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Surgical Safety in Children

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Pediatric Surgery

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Abstract

Awareness of the scale of unintended harm during healthcare delivery has increased dramatically in recent years, with the figure of 10% of hospital admissions suffering an adverse event now being generally accepted. Surgical care poses unique risks to patients, with approximately 50% of untoward surgical outcomes occurring in the operative phase. In accordance with other high-risk industries such as commercial aviation, the majority of these adverse events are not caused by failures of technical skill on the part of the individual surgeon, but rather lie within the wider healthcare team and environment. Lapses and errors in communication, teamworking, leadership, situation awareness, or decision-making all feature highly in post hoc analysis of surgical adverse events.

While system-based improvement programs can help reduce adverse events, they are not of themselves sufficient, and the possession and deployment of good non-technical skills by individual surgeons are now known to play a key role in optimizing outcomes for the surgical patient. The Non-Technical Skills for Surgeons (NOTSS) program has been developed to describe and assess these non-technical skills in the intraoperative environment. The NOTSS classification describes categories of situation awareness, decision-making, teamworking, and communication and leadership. Combined with an awareness of human performance limitation and tools to help improve teamworking and non-technical skills such as briefings and checklists, patient safety can be improved.

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References

  • Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: a critical incident analysis. Qual Saf Health Care. 2005;14(6):401–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004;170(11):1678–86.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bliss LA, Ross-Richardson CB, Sanzari LJ, Shapiro DS, Lukianoff AE, Bernstein BA, et al. Thirty-day outcomes support implementation of a surgical safety checklist. J Am Coll Surg. 2012;215(6):766–76.

    Article  PubMed  Google Scholar 

  • Bradley V, Liddle S, Shaw R, et al. Sticks and stones: investigating rude, dismissive and aggressive communication between doctors. Clin Med (Lond). 2015;15(6):541–5.

    Article  Google Scholar 

  • Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6.

    Article  CAS  PubMed  Google Scholar 

  • Bromiley. 2011 http://www.health.org.uk/blog/human-factors-approach

  • Catchpole KR, de Leval MR, McEwan A, Pigott N, Elliott MJ, McQuillan A, et al. Patient handover from surgery to intensive care: using formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth. 2007;17(5):470–8.

    Article  PubMed  Google Scholar 

  • Catchpole K, McCulloch P. Human factors in critical care: towards standardized integrated human-centred systems of work. Current opinion in critical care. 2010;16(6):618–22.

    Google Scholar 

  • Catchpole K, Mishra A, Handa A, McCulloch P. Teamwork and error in the operating room. Ann Surg. 2008;247(4):699–706.

    Article  CAS  PubMed  Google Scholar 

  • Codman EA. A study in hospital efficiency. 1916.

    Google Scholar 

  • Cooper GE, White MD, Lauber JK, editors. Resource management on the flightdeck: proceedings of a NASA/industry workshop. (NASA CP-2120). Moffett Field: NASA-Ames Research Center; 1980.

    Google Scholar 

  • Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S. Adverse events in New Zealand public hospitals I: occurrence and impact. N Z Med J. 2002;115(1167):U271.

    PubMed  Google Scholar 

  • Endsley MR, Garland DJ. Situation awareness. Mahwah: Lawrence Erlbaum Assoc Incorporated; 2000.

    Google Scholar 

  • Fletcher G. Anaesthetists’ Non-Technical Skills (ANTS): evaluation of a behavioural marker systemdagger. Br J Anaesth. 2003;90(5):580–8.

    Article  CAS  PubMed  Google Scholar 

  • Flin R, Yule S, McKenzie L, Paterson-Brown S, Maran N. Attitudes to teamwork and safety in the operating theatre. Surgeon. 2006;4(3):145–51.

    Article  CAS  PubMed  Google Scholar 

  • Gaba DMD, DeAnda AA. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology. 1988;69(3):387–94.

    Article  CAS  PubMed  Google Scholar 

  • Gawande AA, Thomas EJ, Zinner MJ, Brennan TA. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999;126(1):66–75.

    Article  CAS  PubMed  Google Scholar 

  • Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133(6):614–21.

    Article  PubMed  Google Scholar 

  • Gosfield AG, Reinertsen JL. The 100,000 lives campaign: crystallizing standards of care for hospitals. Health Aff (Millwood). 2005;24(6):1560–70.

    Article  Google Scholar 

  • Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204(4):533–40.

    Article  PubMed  Google Scholar 

  • Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat A-HS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491–9.

    Article  CAS  PubMed  Google Scholar 

  • Henrickson SE, Wadhera RK, ElBardissi AW, Wiegmann DA, Sundt TM. Development and pilot evaluation of a preoperative briefing protocol for cardiovascular surgery. J Am Coll Surg. 2009;208(6):1115–23.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hicks RWR, Becker SCS, Cousins DDD. Harmful medication errors in children: a 5-year analysis of data from the USP’s MEDMARX(R) program. J Pediatr Nurs. 2006;21(4):9–9.

    Article  Google Scholar 

  • Hsu KE, Man FY, Gizicki RA, Feldman LS, Fried GM. Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc. 2008;22(1):196–201.

    Article  CAS  PubMed  Google Scholar 

  • Kennedy I. The report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. Learning from Bristol. London: Stationery Office; 2001. p. 325–32.

    Google Scholar 

  • Klein KJ, Ziegert JC, Knight AP, Xiao Y. Dynamic delegation: shared, hierarchical, and deindividualized leadership in extreme action teams. Adm Sci Q. 2006;51(4):590–621.

    Article  Google Scholar 

  • Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academies Press; 2000. p. 627.

    Google Scholar 

  • Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.

    Article  CAS  PubMed  Google Scholar 

  • Künzle B, Kolbe M, Grote G. Ensuring patient safety through effective leadership behaviour: a literature review. Saf Sci. 2010;48(1):1–17.

    Article  Google Scholar 

  • Leung A, Luu S, Regehr G, Murnaghan ML, Gallinger S, Moulton C-A. “First, Do No Harm.”: balancing competing priorities in surgical practice. Acad Med. 2012;87(10):1368–74.

    Article  PubMed  Google Scholar 

  • Ligi I, Arnaud F, Jouve E, Tardieu S, Sambuc R, Simeoni U. Iatrogenic events in admitted neonates: a prospective cohort study. Lancet. 2008;371(9610):404–10.

    Article  PubMed  Google Scholar 

  • Macdonald AL, Sevdalis N. Patient safety improvement interventions in children’s surgery: a systematic review. J Pediatr Surg. 2016. pii: S0022–3468(16)30415–8.

    Google Scholar 

  • Marsteller JA, Sexton JB, Hsu Y-J, Hsiao C-J, Holzmueller CG, Pronovost PJ, et al. A multicenter, phased, cluster-randomized controlled trial to reduce central line-associated bloodstream infections in intensive care units*. Crit Care Med. 2012;40(11):2933–9.

    Article  PubMed  Google Scholar 

  • Miller G. The magical number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956;63:81–97.

    Article  CAS  PubMed  Google Scholar 

  • Moulton C-AE, Regehr G, Mylopoulos M, MacRae HM. Slowing down when you should: a new model of expert judgment. Acad Med. 2007;82(10 Suppl):S109–16.

    Article  PubMed  Google Scholar 

  • Mullen JE, Kelloway EK. Safety leadership: a longitudinal study of the effects of transformational leadership on safety outcomes. J Occup Organ Psychol. 2010;82(2):253–72.

    Article  Google Scholar 

  • NOTSS: Non-Technical Skills for Surgeons. http://www.abdn.ac.uk/iprc/notss

  • Parker SH, Yule S, Flin R, McKinley A. Surgeons’ leadership in the operating room: an observational study. Am J Surg. 2012;204(3):347–54.

    Article  PubMed  Google Scholar 

  • Porath CL, Erez A. Overlooked but not untouched: how rudeness reduces onlookers’ performance on routine and creative tasks. Organ Behav Hum Decis Process. 2009;109(1):29–44.

    Article  Google Scholar 

  • Rafferty LA, Laura A Rafferty NASAGHW, Stanton NA, Walker GH. The human factors of fratricide (Ebk – Epub). Ashgate Publishing; 2012.

    Google Scholar 

  • Rogers SO, Gawande AA, Kwaan M, Puopolo AL, Yoon C, Brennan TA, et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery. 2006;140(1):25–33.

    Article  PubMed  Google Scholar 

  • Rosenstein AH, O’Daniel M. Impact and implications of disruptive behavior in the perioperative arena. J Am Coll Surg. 2006;203(1):96–105.

    Article  PubMed  Google Scholar 

  • Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34(8):464–71.

    Article  PubMed  Google Scholar 

  • Schimmel EM. The hazards of hospitalization. Ann Intern Med. 1964;60:100–10.

    Article  CAS  PubMed  Google Scholar 

  • Schiøler T, Lipczak H, Pedersen BL, Mogensen TS, Bech KB, Stockmarr A, et al. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr Laeger. 2001;163(39):5370–8.

    PubMed  Google Scholar 

  • Sexton JB, Helmreich RL. Analyzing cockpit communications: the links between language, performance, error, and workload. Hum Perf Extrem Environ. 2000;5(1):63–8.

    CAS  PubMed  Google Scholar 

  • Stahel PF, Sabel AL, Victoroff MS, Varnell J, Lembitz A, Boyle DJ, et al. Wrong-site and wrong-patient procedures in the universal protocol era: analysis of a prospective database of physician self-reported occurrences. Arch Surg. 2010;145(10):978–84.

    Article  PubMed  Google Scholar 

  • Steering Committee on Quality Improvement and Management and Committee on Hospital Care. Policy statement – principles of pediatric patient safety: reducing harm due to medical care. Pediatrics. 2011;127(6):1199–210.

    Article  Google Scholar 

  • Taylor-Adams S, Vincent C. Systems analysis of clinical incidents: the London protocol. Clin Risk. 2004;10(6):211–20.

    Article  Google Scholar 

  • Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322(7285):517–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • de Vries EN, Prins HA, Crolla RM, den Outer AJ, van Andel G, van Helden SH, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med. 2010;363(20):1928–37.

    Article  PubMed  Google Scholar 

  • de Vries-Griever AHG, Meijman TF. The impact of abnormal hours of work on various modes of information processing: a process model on human costs of performance. Ergonomics. 1987;30(9):1287–99.

    Article  Google Scholar 

  • World Health Organisation (W.H.O.) 2008. Safe Surgery Saves Lives. http://who.int/patientsafety/safesurgery/en/

  • Yule SS, Flin RR, Paterson-Brown SS, Maran NN, Rowley DD. Development of a rating system for surgeons’ non-technical skills. Med Educ. 2006;40(11):1098–104.

    Article  CAS  PubMed  Google Scholar 

  • Yule S, Flin R, Maran N, Rowley D, Youngson G, Paterson-Brown S. Surgeons’ non-technical skills in the operating room: reliability testing of the NOTSS behavior rating system. World J Surg. 2008;32(4):548–56.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Paediatric Surgery, University of Aberdeen, Royal Aberdeen Children’s Hospital, Foresterhill, AB25 2ZD, Aberdeen, Scotland, UK

    George G. Youngson

  2. Forth Valley Royal Hospital, Larbert, Scotland, UK

    Craig McIlhenny

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  1. George G. Youngson
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  2. Craig McIlhenny
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Correspondence to George G. Youngson .

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Editors and Affiliations

  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Youngson, G.G., McIlhenny, C. (2016). Surgical Safety in Children. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_27-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_27-1

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  • Print ISBN: 978-3-642-38482-0

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