This study examined variation in operative technical skills among patients undergoing colorectal and non-colorectal procedures and the association with patient outcomes. Higher technical skills were significantly associated with lower rates of complications, unplanned reoperations, and death or serious morbidity. The findings suggest that this skill variation accounts for more than 25% of the variation in patient outcomes.

As part of a quality improvement initiative to enhance surgical onboarding, the authors used semi-structured interviews with 20 physicians to understand potential areas of risk when a physician begins working in an unfamiliar setting. Qualitative analysis found that three key findings: (1) physicians often receive little to no onboarding when starting to practice in a new setting, which can limit their ability to provide safe care; (2) physicians felt onboarding inadequately fostered strong interpersonal relationships among health care teams, which impedes psychological safety and team cohesion, and; (3) physicians noted an increased risk of patient harm during emergency situations in new settings due to lack of understanding of culture, workflow, roles/responsibilities and available equipment.

Using a human factors engineering framework, this study reviewed video of residents performing a simulated hernia repair to identify and characterize errors, error detection and error recovery. The twenty participating residents made 314 errors; the majority were technical errors (63%) and commission errors (69%; defined as failure to perform a surgical step correctly). Nearly half of all errors went undetected by the residents during the procedure, but when errors were detected, the majority were able to be resolved.

… BMJ (Clinical research ed.) … BMJ … Checklists are a popular yet controversial strategy for improving the safety … debate the weaknesses and strengths of checklists through a discussion of the evidence . …

This study in the Health Affairs patient safety theme issue examines the implementation of surgical safety checklists. Checklists have been shown to improve patient outcomes in randomized control trials, but implementation studies have not consistently demonstrated similar improvements. In this statewide initiative, implementation of the checklist varied significantly among sites. Factors associated with more successful implementation included greater leadership participation, frontline engagement, and more frequent activities for all involved groups, including surgeons, nurses, technicians, and administrators. Sites that invested more funding and time also saw greater checklist implementation. The authors conclude that hospitals that participated more did better. Past PSNet interviews with Lucian Leape and David Urbach discussed their perspectives on surgical safety checklists.

Changes in organizational process and governance can create downstream conditions that result in failures. This commentary explored how system expansion affects safety. The authors highlight the need for leadership to use system data to plan for and manage the impact of the resultant infrastructure and patient population changes on care delivery.

Physicians who receive more patient complaints about communication and behavior are more likely to face malpractice claims. This study examined whether results from surgeons' 360-degree reviews, in which team members evaluate a range of professional attributes and behaviors, were associated with risk of malpractice claims. Surgeons with worse performance for attentiveness, informing others, and considering others' suggestions had a significantly higher risk for malpractice claims. Surgeons in the highest 10% for the negative behaviors of snapping at or talking down to others also were more likely to have malpractice claims. These results echo prior studies of physician behavior and malpractice risk. The authors suggest that addressing negative behaviors among surgeons could mitigate malpractice risk. A previous WebM&M commentary discussed patient complaints as safety surveillance.

… The Journal of surgical research … J Surg Res … This survey of academic surgeons found that the …

… Annals of surgery … Ann Surg … Opioid-related mortality is a patient safety concern. Prior studies have demonstrated …

Establishing a robust culture of safety, in which all staff feel free to voice concerns without fear of reprisal and leadership explicitly prioritizes safety, is crucial to safety improvement efforts. The most successful safety improvement programs have all explicitly prioritized enhancing safety culture. This study reports on the baseline results of a program that sought to improve surgical safety at hospitals in South Carolina. Safety culture was assessed among operating room personnel in 31 hospitals using a validated instrument. The investigators found a relatively robust association between better perceived safety culture and lower 30-day postoperative mortality. Studies in other clinical settings have found similar results. The hospitals involved in this study subsequently participated in a program to implement the Surgical Safety Checklist, which resulted in a significant improvement in mortality among participating hospitals compared to nonparticipating hospitals. A recent PSNet interview with Dr. Mary Dixon-Woods discussed the evolving concept of safety culture.

Checklists have been shown to reduce surgical morbidity and mortality in randomized trials, but results of implementation in clinical settings have been mixed. This study reports on a voluntary, statewide collaborative program to implement a surgical safety checklist in South Carolina hospitals. Participating sites undertook a multifaceted process to support checklist implementation and culture change. Cross-institutional educational activities were available to all hospitals in the collaborative. Investigators determined that rates of surgical complications declined significantly in hospitals involved in the collaborative compared with those that did not participate, which had no change in postsurgical mortality over the same time frame. Past PSNet interviews with Lucian Leape and David Urbach discussed their perspectives on surgical safety checklists.

… with nonoverlapping surgeries of the same type at a single referral center. After adjusting for surgeon and …

Surgical site infections are an important type of health care–associated infection that safety efforts aim to prevent. This case-control study compared patients matched on age, gender, and elective procedure who developed surgical site infections with those who did not. Although investigators hypothesized that having additional personnel in the operating room would lead to higher likelihood of infection, after adjusting for patient- and procedure-related factors, they found this was not the case.

Teamwork training can improve communication and prevention of adverse events in the operating room. In this study, focus groups with clinicians and operating room staff found that team members perceived the concept of the "team" and their roles in ensuring optimal handoff communication differently. This exploratory work has implications for the design of effective teamwork training programs.

Surgical checklists have been associated with reduced morbidity and mortality in randomized trials, but real-world implementation has not always resulted in improvement. This pre-post study reports on an initiative to implement surgical checklists in South Carolina hospitals. Investigators surveyed surgical personnel before and after checklist implementation. Compared with the pre-intervention responses, measures of teamwork improved, and 54% of participants reported effective checklist compliance. The study did not report on changes in patient outcomes after checklist introduction, which would substantiate calls for implementing checklists widely. A PSNet interview with Dr. Lucian Leape discussed his perspective on checklists and patient safety.

… … Health Aff (Millwood) … Hospital leadership can play a critical role in improving safety and quality, as … hospitals used more effective management practices, i.e., they consistently set quality targets and had a greater … … Tsai TC, Jha AK, Gawande AA, Huckman RS, Bloom N, Sadun R. Hospital board and management practices are strongly …

… investigators evaluated all procedural never events using a validated human factors analysis method. They uncovered …

In this survey of surgical teams at South Carolina hospitals that were implementing the World Health Organization's surgical safety checklist, the majority of overall responses about patient safety were positive. However, there was wide variation between hospitals. In some hospitals surveyed, up to 57% of respondents reported that they would not feel safe being treated in their own operating room.

The World Health Organization's surgical safety checklist has been successfully implemented in multiple clinical settings. This study, conducted in Moldova, found that checklist usage remained high 2 years after initial implementation, with postoperative complication rates continuing to decline over that time period.

… and surgical outcomes over time. This study examined 3 and a half years of data from the University HealthSystem Consortium, which represents a large cohort of academic medical centers. …