Clinician workload has been linked with poor patient outcomes. This retrospective cohort study assessed the outcomes for patients undergoing coronary artery bypass graft (CABG) performed as a surgeons’ first versus non-first procedure of the day. Findings suggest that prior workload adversely affected outcomes for patients undergoing CABG surgery, with increases in adverse events, myocardial infarction, and stroke compared to first procedures.

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.

The sterile cockpit rule mandates elimination of nonessential activities during aircraft takeoffs and landings. This study found disturbingly frequent interruptions during analogous phases of anesthesia management, demonstrating the need to develop a similar rule for the operating room.

Classic research has demonstrated a link between increased surgical volume and improved patient outcomes at the hospital level. This research has raised interest in systematic referral of certain procedures to specialized centers, and the Leapfrog Group included volume-based referral as one of its recommended safety practices. However, this study finds that the volume–outcome relationship is limited to a few specific surgeries, and that wide overall variation in surgical mortality exists even after controlling for volume. The authors argue that given these findings, systematic volume-based referral is unlikely to improve surgical outcomes.

In this survey, residency program directors and residents indicated that new regulations limiting duty hours for surgical residents to 50 hours per week have had a negative impact on residents' educational experience.

Safety improvement efforts are often guided by error data that are gathered retrospectively (e.g., incident reports). This study reports on a collaborative process used to prospectively identify safety hazards and improvement strategies in perioperative care.

Increased nurse staffing on postoperative general wards—but not in the intensive care unit—was associated with reduced mortality for cardiac surgery patients.

This article reviews factors contributing to anesthesia-related cardiac arrests and details prevention strategies.

Through nursing interviews and focus groups, this study found that nurses share a common belief around their role in preventing errors in the operating room.

This study used a mathematical simulation model to estimate the risk of adverse events due to unavailability of an anesthesiologist to attend to urgent problems. The risk of system failure was significantly higher when one anesthesiologist was required to cover more than two operating rooms and was also increased when multiple lengthy operations took place simultaneously. An Agency for Healthcare Research and Quality (AHRQ) WebM&M commentary discusses a devastating error that occurred when no anesthesiologist was available for an urgent cesarean section.

The researchers observed a urology surgery team to measure the frequency and source of interruptions in the operating theater.