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The COVID-19 pandemic has dramatically increased the use of telehealth across various medical specialties.This systematic review did not identify any differences in patient or surgeon satisfaction or patient-reported outcomes with telehealth for orthopedic care delivery as compared to in-person visits.However, the authors note that the included studies did not adequately capture or report safety endpoints, such as complications or missed diagnoses.

Engaging patients and families is an important strategy in ensuring safe health care delivery. In this prospective, observational study, use of a parent-centered script did not improve parent engagement during the preinduction checklist and resulted in an expected decline in checklist adherence.  

Prior research has found that intraoperative anesthesia handovers can increase patient morbidity and mortality. However, this retrospective cohort study, focused on pediatric surgical patients treated, found that intraoperative anesthesia handovers were not associated with adverse postoperative outcomes.  

Utilizing American College of Surgeons National Surgical Quality Improvement Project  (ACS NSQIP) data, the authors looked at the effects of intraoperative handoffs  involving anesthesia personnel in two hospitals. Initial findings of higher rates of adverse outcomes were no longer statistically significant when confounding variables were added to the analysis.

Missed nursing care may result from inadequate nurse staffing and explain the relationship between nurse-to-patient ratios and patient outcomes. Research has shown that higher nurse staffing levels are associated with lower inpatient mortality and that reduced staffing increases the risk for postoperative complications. In this study, investigators examined data from more than 400,000 surgical patients from 300 hospitals in 9 countries as well as survey responses from 26,516 nurses. They found a significant association between nurse staffing and missed nursing care with 30-day risk-adjusted postoperative mortality. The authors conclude that measuring missed nursing care may help identify patients at greater risk for adverse outcomes earlier in their course. A past WebM&M commentary highlighted important issues associated with nurse staffing ratios.

Checklists have been shown to improve safety in the surgical setting. This retrospective chart review examined communication among staff members before and after implementation of an obstetric checklist for cesarean deliveries. Investigators found better agreement about reason for cesarean deliveries among the obstetric, anesthesiology, and pediatric staff after implementation of their checklist.

Handoffs are comprised of a multitude of steps that are prone to communication error. This commentary describes how a hospital drew from Lean Six Sigma concepts to develop and implement a standardized handoff process. The effort achieved improvements and established a concrete method for nurses to apply safe communication and data sharing principles in the perioperative environment.

The initial evidence supporting the impact of the World Health Organization's surgical safety checklist was a cohort study that found a significant reduction in mortality associated with the use of the checklist. More recently, the mandated adoption of surgical checklists in Canada failed to show any benefits on surgical outcomes. This retrospective point prevalence study evaluated checklist use in 426 hospitals across 28 European nations, involving more than 45,000 patients undergoing noncardiac inpatient surgery. Notably, there was striking variation in surgical checklist exposure, with checklists used for 0% to 99.6% of patients, depending on the nation. The use of surgical checklists was associated with lower hospital mortality, even after adjusting for risk factors. However, it is unclear from this study whether this improvement is due to the checklist or rather checklist usage is a process measure indicating higher overall perioperative quality. A prior AHRQ WebM&M perspective reviewed best practices for creating effective checklists.