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Surgical Quality and Safety: Current Initiatives and Future Directions

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The SAGES Manual Transitioning to Practice

Abstract

More than a decade ago, the Institute of Medicine released a comprehensive report “To Err is Human: Building a Safer Health System,” addressing issues related to patient safety and laying out an ambitious national agenda for reducing errors in healthcare and improving patient safety. This groundwork led to the recognition that most medical errors were the result of communication barriers and system failures. Since then, initiatives towards re-designing system processes have made tremendous strides in reducing the number of medical errors and adverse events. This chapter discusses the current topics around patient safety including government initiatives, public reporting, human factors in surgery, surgery checklists, crew resource management, resident duty hours, and physician burnout.

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References

  1. Centers for Disease Control and Prevention. National Hospital Discharge Survey: 2010 table, Procedures by selected patient characteristics—number by procedure category and age. Atlanta: CDC; 2010.

    Google Scholar 

  2. Mills DH. Report of the medical insurance feasibility study. San Francisco: California Medical Association; 1977.

    Google Scholar 

  3. Couch NP, Tilney NL, Rayner AA, Moore FD. The high cost of low-frequency events: the anatomy and economics of surgical mishaps. N Engl J Med. 1981;304(11):634–7.

    Article  CAS  PubMed  Google Scholar 

  4. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care. 2004;13(2):145–51. discussion 151–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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 

  6. Leape LL, Lawthers AG, Brennan TA, Johnson WG. Preventing medical injury. QRB Qual Rev Bull. 1993;19(5):144–9.

    Article  CAS  PubMed  Google Scholar 

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

    Google Scholar 

  8. AHRQ. Patient Safety and Quality Improvement Act of 2005. Agency for Healthcare Research and Quality; 2008. http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html.

  9. Center for Medicare and Medicaid. Acute care episode demonstration. http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html. 2008.

  10. Herman B. 2 major lessons from CMS’ bundled payment ACE demonstration. Becker’s Hospital Review. http://www.beckershospitalreview.com/hospital-physician-relationships/2-major-lessons-from-CMS-bundled-payment-ace-demonstration.html.

  11. Vesely R. An ACE in the deck? Bundled-payment demo shows returns. Mod Healthc. 2011;41(6):32–3.

    Google Scholar 

  12. U.S. Department of Health & Human Services. Key features of the affordable care act by year. http://www.hhs.gov/healthcare/facts-and-features/key-features-of-aca-by-year/index.html. Accessed Nov 22, 2015.

  13. Bundled Payments for Care Iniative (BCPI) overview: general information. Center for Medicare and Medicaid Services. http://innovation.cms.gov/initiatives/bundled-payments/.

  14. Centers for Medicare and Medicaid Services. Readmissions reduction program. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed Nov 22, 2015.

  15. The Official U.S. Government Site for Medicare. https://www.medicare.gov/hospitalcompare/data/total-performance-scores.html. 2015.

  16. Hospital-acquired Condition Reduction Program. The Official U.S. Government Site for Medicare. https://www.medicare.gov/hospitalcompare/HAC-reduction-program.html. Accessed Nov 22, 2015.

  17. AHRQ. Guide to the prevention quality indicators. Agency for Healthcare Research and Quality 2006; Sages Patient Safety Chapter 11.22.docx Accessed Nov 22, 2015.

    Google Scholar 

  18. AHRQ. Guide to inpatient quality indicators. Agency for Healthcare Research and Quality 2006. http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V30/iqi_guide_v30.pdf. Accessed Nov 22, 2015.

  19. AHRQ. Guide to patient safety indicators. AHRQ for Healthcare Research and Quality 2007; http://www.qualityindicators.ahrq.gov/Downloads/Modules/PSI/V31/psi_guide_v31.pdf. Accessed Nov 22, 2015.

  20. AHRQ. Agency for Healthcare Research and Quality. U.S. Department of Health & Human Services. http://www.ahrq.gov, 2015.

  21. Cima RR, Lackore KA, Nehring SA, et al. How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution. Surgery. 2011;150(5):943–9.

    Article  PubMed  Google Scholar 

  22. Kaafarani HM, Borzecki AM, Itani KM, et al. Validity of selected Patient Safety Indicators: opportunities and concerns. J Am Coll Surg. 2011;212(6):924–34.

    Article  PubMed  Google Scholar 

  23. Koch CG, Li L, Hixson E, Tang A, Phillips S, Henderson JM. What are the real rates of postoperative complications: elucidating inconsistencies between administrative and clinical data sources. J Am Coll Surg. 2012;214(5):798–805.

    Article  PubMed  Google Scholar 

  24. Romano PS, Mull HJ, Rivard PE, et al. Validity of selected AHRQ patient safety indicators based on VA National Surgical Quality Improvement Program data. Health Serv Res. 2009;44(1):182–204.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Utter GH, Cuny J, Strater A, Silver MR, Hossli S, Romano PS. Variation in academic medical centers’ coding practices for postoperative respiratory complications: implications for the AHRQ postoperative respiratory failure Patient Safety Indicator. Med Care. 2012;50(9):792–800.

    Article  PubMed  Google Scholar 

  26. TOPS (Tracking Operations and Outcomes for Plastic Surgeons). American Society of Plastic Surgeons. http://www.plasticsurgery.org/for-medical-professionals/quality-and-health-policy/tops.html. Accessed Nov 22, 2015.

  27. American College of Surgeons. National Cancer Data Base. https://www.facs.org/quality programs/cancer/ncdb. Accessed Nov 22, 2015.

  28. Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA. 2015;313(5):496–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Etchells E, O’Neill C, Bernstein M. Patient safety in surgery: error detection and prevention. World J Surg. 2003;27(8):936–41. discussion 941–32

    Article  PubMed  Google Scholar 

  30. Weigmann D, Shappell S. A human error approach to aviation accident analysis: the human factors analysis and classification system. Farnham: Ashgate; 2003.

    Google Scholar 

  31. Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient safety: the SEIPS model. Qual Saf Health Care. 2006;15(Suppl 1):i50–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Fanning J. Illumination in the operating room. Biomed Instrum Technol. 2005;39(5):361–2.

    PubMed  Google Scholar 

  33. Healey AN, Sevdalis N, Vincent CA. Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics. 2006;49(5–6):589–604.

    Article  CAS  PubMed  Google Scholar 

  34. Ofek E, Pizov R, Bitterman N. From a radial operating theatre to a self-contained operating table. Anaesthesia. 2006;61(6):548–52.

    Article  CAS  PubMed  Google Scholar 

  35. Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143(1):12–7. discussion 18

    Article  PubMed  Google Scholar 

  36. 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 

  37. Moffatt-Bruce SD, Hefner JL, Mekhjian H, et al. What is the return on investment for implementation of a crew resource management program at an Academic Medical Center? Am J Med Qual. 2015.

    Google Scholar 

  38. Pettker CM, Thung SF, Norwitz ER, et al. Impact of a comprehensive patient safety strategy on obstetric adverse events. Am J Obstet Gynecol. 2009;200(5):492.e1–8.

    Article  Google Scholar 

  39. Haynes AB, Weiser TG, Berry WR, 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 

  40. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.

    Article  CAS  PubMed  Google Scholar 

  41. Fudickar A, Horle K, Wiltfang J, Bein B. The effect of the WHO Surgical Safety Checklist on complication rate and communication. Dtsch Arztebl Int. 2012;109(42):695–701.

    PubMed  PubMed Central  Google Scholar 

  42. Gelfand DV, Podnos YD, Carmichael JC, Saltzman DJ, Wilson SE, Williams RA. Effect of the 80-hour workweek on resident burnout. Arch Surg. 2004;139(9):933–8. discussion 938–40

    Article  PubMed  Google Scholar 

  43. Wetzel CM, Kneebone RL, Woloshynowych M, et al. The effects of stress on surgical performance. Am J Surg. 2006;191(1):5–10.

    Article  PubMed  Google Scholar 

  44. Wiggins-Dohlvik K, Stewart RM, Babbitt RJ, Gelfond J, Zarzabal LA, Willis RE. Surgeons’ performance during critical situations: competence, confidence, and composure. Am J Surg. 2009;198(6):817–23.

    Article  PubMed  Google Scholar 

  45. Wetzel CM, Black SA, Hanna GB, et al. The effects of stress and coping on surgical performance during simulations. Ann Surg. 2010;251(1):171–6.

    Article  PubMed  Google Scholar 

  46. Borman KR, Jones AT, Shea JA. Duty hours, quality of care, and patient safety: general surgery resident perceptions. J Am Coll Surg. 2012;215(1):70–7. discussion 77–9

    Article  PubMed  PubMed Central  Google Scholar 

  47. Bilimoria KY, Chung JW, Hedges LV, et al. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016;374(8):713–27.

    Article  CAS  PubMed  Google Scholar 

  48. Maslach C, Jackson SE. Burnout in health professionals: a social psychological analysis. Social Psychology of Health and Illness: Hillsdale; 1982.

    Google Scholar 

  49. Elmore LC, Jeffe DB, Jin L, Awad MM, Turnbull IR. National Survey of Burnout among US General Surgery Residents. J Am Coll Surg. 2016;223(3):440–51.

    Article  PubMed  Google Scholar 

  50. Medscape 2016: Bias and burnout. Lifestyle Report. http://www.medscape.com/features/slideshow/lifestyle/2016/public/overview. Accessed Sept 30, 2016.

  51. Gundersen L. Physician burnout. Ann Intern Med. 2001;135(2):145–8.

    Article  CAS  PubMed  Google Scholar 

  52. O’Connor PG, Spickard Jr A. Physician impairment by substance abuse. Med Clin North Am. 1997;81(4):1037–52.

    Article  PubMed  Google Scholar 

  53. Vaillant GE, Sobowale NC, McArthur C. Some psychologic vulnerabilities of physicians. N Engl J Med. 1972;287(8):372–5.

    Article  CAS  PubMed  Google Scholar 

  54. Olson K, Kemper KJ, Mahan JD. What factors promote resilience and protect against burnout in first-year pediatric and medicine-pediatric residents? J Evid Based Complementary Altern Med. 2015;20(3):192–8.

    Article  PubMed  Google Scholar 

  55. Kemper KJ, Khirallah M. Acute effects of online mind-body skills training on resilience, mindfulness, and empathy. J Evid Based Complementary Altern Med. 2015;20(4):247–53.

    Article  PubMed  Google Scholar 

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Correspondence to Susan D. Moffatt-Bruce M.D., Ph.D., F.A.C.S. .

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Nguyen, M.C., Moffatt-Bruce, S.D. (2017). Surgical Quality and Safety: Current Initiatives and Future Directions. In: Renton, D., Nau, P., Gee, D. (eds) The SAGES Manual Transitioning to Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-51397-3_9

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  • DOI: https://doi.org/10.1007/978-3-319-51397-3_9

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