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Search results for "United States of America"

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Journal Article > Study

Proactive risk assessment of surgical site infections in ambulatory surgery centers.

Bish EK, Azadeh-Fard N, Steighner LA, Hall KK, Slonim AD. J Patient Saf. 2017;13:69-75.

This study reports on the use of a prospective risk assessment tool to identify risks for surgical site infection in an ambulatory surgery center. A safety intervention was developed that specifically targeted the vulnerabilities identified by the risk assessment. Other methods of prospective error detection are discussed in the Detection of Safety Hazards Patient Safety Primer.

Clinical Guideline

Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.

Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. JAMA Surg. 2017 May 3; [Epub ahead of print].

Surgical site infections are a common hospital-acquired condition. This clinical guideline reviews the literature and gathers expert opinion to identify generalizable evidence-based strategies to reduce surgical site infections. The authors highlight antimicrobial, preoperative hygiene, glycemic control, and skin preparation procedures to prevent infection.

Tools/Toolkit > Government Resource

Toolkit To Improve Safety in Ambulatory Surgery Centers.

Agency for Healthcare Research and Quality: Rockville, MD.

Ambulatory surgery centers provide care to growing numbers of patients. This toolkit draws from AHRQ's Comprehensive Unit-based Safety Program to help ambulatory surgical center teams develop communication and teamwork skills to reduce infections and other iatrogenic harms.

Journal Article > Study

Association between state medical malpractice environment and postoperative outcomes in the United States.

Minami CA, Sheils CR, Pavey E, et al. J Am Coll Surg. 2017;224:310-318.e2.

This retrospective observational study determined that state malpractice climate was not associated with postoperative outcomes. These data are consistent with previous studies suggesting that more stringent malpractice law does not prevent adverse events.

Journal Article > Study

Use of unsolicited patient observations to identify surgeons with increased risk for postoperative complications.

  • Classic

Cooper WO, Guillamondegui O, Hines OJ, et al. JAMA Surg. 2017;152:522-529.

Most patient safety problems can be ascribed to underlying systems failures, but issues with individual clinicians play a role as well. Prior studies have shown that a small proportion of physicians account for a disproportionate share of patient complaints and malpractice lawsuits. This retrospective cohort study used data from the Patient Advocacy Reporting System (which collects unsolicited patient concerns) and the National Surgical Quality Improvement Program to examine the association between patient complaints and surgical adverse events. The investigators found that patients of surgeons who had received unsolicited patient concerns via the reporting system were at increased risk of postoperative complications and hospital readmission after surgery. Although the absolute increase in complication rates was relatively small across all surgeons, surgeons in the highest quartile of unsolicited observations had an approximately 14% higher risk of complications compared to surgeons in the lowest quartile. This study extends upon prior research by demonstrating an association between patient concerns about individual clinicians and clinical adverse events, and it strengthens the argument for using data on patient concerns to identify and address problem clinicians before patients are harmed.

Newspaper/Magazine Article

A lost voice.

Baker M. Seattle Times. February 10, 2017.

Reporting on an incident involving a patient who died after a surgery, this news article discusses potential contributing factors in the incident such as concurrent surgeries and failure to consider patient and family concerns. A past WebM&M commentary highlighted the importance of listening to families when they advocate for patients in the hospital.

Journal Article > Study

A patient safety dilemma: obesity in the surgical patient.

Goode V, Phillips E, DeGuzman P, et al. AANA J. 2016;84:404-412.

Postoperative complications are key measures of surgical safety and quality. This analysis of electronic health record data found that AHRQ Patient Safety Indicators of surgical complications were more common in patients with obesity. The authors suggest that systems approaches are needed to mitigate surgical risk for patients with obesity.

Journal Article > Organizational Policy/Guidelines

American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.

Ban KA, Minei JP, Laronga C, et al. J Am Coll Surg. 2017;224:59-74.

Surgical site infections are a persistent and costly challenge to patient safety. These guidelines provide recommendations to reduce this common hospital-acquired condition, including policies for surgeon attire, hand hygiene, and equipment sterilization.

Journal Article > Commentary

Consensus bundle on prevention of surgical site infections after major gynecologic surgery.

Pellegrini JE, Toledo P, Soper DE, et al. Obstet Gynecol. 2017;129:50-61.

Surgical site infections are a common complication, and they can have serious consequences. This consensus statement provides a set of recommendations to prevent surgical site infections in gynecologic surgical care that focus on readiness, recognition and prevention, response, and reporting and systems learning. The authors highlight the importance of teamwork and communication to achieving success and suggest that components of the bundle are applicable across a variety of surgical settings.

Newspaper/Magazine Article

More than half a million heart surgery patients at risk of a dangerous infection.

Sun LH. The Washington Post. October 13, 2016.

Medical devices can contribute to the spread of health care–associated infections. This news article discusses a government report that raises concerns that patients may have been exposed to a deadly bacterial infection related to an essential piece of equipment used in cardiac surgery worldwide. The resulting infection can be difficult to diagnosis as symptoms may remain dormant for months after the initial exposure.

Journal Article > Review

Factors influencing patient safety during postoperative handover.

Rose M, Newman SD. AANA J. 2016;84:329-338.

Patient handoffs between care teams are vulnerable to error. This scoping review explored the literature to identify factors that affect the safety of handoffs from anesthesia providers to the postanesthesia care unit. Individual communication styles, team dynamics, and policy were described as elements that influence information transfers. A past PSNet perspective discussed the importance of safe inpatient handovers.

Journal Article > Study

Operating room traffic as a modifiable risk factor for surgical site infection.

Wanta BT, Glasgow AE, Habermann EB, et al. Surg Infect (Larchmt). 2016;17:755-760.

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.

Journal Article > Study

Impact of hospital-acquired conditions on financial liabilities for Medicare patients.

Coomer NM, Kandilov AMG. Am J Infect Control. 2016;44:1326-1334.

Hospital-acquired conditions (HACs) are a costly source of patient harms. Prior analyses have suggested that HACs lead to nearly $150 million per year in excess Medicare costs. Examining the financial burdens placed on Medicare patients who develop an HAC, this study found that these patients are liable for increased deductibles, copayments, and coinsurance, resulting in approximately $20.5 million per year in added cost burdens.

Journal Article > Study

Association of safety culture with surgical site infection outcomes.

  • Classic

Fan CJ, Pawlik TM, Daniels T, et al. J Am Coll Surg. 2016;222:122-128.

Safety culture is widely measured and discussed, but its link to patient outcomes has not been consistently demonstrated. Surgical site infections are considered preventable adverse events. In this cross-sectional study, investigators found that better safety culture was associated with lower rates of surgical site infections after colon surgery. Specifically, aspects of safety culture associated with teamwork, communication, engaged leadership, and nonpunitive response to error were linked to fewer infections. Although this work does not establish a clear cause-and-effect relationship between safety culture and patient outcomes, it suggests that efforts to enhance safety culture could improve patient outcomes.

Journal Article > Study

Electronic health record-based triggers to detect adverse events after outpatient orthopaedic surgery.

Menendez ME, Janssen SJ, Ring D. BMJ Qual Saf. 2016;25:25-30.

Trigger tools facilitate detection of adverse events in medical records, which enables more efficient record review. This study identified adverse events following outpatient orthopedic surgeries using a trigger tool. There was an overall adverse event rate of 10%, suggesting significant improvements are needed in this ambulatory surgery setting.

Special or Theme Issue

Infection Prevention.

Allen G, ed. AORN J. 2015;101:505-596.

A primary concern in the perioperative setting is the prevention of health care–associated infections, particularly surgical site infections. Articles in this special issue explore strategies to reduce risk of infection in the perioperative environment, with discussions focusing on human factors principles, instrument sterilization, and specimen management.

Journal Article > Study

Crisis management on surgical wards: a simulation-based approach to enhancing technical, teamwork, and patient interaction skills.

Arora S, Hull L, Fitzpatrick M, Sevdalis N, Birnbach DJ. Ann Surg. 2015;261:888-893

This simulation study examined how residents respond to postoperative deterioration in the surgical ward. Residents improved in validated assessments of clinical performance, teamwork, and communication with patients compared to before the simulation. This work underscores the importance of simulation in patient safety education across multiple clinical settings.

Journal Article > Study

The impact of hospital-acquired conditions on Medicare program payments.

Kandilov AMG, Coomer NM, Dalton K. Medicare Medicaid Res Rev. 2014;4:E1-E23.

In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped paying for many preventable hospital-acquired conditions (HACs). However, according to this matched case-control study, HACs still result in numerous downstream financial effects, costing CMS an estimated $146 million per year. This study evaluated costs related to the index hospitalization and 90 days following discharge of six HACs—severe pressure ulcers, fractures, catheter-associated urinary tract infections, venous catheter-related infections, surgical site infections, and post-surgical venous thromboembolism. Severe pressure ulcers and orthopedic surgical site infections resulted in an average increase in payments of more than $20,000 across the episode of care. The extra costs are largely related to CMS index outlier payments, as well as payments for readmissions and post-acute care. A previous AHRQ WebM&M perspective by Dr. Peter Lindenauer discussed the business case for patient safety.

Journal Article > Study

The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings.

Keenan JE, Speicher PJ, Thacker JKM, Walter M, Kuchibhatla M, Mantyh CR. JAMA Surg. 2014;149:1045-1052.

Surgical site infections are a major contributor to the overall burden of health care–associated infections. In this study, implementation of a formal bundle for preventing surgical site infections resulted in a significant decrease in both superficial infections and postoperative sepsis.

Journal Article > Study

Preventable mortality after common urological surgery: failing to rescue?

Sammon JD, Pucheril D, Abdollah F, et al. BJU Int. 2015;115:666-674.

This analysis of national hospital data found that while odds of overall mortality from urological surgery decreased, failure to rescue increased over time, with lower-income, older aged, and ethnic minority patients as predictors for higher risk. This work emphasizes the need to examine disparities in patient safety outcomes.

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