Well-designed workspaces minimize disruptions and distractions. This review and study describes several important ways to improve the anesthesia workspace in the operating room. Recommendations include demarcating an anesthesia zone with adequate space for equipment and storage and that restricts unnecessary staff travel into and through the zone. Each recommendation includes an illustrative diagram, explains its importance, and offers methods to achieve it.

Tall Man lettering and color-coding of medication syringes provide visual cues to decrease medication ordering and administration errors. In this study, an icon was added to the standard medication label; participants were asked to identify four medications, with and without the icon, from pre-defined distances. Participants correctly identified the medications with icons slightly more often.

… effects of flow disruptions in surgery. … Koch A, Burns J, Catchpole K, et al. Associations of workflow disruptions in …

Using a participatory action research approach, this study evaluated a smartphone app intended to empower surgical patients and caregivers to help optimize their care. Forty-two patients were enrolled in the study and they underwent a variety of different surgical procedures. Most patients felt that app was useful and informative (79%), was easy to use (74%) and helped participants to ask better questions (76%) and feel more involved in conversations about their care. However, almost half of participants (48%) were unsure about how the app could affect safety, citing that safety was the responsibility of the clinical staff alone rather than patients.

This direct observation study found that minor disruptions in usual workflow can combine to lead to an adverse event. More than half of the observed disruptions were related to the physical layout of the operating room, suggesting that physical design of operating rooms may affect surgical safety.

Efforts to measure and monitor patient safety improvement can help reveal how work is actually done. This commentary reviews observational study techniques to provide a framework and interactions to consider for researchers seeking to develop observational studies in health care.

Implementation science is utilized to understand how to apply research into practice. This review explores the use of implementation science in surgical patient safety initiatives to enable the translation of research into active care. The authors focus their discussion on the widely implemented World Health Organization surgical checklist to identify factors that drive and sustain improvement, including context, implementation strategies, and outcomes.

Despite the interest in integrating human factors engineering concepts into patient safety improvement strategies, barriers have hindered progress. This commentary explores the evidence around human factors engineering in health care to determine how to enhance the application of these concepts, such as through overlapping attention to work design, performance, and culture.

Safety culture and work systems influence safety, but it is unclear whether safety improvement efforts should focus on one or both factors. This study sought to improve adherence to the WHO surgical safety checklist and to enhance technical and nontechnical team performance using several safety interventions. One intervention focused on improving safety culture, while another was directed at the work system. Investigators also tested a combined approach. Although both team training and system redesign individually demonstrated improvement, the combined approach was more successful than either individual approach. This finding suggests that in order to truly enhance surgical safety, organizations must invest in both systems and culture interventions.

Checklists, while popularly considered to address safety issues, can be difficult to use reliably. Spotlighting the complexities around designing and implementing checklists to augment health care safety, this commentary relates the differences between medical and aviation checklists to underscore the need to consider sociocultural elements to ensure the success of this safety intervention.

The remarkable initial success of the World Health Organization surgical safety checklist led to the United Kingdom's National Health Service mandating its use in 2009. Subsequent studies of the checklist, however, have failed to demonstrate improvements in perioperative complication rates. This study analyzed the relationship between checklist implementation and complication rates at five hospitals in the UK. The investigators found that the checklist was effective only when it was fully completed—the odds of a postoperative complication were reduced by more than 40% if the full checklist was completed, but this was done in only 62% of cases. Moreover, even complete checklist usage did not seem to prevent complications in low-risk patients. The results of this and other studies clearly demonstrate that a checklist is a complex intervention that requires rigorous implementation and monitoring in order to improve safety.

Human factors engineering and quality improvement each offer promising strategies for designing patient safety interventions. This commentary discusses the value of cross-training individuals in elements of both disciplines to encourage integrated research, education, and professional development opportunities.

An intervention that combined teamwork training with efforts to standardize certain operative procedures resulted in increased adherence to the World Health Organization safe surgery checklist and improved communication within the operating room. No effect was found on clinical outcomes, but the study was likely too small to detect such an impact.

This direct observation study used a standardized protocol to assess the implementation of the safe surgery checklist and found wide variation in actual use of the tool. Challenges with implementation are thought to explain varying efficacy of checklists in clinical practice, in contrast to dramatic reductions in surgical mortality and complications in clinical trials.

Standard operating procedures, or SOPs, are a key tenet of human factors engineering. This time-series analysis found that implementing SOPs in the operating room did not change either surgical process outcomes, such as adherence to the WHO surgical checklist, or clinical outcomes. These results emphasize the challenge of applying systems solutions in clinical settings.

Human factors analysis led to five system changes in trauma care: standardizing equipment storage, incorporating medical transport packs, using whiteboards, conducting pretrauma briefings, and performing teamwork training. Implementation of improved processes led to decreased treatment time and length of hospital stay, emphasizing the importance of human factors in enhancing safety and outcomes.

Every day the care of hospital patients is handed off from clinician to clinician, creating serious risks for patient safety. The Joint Commission and the Accreditation Council for Graduate Medical Education have called for institutions to implement standardized handoff strategies. However, despite mandates to create safer handoffs, this systematic review found a lack of reliable strategies to improve clinical handoff outcomes. The literature search uncovered 29 relevant handoff studies, only 2 of which were randomized controlled trials. The studies took varied approaches to intervention design and outcome measurement. The quality of most studies was poor, with the majority representing small, uncontrolled, unblinded before-and-after comparisons. The authors of this review call for establishing a common taxonomy to better classify handoffs, improvement methods, and outcomes. Dr. Vineet Arora discussed the challenges of handoffs in a prior AHRQ WebM&M interview.

This systematic review found that safety checklists in the operating room measurably augment teamwork and communication, which may explain how they improve patient outcomes.