Quality Patient Safety Research Articles

Voices from frontline nurses on care quality and patient safety during COVID-19: An application of the Donabedian model

The COVID-19 pandemic has adversely impacted quality of care and patient safety. This study aimed to describe registered nurses' (RNs) perceptions on the impact of the COVID-19 pandemic on their ability to adhere to patient safety protocols using Donabedian's Health Care Quality model. In October 2020, a survey was conducted among all actively licensed RNs in New Jersey who provided direct patient care during the first peak of COVID-19. Of 3,027 participants, 68% reported that the number of patients assigned impacted their ability to adhere to protocols. RNs identified a variety of organizational structures impacting adherence, including inadequate staffing, staff qualifications, and inadequate resources. Impacted processes included the inability to adhere to patient safety protocols and conduct comprehensive assessments and surveillance, the need for additional time spent on personal protective equipment and isolation policies, and difficulty maintaining isolation integrity; the need to prioritize and cluster care; and guidelines limiting personnel who could enter the room. Nurses attributed both adverse patient and staff outcomes to inadequate staffing and high patient acuity. These findings highlight the need for health care organizations to support frontline nursing staff in adhering to patient safety and infection prevention and control protocols during times of crises. Infection preventionists have substantial contact with bedside nurses and should leverage their collegial relationships to promote patient safety.

Implementation Assessment of Electronic Records Management System in Bayelsa State, Nigeria

The quality of information available to medical practitioners when delivering treatment to patients influences the outcome of service delivery. In the healthcare industry, health information technology has been shown to improve patient safety and treatment quality. The purpose of this research is to identify the facilitators and hurdles to the deployment of an electronic records management system at NDUTH, Okolobiri. For this study, a descriptive cross-sectional research design was used. The stratified random sample was taken from the 204 staff members that participated in the survey at NDUTH Okolobiri. Telephone interviews were also conducted with a small number of hospital staff who had deployed the electronic records system. According to the findings, the majority of participants (51.0%) were female, with an average age of 37(SD+9.0) years. The respondents’ overall understanding of electronic records management systems was 45.9%. The overall implementation rate was 22.8%. The study’s facilitators were leadership support along with the availability of ICT equipment, whereas the barriers were funding, a lack of power, insufficient ICT infrastructures, administrative challenges, poor staff compliance, a lack of government support, and poor maintenance of software and ICT equipment. The findings indicate that government and private enterprises should invest more in healthcare delivery via electronic records management systems. This is critical because the quality of information that medical practitioners have access to when caring for patients influences the effectiveness of health service delivery. It has also been discovered to ensure the proper operation of health institutions.

Cognitive biases regarding utilization of emergency severity index among emergency nurses

AimThe study aimed to measure emergency nurses' prevalence of cognitive biases when utilizing Emergency Severity Index (ESI). Moreover, the study aimed to measure the differences between cognitive biases and demographic variables. BackgroundNurses use Emergency Severity Index (ESI) to prioritize the patients. Cognitive biases could compromise the clinical decisions of nurses in triage. Consequently, this hinders the delivery of safe and quality patient care. MethodsA cross-sectional analytical approach invited 208 emergency nurses from four tertiary care hospitals. Institutional review board approval and permission from institutional heads were obtained. Informed consent was attained before data collection. Data was collected through a structured scenario-based questionnaire to measure cognitive biases at five levels of ESI. Descriptive and inferential statistics were obtained through v25.0 of SPSS. ResultsAmong the 86.6% response rate, 56.2% of nurses were male. 62.90% had nursing diplomas. Cognitive biases were present at all ESI levels one to five, in order 51%, 45%, 90%, 89%, and 91% among nurses. Premature closure 22%, tolerance to risk 12%, satisfying bias 25%, framing effect 22%, and blind obedience 34% from level one to five consecutively. Demographic variables, including males, experience between 2 and 5 years, general nursing as qualification, and without emergency severity index certification, were identified to encounter more cognitive biases when making triage decisions. ConclusionNumerous cognitive biases are considerably existing among emergency nurses when prioritizing patients. Cognitive de-biasing measures can improve triage decisions among nurses that could enhance quality care and patient safety.

Evaluation of a Standard Handover Tool at a Pediatric Tertiary Care Unit in Oman.

Background The handover system is a great communication tool physicians use to transfer and receive patients' care-related information. The introduction of structured handover tools has resulted in a dramatic reduction in hospital-acquired injuries. We hypothesize that the I-PASS handover tool will improve both written and verbal communication without compromising the handover duration. The current study aims to improve the quality of care and patient safety by evaluating the applicability of I-PASS handover in the Child Health Department at Sultan Qaboos University Hospital, Oman. Results A total of 20 trainees were enrolled in this study.After the implementation of I-PASS, 70% (14/20) of the respondents thought that the handover was well-structured, compared to 30% (6/20) prior to the implementation of I-PASS (P = .003). Due to I-PASS, about 80% of the participants could identify deteriorating patients and around 60% were confident in addressing emergencies. The I-PASS handover technique has raised participants' satisfaction from 80% to 95%. Before I-PASS, the mean adherence rate across all 10 variables was 28.7/50 (57.4%), compared to the post-I-PASS rate of 47/50 (94%). Conclusion The I-PASS system is a feasible and flexible clinical handover tool. This study showed that I-PASS has improved on-call handovers and patient safety.

Interventions to Minimize Medication Error by Nurses in Intensive Care: A Scoping Review Protocol.

Medication errors represent a concern for healthcare organizations due to their negative consequences. In the nursing context, these errors represent a threat to the quality of care and patient safety. Many factors have been identified as potential causes for these errors in intensive care units. A scoping review will be developed to identify interventions/strategies to minimize the occurrence of medication errors by nurses, considering the Joanna Briggs Institute (JBI) methodology. A search will be conducted in the EbscoHost (CINAHL Complete and MEDLINE), Embase and PubMed databases. Data analysis, extraction and synthesis will be carried out by two reviewers independently. This review will attempt to map which interventions are more specific to minimizing medication error by nurses in intensive care and to recognize which factors influence this type of error to mitigate practices that may lead to error. This protocol acts as the framework for a scoping review in the strategy to map the interventions and which factors contribute to the medication error by intensive care nurses. This study was prospectively registered with the Open Science Framework on 21 April 2023 with registration number DOI 10.17605/OSF.IO/94KH3.

Transferencia segura de pacientes y mejora de la comunicación en distintos entornos asistenciales

Inadequate information management, especially during patient handoff, contributes to a large part of health care-related adverse events. The Committee for Quality of Care and Patient Safety of the Asociación Española de Pediatría has developed this document to provide an overview of handover practices in different paediatric care settings (emergency, inpatient, intensive care, neonatal and primary care). It describes resources to achieve safe and effective communication in all these settings, such as standardized handoff tools. It also proposes recommendations for the prevention of medication errors during the handover process, to improve safety in interhospital and intrahospital patient transfer, and to optimize communication and continuity of care in chronically ill and medically complex children.

Work-related stress, stress reactions and coping strategies in ambulance nurses: A qualitative interview study.

To describe experiences of work-related stress, stress reactions and coping strategies among registered nurses (RNs) in the ambulance service (AS). A descriptive and qualitative design. Participants were recruited from eight different ambulance stations from different geographical locations in central Sweden. Data were collected from 14 RNs during the period from January 2022 to May 2022 using a semi-structured interview guide. Qualitative content analysis was used to analyse data using an abductive approach. Three categories describe the RNs' experiences; (1) Situations that cause work-related stress, (2) Reactions and feelings that occur and (3) Management of work-related stress. These three main categories included a total of 12 subcategories. Work-related stress was experienced when participants were a part of traumatic events or experienced insufficient cooperation or a disturbing event in the work environment. The different causes lead to different kinds of reactions with feelings of frustration, fear and loneliness being prominent. To manage the work-related stress, RNs used different kinds of strategies and support from colleagues or lack thereof seemed to have a major impact. Findings revealed the importance of having competent colleagues in the AS. Working with a competent colleague can reduce experiences of stress and prevent feelings of loneliness. It is important for the AS to provide stress-reduction support, to promote cooperation and to maintain and develop RNs' professional competence to ensure quality care and patient safety in the AS.

Status of Quality and Compliance to Inpatient Quality Indicators and Patient Safety Indicators in a Selected Private Corporate Hospital at Dhaka City Bangladesh

Background: The stutus of quality and compliance to inpatient quality indicators (IQIs) and patient safety indicators (PSIs) in corporate hospitals at dhaka city Bangladesh are not known as they are not adequately studied. Objective: The present descriptive cross-sectional study was therefor undertaken to know the status of quality and compliance to selected IQIs and PSIs in a selected private (corporate) hospital at Dhaka City Bangladesh. The period of study and hospital data collection period were May to August 2019 and January to March 2019 respectively. Methods: Selected IQIs and PSIs developed by Agency for Healthcare Research and Quality (AHRQ), USA and hospital facilities utilization parameters were investigated. Data were collected using questionnaires and checklists for the period of January to March 2019 from the purposively selected private (corporate) hospital. Sociodemographic information of randomly selected junior doctors and nurses were taken. Randomly selected senior clinicians, nurses and executives were interviewed regarding knowledge about selective IQIs, PSIs, JCIS, ISO relevant to quality healthcare. Data were analysed by SPSS programme version 20. Results: The hospital has all relevant admistrative and clinical departments, bed patterns and has efficient admission and discharge processes for inpatients. Bed utilization was 87.5% of total 159 available beds. Patients visited OPD: 2434 per day, admitted: 28 per day and discharged with successful outcome: 27 per day. Average length of stay (ALS), hospital acquired infection (HAI) and hospital deaths were 3.6 days, 1.76% (18/1000 cases), and 124 (01 per day) respectively during data collection period. Tests done in Laboratory Medicine were 267637 with Clinical Biochemistry tests highest (51.21%) and investigations in Radiology-Imaging departments were 74997 with X-rays being highest (40.22%). Of the five selected IQIs, total CABG cases done were 191 with 04 hospital deaths i.e. 2.1% (21 per 1000 cases) and total AMI cases done were 140 with 12 hospital deaths i.e. 8.5% (85 per 1000 cases). No casualties were reported for caesarean deliveries or primary/normal deliveries. None of the five selected PSIs were traced over the data collection period. Conclusion: These findings suggested that the selected hospital’s services were demanding and it was concerned about quality healthcare services. However, comparative studies with other private corporate hospotals at Dhaka City including larger number of respodents are warrented. Bangladesh Medical Res Counc Bull 2023; 49(2): 98-112

Unplanned transfer of pediatric patients from the general ward to the intensive care unit.

Introduction. During hospitalization, patients may develop significant clinical deterioration and require unplanned admission to the pediatric intensive care unit (PICU). This may result in increased morbidity and mortality. These events are often preceded by a deterioration phase that may go unnoticed. Objective. To determine the frequency, analyze the causes, and describe the clinical characteristics and outcomes of unplanned transfers of hospitalized pediatric patients from the general pediatric ward (GPW) to the PICU, and analyze the differences between urgent and emergent transfers. Population and methods. Prospective, descriptive study; all unplanned transfers from the GPW to the PICU occurring between January 1st , 2014 and December 31st, 2019 were analyzed. Results. There were 212 unplanned transfers (21 transfers per 1000 admissions). An associated comorbidity was present in 76% of transferred patients -being cancer the most frequent one (36%)- and they had been hospitalized for more than 24 hours in the GPW. The most frequent causes of transfer were respiratory distress (43%), sepsis (20%), and neurological/neurosurgical complications (20%). The overall mortality rate was 8.96% (19 patients). Conclusions. The analysis of unplanned transfers is a critical component in the assessment of the quality of care and patient safety of an area, and should be an indicator integrated into the control panel. The interpretation of unplanned transfers as a preventable event is a key paradigm shift.

Building a Sustainable Career in Hospital Medicine: Strategies for Research and Preventing Burnout

The hospital is the optimal setting for conducting research on healthcare quality improvement and patient safety, and hospital medicine is an auspicious field for career growth. Integrating clinical practice with non-clinical activities, including education and scholarly endeavors, has the potential to enhance job satisfaction and mitigate the risk of burnout. As a hospitalist, it is imperative to establish a professional growth plan, and to identify and prioritize core values. This review discusses strategies for engaging in research, fostering career progression, and preventing burnout among hospitalists.

Lessons learned from the EACTS-MSTCVS quality fellowship: a call to action for continuous improvement of cardiothoracic surgery outcomes in Europe.

The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS), a pioneer in initiating and nurturing quality improvement strategies in statewide cardiothoracic surgery, has been running the Quality Collaborative (MSTCVS-QC) program since 2001. This initiative has significantly grown over the years, facilitating at least 4 in-person meetings annually. It actively engages cardiac and general thoracic surgeons, data managers and researchers from all 32 non-federally funded cardiothoracic surgery sites across Michigan. Broadening its influence on joint learning and clinical outcomes, the MSTCVS-QC formed a strategic partnership with Blue Cross Blue Shield of Michigan, the state's largest private insurer, to further promote its initiatives. The MSTCVS-QC, operating from a dedicated QC centre employs an STS-associated database with additional aspects for data collection and analysis. The QC centre also organizes audits, facilitates collaborative meetings, disseminates surgical outcomes and champions the development and implementation of quality improvement initiatives related to cardiothoracic surgery in Michigan. Recognizing the MSTCVS-QC's successful efforts in advancing quality improvement, the European Association for Cardiothoracic Surgery (EACTS) introduced a fellowship program in 2018, facilitated through the EACTS Francis Fontan Fund (FFF). This program allows early-career academic physicians to spend 4-6 months with the MSTCVS-QC team in Ann Arbor. This article chronicles the evolution and functionality of the MSTCVS-QC, enriched by the experiences of the inaugural 4 EACTS/FFF fellows. Our objective is to emphasize the critical importance of fostering a culture of quality improvement and patient safety in the field of cardiothoracic surgery with open discussion of audited, high-quality data points. This principle, while implemented locally, has implications and value extending far beyond Europe, resonating globally.

Improving Thoracic Surgery Ward Round Quality and Enhancing Patient Safety in a Referral Centre.

Introduction Ward rounds are vitalclinical processes that facilitate an opportunity for daily review and management of thoracic surgery inpatients. The aim of this study was to comparethoracic surgery ward round documentationagainst locally agreedstandards and design a template to improve the detail and uniformity of this process to enhance patient care. Materials and methods Data for this audit was collected retrospectively and prospectively. Data was collected during three auditing periods and managed on Microsoft Excel. Descriptive statistics were used for its analysis. Chi-square and Fisher's Exact tests were used to test for differences in reporting rates. Results and discussion Initially, a total of 199 ward round notes were reviewed. Imaging results (19%) and discharge planning (23%) were not reported. eCARE (electronic Clinical Assessment for Round Evaluation) was developed to ensure that all aspects of patient evaluation recommended by the guidelines were included. Reporting rates significantly improved after such changes. We analysed the effect of the new ward round note on discharge planning (23.3 vs 41%, p<0.001), complication rates (32.6 vs 21.9%, p=0.03), post-surgical length of stay (LOS) (7.0 vs 5.0, p<0.001). Conclusion Over a year, we auditedthe Thoracic Surgery Department's ward round documentation against locally agreed standards in line with national recommendations. Several important items were not regularly reported. Using closed-ended questions improved reporting rates, and patient care was optimised. Further research should explore the impact of this new documentation method on patient care and postoperative outcomes in our Trust as well as other cardiothoracic centres.

Bringing a Multiteam Systems Perspective to the Perioperative Context: Considerations for Future Research of Perioperative Handoffs

Perioperative handoffs entail transferring responsibility for surgical patients from one specialized group or team to another. Multiteam system (MTS) theory has not yet been considered within perioperative handoff literature, even though multiple teams must work within and across the preoperative, intraoperative, and postoperative settings to care for shared patients. Using a case study from gynecological oncology, the authors demonstrate the applicability of an MTS taxonomy to the perioperative context. Compositional, linkage, and developmental MTS attributes are defined, along with the concept of boundary spanning, using examples from the case study to illustrate their relevance to the perioperative environment. Key research issues invoked through the application of the MTS taxonomy are discussed alongside overarching recommendations regarding approaches and methods to study these issues. This discussion of perioperative handoffs considers team functional diversity and motivation, between-team interdependence and communication patterns, changes in MTS composition and structure, and boundary spanning. The authors make overarching recommendations for future research that specify mapping perioperative MTSs, identifying weaknesses in MTS functioning and possible handoff design countermeasures, and evaluating handoffs designs' impact on patient care and MTS outcomes using several study designs. An MTS perspective can uniquely inform key research questions to advance the practice of perioperative handoffs. Processes that affect complex patient safety and care quality outcomes demand consideration of between-team collaboration quality during perioperative periods. The application of MTS theory in intervention research addressing perioperative handoffs can support MTS functioning for the benefit of safe, high-quality care.

How do we PI? Results of an EAST quality, patient safety, and outcomes survey

BackgroundQuality improvement is a cornerstone for any verified trauma center. Conducting effective quality and performance improvement, however, remains a challenge. In this study, we sought to better explore the landscape...

Invisible challenges in healthcare leadership

This paper explores ten hidden challenges in healthcare leadership and provides practical strategies to address them. These challenges include a lack of self-awareness, ineffective communication, empathy deficiency, resistance to change, delegation issues, overconfidence, accountability shortcomings, cognitive biases, time management problems, and issues related to pride and ego. Leaders in healthcare must first focus on self-awareness by regularly reflecting on their values and seeking honest feedback from colleagues. Effective communication skills are crucial, and leaders must convey information clearly, adapt to their audience, and foster open and honest communication. Empathy is essential for healthcare leaders, as it helps build strong relationships and fosters a collaborative work environment. Leaders should actively listen, show genuine interest in concerns, and seek to understand perspectives beyond differences of opinion. Resistance to change can limit growth, so leaders must adopt an open mindset, surround themselves with diverse perspectives, and be willing to learn and adapt. Delegation is crucial, and leaders should trust their team and assign tasks based on individual skills. Overconfidence can lead to poor decisions, so leaders must practice humility, consult with colleagues, and conduct reviews before important decisions. Accountability is essential, and leaders must acknowledge their responsibility and be transparent about their actions. Cognitive biases can influence decision-making, so leaders should develop emotional intelligence and awareness of their biases. Effective time management involves setting realistic goals and prioritizing tasks. Finally, pride and ego can hinder collaboration, so leaders must practice self-control and connect their leadership to a higher purpose. In conclusion, healthcare leaders must address these challenges to ensure quality healthcare and patient safety. By focusing on self-improvement and building collaborative teams, leaders can play a pivotal role in delivering quality healthcare and promoting patient well-being

Asynchronous Conferencing Through a Secure Messaging Application Increases Reporting of Medical Errors in a Mature Trauma Center.

Medical errors occur frequently, yet they are often under-reported and strategies to increase the reporting of medical errors are lacking. In this work, we detail how a level 1 trauma center used a secure messaging application to track medical errors and enhance its quality improvement initiatives. We describe the formulation, implementation, evolution, and evaluation of a chatroom integrated into a secure texting system to identify performance improvement and patient safety (PIPS) concerns. For evaluation, we used descriptive statistics to examine PIPS reporting by the reporting method over time, the incidence of mortality and unplanned ICU readmissions tracked in the hospital trauma registry over the same, and time-to-loop closure over the study period to quantify the impact of the processes instituted by the PIPS team. We also categorized themes of reported events. With the implementation of a PIPS chatroom, the number of events reported each month increased and texting became the predominant way for users to report trauma PIPS events. This increase in PIPS reporting did not appear to be accompanied by an increase in mortality and unplanned ICU readmissions. The PIPS team also improved the tracking and timely resolution of PIPS events and observed a decrease in time-to-loop closure with the implementation of the PIPS chatroom. The adoption of clinical texting as a way to report PIPS events was associated with increased reporting of such events and more timely resolution of concerns regarding patient safety and healthcare quality.

Perioperative optimization and profitability (POP) in a high-volume bariatric surgery center.

Currently, bariatric surgery is the most effective long-term treatment of obesity. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the primary types of bariatric surgery performed worldwide. To minimize the risks of surgical complications and optimize cost-effectiveness, it is essential to develop fast-track protocols and patient logistics. At Aleris Hospitals in Denmark, a fast-track methodology in bariatric surgery has been implemented and continuously optimized over the last 15years. The main objective was to demonstrate timelines recorded during one consecutive year in a fast-track, high-volume bariatric surgery setting after logistic optimization. This study included 949 consecutive patients who had undergone primary bariatric surgery in 2021. The primary outcomes were length of hospital stay and perioperative timeline recordings that were prospectively collected. The secondary outcomes were mortality, complication rates, and weight loss data. The vast majority of our patients (99.1%) were discharged from the hospital within the day after surgery. The median total surgery time was 30min, after 12min of patient preparation and with a turnover time between patients of seven min. The median knife-to-knife time in one operating room was 56min. Mortality was zero, 30-day reoperation rate was 1.2%, and 30-day readmission rate was 0.8%. SG and RYGB patients had an excess weight loss after four months of 45.6% and 57.9%, respectively. Implementation of fast-track principles in the clinical practice of bariatric surgery allows for an optimized, cost-effective surgical organization supporting the quality of procedures and patient safety.

Insights into clinical pharmacy practice in Latin America

AbstractBackgroundIn Latin America, clinical pharmacy has undergone significant changes in recent decades, with more pharmacists seeking advanced training. Clinical pharmacists are now recognized for their crucial role in patient care, particularly in medication management, patient education, and interprofessional collaboration. However, the region's progress in this field has been influenced by diverse economic, social, and cultural factors, leading to different levels of advancement across different countries.AimsTo describe the practice and training of professionals in clinical pharmacy, as a distinct field within the pharmaceutical profession, across eight Latin American countries.Materials &amp; MethodsArgentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay were chosen for this review. Data on clinical pharmacy practices in these countries was collected through a survey comprising five sections with 21 targeted questions. Following the survey's completion, an extensive literature review was conducted across multiple databases.ResultsBrazil has the most responsive education system to meet the demands of the population for the pharmacy career, with a University to Pharmacy (UP) index of 0.31, the lowest among all the countries included. Brazil also offers the highest number of postgraduate programs in the area of clinical pharmacy. Furthermore, diverse basic and advanced clinical pharmacy practices were identified in the included regions. These practices range from pharmacotherapeutic monitoring of patients to interdisciplinary collaboration in managing critically ill hospitalized patients. Each country exhibits a varying degree of acceptance towards clinical pharmacy.ConclusionThe evolution of clinical pharmacy in Latin America offers a promising opportunity to optimize drug therapy and improve patient safety and care quality. However, challenges remain, such as the need for more clinical sub‐specializations and better recognition of pharmacists' roles within healthcare teams. To address these challenges, continued professional development and advocacy are essential to enhance clinical pharmacy practice in the region.

Developing an Inclusive Scholarship Curriculum for Medical Students.

As part of a curriculum renewal, in 2020, Washington University School of Medicine in St. Louis sought to create an integrated curriculum that allows students to explore 4 academic career pathways (advocacy/global health, education, innovation, and research) and engage in scholarship activities-the Inquiry Curriculum. The curriculum needed to focus on foundational scholarship skills that would be applicable to all pathways. This article describes the process used to develop the curriculum learning objectives and lessons learned from initial implementation. The authors used a modified Delphi process to survey faculty experts from the 4 pathways to determine the objectives (March-May 2020). Twenty-four faculty were surveyed about 48 initial objectives created using Glassick's scholarship criteria. After 2 rounds, 28 objectives met consensus. Further oversight committee review and revisions by session leads resulted in 77 unique objectives for 23 sessions in the curriculum that launched in spring 2021. Four themes were identified from student feedback: (1) the Inquiry Curriculum framework creates opportunities for students to gain exposure to various approaches to understanding and addressing health care problems, (2) the curriculum targeted higher-level objectives for traditional research content and lower-level objectives for nontraditional content, (3) Glassick's criteria provided a useful structure for students to understand the rationale for and ordering of content, and (4) the curriculum had natural overlap with content often taught elsewhere in the curriculum, including evidence-based medicine, health equity, public and population health, and quality improvement and patient safety. The authors plan to consolidate sessions where there is redundancy, expand other sessions that require more time, and more purposefully discuss prior content when redundancy is intentional. Exploring other potential measures of curricular success, such as student learning outcomes, scholarly productivity, and impact on future scholarship engagement and career paths, is part of ongoing work.

Anterior cruciate ligament reconstruction learning curve study – Comparison of the first 50 consecutive patients of five orthopaedic surgeons during a 5-year follow-up

BackgroundThe goal of all surgical and orthopaedic training is to ensure necessary education and surgical skills without compromising the quality of operations or patient safety. Anterior cruciate ligament reconstruction (ACLR) is a common multi-staged orthopaedic surgical procedure with a learning curve. Previous studies focus mainly on learning or the learning curve of one surgeon and tunnel placements. The aims of this study were to define the learning curve in arthroscopic ACLRs, define the number of procedures needed before the surgical “knifetime” plateaus, examine the effect of experience on complications, and identify possible individual differences in the surgical learning curve. MethodsThe study included the first 50 consecutive ACLR operations of five orthopaedic surgeons, thus, a total of 250 patients. For comparison and statistical analysis, patients were arranged into five groups, each comprising 50 patients (=order group). Order group 1 comprised the first 10 patients operated on by each of the five surgeons, group 2 patients 11–20, group 3 patients 21–30, group 4 patients 31–40, and group 5 the last 10 patients. The learning curve was defined with a LOESS curve. Surgical time and complications, including graft failure and postoperative knee instability, were analysed between order groups and between surgeons. ResultsMedian surgical time was 105 (interquartile range 82–124) min. The learning curve showed the first steep decline in surgical time and started to settle slowly after 20 reconstructions. Surgical time was significantly longer when order group 1 was compared with order group 2 (p = 0.031), and when order group 1 was compared separately with order groups 3, 4, and 5 (p < 0.001). Operation order alone explained only 17.1% of the alteration in surgical time. No significant difference emerged in graft failure rate between the order groups or the surgeons. Objective instability of the knee showed a significant difference when order group 1 was compared separately with order group 3 and with order group 4 (p = 0.004). Surgical time differed between surgeons (p < 0.001), and the shape of the learning curve showed great individual variability. ConclusionIn the first 10 to 20 ACLR operations, the surgical time was longer and the complication rate higher, but thereafter both started to settle down. We recommend that first 10–20 ACLR operations should be supervised.