants visually fixated 9 of 11 vital signs statistically significantly longer using the avatar (all P<.001). Four critical vital signs (pulse rate, blood pressure, oxygen saturation, and respiratory rate) were visible almost the entire time of a scenario with the avatar; these were only visible for fractions of the observations with conventional monitoring. Visual fixation of a certain vital sign was associated with the correct perception of that vital sign in both technologies (avatar: phi coefficient=0.358; conventional monitoring: phi coefficient=0.515, both P<.001).ConclusionsThis eye-tracking study uncovered that the way the avatar-based technology integrates the vital sign information into a virtual patient model enabled parallel perception of multiple vital signs and was responsible for the improved information transfer. For example, a single look at the avatar’s body can provide information about: pulse rate (pulsation frequency), blood pressure (pulsation intensity), oxygen saturation (skin color), neuromuscular relaxation (extremities limp or stiff), and body temperature (heatwaves or ice crystals). This study adds a new and higher level of empirical evidence about why avatar-based monitoring improves vital sign perception compared with conventional monitoring.

Management of ophthalmic perioperative period during 2019 novel coronavirus disease outbreak

Objective To explore the perioperative management and infection prevention methods for acute eye diseases during the outbreak of 2019 novel coronavirus disease (COVID-19). Methods Since the COVID-19 was included in the Class B infectious diseases and was managed according to Class A infectious diseases in China, 127 patients who underwent ophthalmic surgery were enrolled at First Affiliated Hospital of Army Military Medical University from January 21 to February 19,2020. The perioperative management according to the national epidemic prevention and control requirements was summarized, and the perioperative clinical management that should be taken during the epidemic prevention period were discussed. Results One hundred and twenty-seven patients underwent ophthalmic surgeries, including emergency surgery, daytime surgery and other surgeries for sight-threatening diseases. The methods of anesthesia included general anesthesia, local anesthesia and ocular superficial anesthesia. According to the national epidemic prevention and control requirements, epidemic screening for these patients and infectious managing measures were performed during the perioperative period, including the sterilization of relevant environment and equipments, the personal medical prevention and protection for medical staffs and patients, which made surealltheoperationswent smoothlyand safely. There were no 2019-nCoV infection, surgical-relative infection, crossing infection and operation-related complications occurred. Meanwhile, there were not COVID-19-related infection events of medical staffs. The air sampling compliance rate in the operating room, ward, examination and other areas was 100%. Conclusions During the prevention and control period of the epidemic of COVID-19, strict adherence to the prevention and control measures can effectively ensure the smooth implementation of the operation and the perioperative safety of medical staff and patients. Key words: Corona virus disease-19; Eye diseases/surgery; Infectious management; Perioperative period; Opthalmology

Impact of a Preoperative Safety Checklist on Perioperative Quality Outcomes and Operative Efficiency.

Additional preoperative safety checklist requirements at Penn State Health were recently implemented on the morning of surgery. We evaluate whether this added safety policy impacted reported adverse patient safety events and institutional operating room performance indicators. Key operating room performance indicators from fiscal years 2016 through 2019 quarter 2 were reviewed. Additional attestation requirements by the attending surgeon were implemented at start of fiscal year 2018 (July 1, 2017). All reported perioperative patient safety events during this time were reviewed with events classified into one of 8 select categories. Total operative case volume was 49,894 cases in fiscal years 2016 and 2017, and 36,533 in fiscal years 2018 and 2019 through quarter 2 (p <0.10). Mean operating room use was 81% in both groups (p <0.46). First case on time start rates decreased from 79.5% to 58%, respectively (p <0.0001). Mean turnover time between cases also increased from 35 minutes to 40 minutes, respectively (p <0.0001). There were 252 patient events (0.51%) in fiscal years 2016 and 2017 compared to 94 (0.26%) events in fiscal years 2018 and 2019 through quarter 2 following implementation of the surgical safety checklist (p <0.0001). The number of incomplete preoperative checklists (39 vs 14, p=0.008) and missing/incomplete patient identification bands (15 vs 2, p=0.004) were also decreased between fiscal years 2016 and 2017, and fiscal years 2018 and 2019 through quarter 2, respectively. A day-of-surgery safety checklist decreased the number of reported patient safety events but with a negative impact on standard metrics of operating room productivity for 18 months following implementation. Further study is necessary to determine if these effects persist over time.

Comparison of sequential, delayed and simultaneous resection strategies for synchronous colorectal liver metastases

BackgroundThe present study aimed to compare the perioperative safety and long-term survival of patients with synchronous colorectal liver metastases undergoing sequential resection (SeR), delayed resection (DeR) and simultaneous resection (SiR).MethodsFrom January 2007 to December 2016, data from patients undergoing surgery at Peking University Cancer Hospital for synchronous colorectal liver metastases were retrospectively collected. The above three different surgical strategies were compared.ResultsA total of 233 cases were included, with 49 in the SeR group, 98 in the DeR group and 86 in the SiR group. The incidence of severe complications was 26.7% in the SiR group, higher than that in the DeR group (11.2%, P = 0.007) and the SeR group (16.3%, P = 0.166). The overall survival at 1 and 3 years in the SeR group (93.9 and 50.1%) was lower than that in the DeR group (94.9 and 64.8%, P = 0.019), but not significantly different from that in the SiR group (93.0 and 55.2%, P = 0.378). Recurrence-free survival at 1 and 3 years in the SeR group (22.4 and 18.4%) was lower than that in the DeR group (43.9 and 24.2%, P = 0.033) but not significantly different from that in the SiR group (31.4 and 19.6%, P = 0.275). Cox multivariate analysis indicated that T4, lymph node-positive primary tumour, liver metastases > 30 mm and SiR (compared with DeR) were correlated with poor prognosis.ConclusionSimultaneous resection has a relatively higher incidence of severe complications, and with a staged resection strategy, the prognosis of delayed resection was better than that of sequential resection.

Prospective methods for identifying perioperative risk-assessment methods for patient safety over 20 years: a systematic review.

BackgroundSerious preventable surgical events still occur despite considerable efforts to improve patient safety. In addition to learning from retrospective analyses, prospective risk‐assessment methods may help to decrease preventable events further by targeting perioperative hazards. The aim of this systematic review was to assess the methods used to identify perioperative patient safety risks prospectively, and to describe the risk areas targeted, the quality characteristics and feasibility of methods.MethodsMEDLINE, Embase, CINAHL and Cochrane databases were searched, adhering to PRISMA guidelines. All studies describing the development and results of prospective methods to identify perioperative patient safety risks were included and assessed on methodological quality. Exclusion criteria were interventional studies, studies targeting one specific issue, studies reporting on structural factors relating to fundamental hospital items, and non‐original or case studies.ResultsThe electronic search resulted in 16 708 publications, but only 20 were included for final analysis, describing five prospective risk‐assessment methods. Direct observation was used in most studies, often in combination. Direct (16 studies) and indirect (4 studies) observations identified (potential) adverse events (P)AEs, process flow disruptions, poor protocol compliance and poor practice performance. (Modified) Healthcare Failure Mode and Effect Analysis (HFMEA™) (5 studies) targeted potential process flow disruption failures, and direct (P)AE surveillance (3 studies) identified (P)AEs prospectively. Questionnaires (3 studies) identified poor protocol compliance, surgical flow disturbances and patients' willingness to ask questions about their care. Overall, quality characteristics and feasibility of the methods were poorly reported.ConclusionThe direct (in‐person) observation appears to be the primary prospective risk‐assessment method that currently may best help to target perioperative hazards. This is a reliable method and covers a broad spectrum of perioperative risk areas.

No Surgical Items Left Behind: A Multidisciplinary Approach to the Surgical Count Process

The counting process is designed to prevent retained foreign bodies while providing optimal perioperative patient safety. Intraoperative distractions are prevalent and potentially contribute to patient safety risks. Counting is an important preventative measure that is a human process prone to error, especially in this busy environment where multiple things are happening simultaneously. We sought to evaluate the impact of distractions during the count process on patient safety. Trained, nationally certified registered nurses used a validated tool to observe the number of interruptions that occurred during the count process in cardiac surgery. Observation included the key personnel that lead the count process including the scrub person, circulating nurse, attending surgeons, fellows, and residents of all disciplines. Observation included scheduled cases in the cardiac specialty for the adult population including all shifts (24 hours). The predictor in this study was distraction. The primary measure of distraction was the total number of distraction for each case. There are different distraction levels for each distraction. Thus, weighted distraction score for each case was created as the summation of distraction level and it is the secondary measure of distraction. To detect a medium effect size with 80% power at 0.05 level, we needed a minimum sample size of 54. We correlated the relationship between the number of interruptions observed and sequelae. Working together as a cohesive team to minimize interruptions can enhance patient safety and decrease additional workload across departments.

A Guide for Submitting a Manuscript That Is Aligned With the Mission of A&A Practice.

Anesthesia & Analgesia (A&A) Practice is a journal for clinicians worldwide. It is aligned with the educational mission of its parent organization, the International Anesthesia Research Society. A&A Practice is an online-only companion journal of A&A. A&A Practice seeks to publish short yet informative, peer-reviewed, PubMed indexed articles that offer a solution to a perioperative care or patient safety conundrum or a health management issue, which is communicated as one of the several manuscript types. We herein provide authors with a guide to assist them toward a successfully published manuscript in A&A Practice.

Surgical Specimen Management in the Preanalytic Phase: Perioperative Nursing Implications.

Surgical specimen management is an important responsibility of perioperative nurses and is essential to the provision of safe, quality patient care. Errors related to surgical specimen management can lead to a variety of negative consequences for patients and personnel. Unfortunately, surgical specimen management errors can and do occur, particularly during the preanalytic phase, and thus are a major perioperative patient safety concern. The overall management process for various surgical specimens is essentially the same, requiring a multifaceted, multidisciplinary, standardized method that includes specimen identification, labeling, collection, handling, transferring, containing, and transporting. For perioperative nurses to advocate for their patients and help ensure effective surgical specimen management, effective communication among care team members is imperative, along with a culture of safety that focuses on the minimization of distractions and an increased awareness of opportunities for errors.