BACKGROUND: Complications are a common and accepted risk of surgery. Failure to optimize the management of patients who suffer postoperative morbidity may result in poorer surgical outcomes. This study aimed to evaluate a checklist-based tool to improve and standardize care of postoperative complications. METHODS:Surgical trainees conducted baseline ward rounds of three patients with common postoperative complications in a high-fidelity simulated ward environment. Subjects were randomized to intervention or control groups, and final ward rounds were conducted with or without the aid of checklists for management of postoperative complications. Adherence to critical care processes was assessed, in addition to technical (Surgical Ward-care Assessment Tool, SWAT) and non-technical (Ward NOn-TECHnical Skills (W-NOTECHS) scale) performance. Subjects completed a feedback questionnaire regarding their perception of the checklists. RESULTS:Twenty trainees completed 120 patient assessments. All intervention group subjects opted to use the checklists, resulting in significantly fewer critical errors compared with controls (median (i.q.r.) 0 (0-0) versus 60 (40-73) per cent; P < 0·001). The intervention group demonstrated improved patient management (SWAT-M) (P < 0·001) and non-technical skills (P = 0·043) between baseline and final ward rounds, whereas controls did not (P = 0·571 and P = 0·809 respectively). A small learning effect was seen with improvement in patient assessment (SWAT-A) in both groups (P < 0·001). Intervention group subjects found checklists easy and effective to use, and would want them used for their own care if they were to experience postoperative complications. CONCLUSION: Checklist use resulted in significantly improved standardization, evidence-based management of postoperative complications, and quality of ward rounds. Simulation-based piloting aided appropriate use of checklists and staff engagement. Checklists represent a low-cost intervention to reduce rates of failure to rescue and to improve patient care.
RCT Entities:
BACKGROUND: Complications are a common and accepted risk of surgery. Failure to optimize the management of patients who suffer postoperative morbidity may result in poorer surgical outcomes. This study aimed to evaluate a checklist-based tool to improve and standardize care of postoperative complications. METHODS: Surgical trainees conducted baseline ward rounds of three patients with common postoperative complications in a high-fidelity simulated ward environment. Subjects were randomized to intervention or control groups, and final ward rounds were conducted with or without the aid of checklists for management of postoperative complications. Adherence to critical care processes was assessed, in addition to technical (Surgical Ward-care Assessment Tool, SWAT) and non-technical (Ward NOn-TECHnical Skills (W-NOTECHS) scale) performance. Subjects completed a feedback questionnaire regarding their perception of the checklists. RESULTS: Twenty trainees completed 120 patient assessments. All intervention group subjects opted to use the checklists, resulting in significantly fewer critical errors compared with controls (median (i.q.r.) 0 (0-0) versus 60 (40-73) per cent; P < 0·001). The intervention group demonstrated improved patient management (SWAT-M) (P < 0·001) and non-technical skills (P = 0·043) between baseline and final ward rounds, whereas controls did not (P = 0·571 and P = 0·809 respectively). A small learning effect was seen with improvement in patient assessment (SWAT-A) in both groups (P < 0·001). Intervention group subjects found checklists easy and effective to use, and would want them used for their own care if they were to experience postoperative complications. CONCLUSION: Checklist use resulted in significantly improved standardization, evidence-based management of postoperative complications, and quality of ward rounds. Simulation-based piloting aided appropriate use of checklists and staff engagement. Checklists represent a low-cost intervention to reduce rates of failure to rescue and to improve patient care.
Authors: Bhavesh Patel; Maximilian Johnston; Natalie Cookson; Dominic King; Sonal Arora; Ara Darzi Journal: J Med Internet Res Date: 2016-04-06 Impact factor: 5.428
Authors: Franziska Schöppe; Wieland H Sommer; Florian Schmidutz; Dominik Pförringer; Marco Armbruster; Karolin J Paprottka; Jessica L V Plum; Bastian O Sabel; Felix G Meinel; Nora N Sommer Journal: BMC Med Imaging Date: 2018-07-03 Impact factor: 1.930
Authors: Salomone Di Saverio; Gregorio Tugnoli; Fausto Catena; Arianna Birindelli; Carlo Coniglio; Giovanni Gordini Journal: Patient Saf Surg Date: 2015-11-13
Authors: Fernando G Zampieri; Thiago C Lisboa; Thiago D Correa; Fernando A Bozza; Marcus Ferez; Haggeas S Fernandes; André M Japiassú; Juan Carlos R Verdeal; Ana Cláudia P Carvalho; Marcos F Knibel; Bruno F Mazza; Fernando Colombari; José Mauro Vieira; William N Viana; Roberto Costa; Michele M Godoy; Marcelo O Maia; Eliana B Caser; Jorge I F Salluh; Marcio Soares Journal: BMJ Open Date: 2018-01-24 Impact factor: 2.692
Authors: Jimmy Ng; Ahmed Abdelhadi; Peter Waterland; Jonathan Swallow; Deborah Nicol; Steve Pandey; Miguel Zilvetti; Ahmed Karim Journal: BMJ Open Qual Date: 2018-07-21