Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.

Is perioperative home the future of surgical patient care?

Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.

Reengineering Surgical Patient Transfer and Handover Process in Operating Room

Objective:To reform the transfer process of surgical patients,standardize the transfer process,and improve the quality of safe transfer;unify the intrahospital transfer process to achieve standardized management;ensure patient safety,improve work efficiency,and reduce the occurrence of adverse events.Methods:A transfer team was formed,a handover record sheet for surgical patients was designed,and the workflow and specifications for handover and transfer of surgical patients were formulated.Results:After using the re-designed handover record sheet for surgical patients and improving the procedure for transferring surgical patients,the accuracy of surgical patient handover was ensured,the handover and transfer time was shortened,and the surgical turnover rate improved.Conclusion:By designing and reforming the service model,it is possible to change and standardize the transfer process of surgical patients and improve the quality of safe transfer,the operating room management system so that it is more rational and humanized,the management model,the working environment,as well as the overall quality and efficiency of operating room nursing.

Identification of surgical patients at high risk of OSAS using the Berlin Questionnaire to detect potential high risk of adverse respiratory events in post anesthesia care unit

Obstructive sleep apnea syndrome （OSAS） increases the risk of post-surgery complications. This study uses Berlin Questionnaire （BQ） to identify Chinese adult surgical patients who are at a high risk of OSAS and to determine if the BQ could be used to detect potential high risk of adverse respiratory events in the post anesthesia care unit （PACU）. Results indicated that only 11.4% of the patients were considered at a high risk of OSAS. Age and body mass index are the key factors for the risk of OSAS prevalence in China and also gender specific. Furthermore, the incidence of adverse respiratory events in the PACU was higher in patients with high risk of OSAS than others （6.8% vs. 0.9%, P 〈 0.001）. They also stayed longer than others in the PACU （95 ~ 28 min vs. 62 ~ 19 min, P 〈 0.001）. Age, high risk for OSAS, and smoking were independent risk factors for the occurrence of adverse respiratory events in the PACU. The BQ may be adopted as a screening tool for anesthesiologists in China to identify patients who are at high risk of OSAS and determine the potential risk of developing postoperative respiratory complications in the PACU.

Adjustable muscle plication:a new surgical technique for strabismic patients with high risk for anterior segment ischemia

【正】INTRODUCTION Anterior ciliary arteries provide 70%of the vascular supply of the anterior segment.A significant interruption of the vascular flow of these arteries increases the risk for anterior ischemia.Although the frequency of this special condition is low after strabismus surgery(1:13 000)[1],its effects may involve substantial visual problems[2].We report the successful outcome of a new surgical approach for strabismus management in a case of high risk for anterior ischemia.Specifically,we show the correction of the horizontal ocular deviation by means of an adjustable muscle

Surgical results and prognosis of patients with primary bronchogenic carcinoma aged less than 30 years

Objective To investigate and analyze the clinical and pathological features of surgical treatment for primary bronchogenic carcinoma in adolescent patients. Methods A retrospective review is presented of patients less than 30 years with surgical treatment of bronchogenic

Surgical treatment of spinal tuberculosis in older patients

Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal

Prevalence and Associations of Hepatitis B Seropositivity in a Rural African Ophthalmic Surgical Population

Objective: Globally, Hepatitis B virus (HBV) infection remains a public health issue. It is a major cause of morbidity and mortality, especially in developing countries. Working in a healthcare setting particularly in low resource area is a major risk factor for contracting HBV infection. Despite this, routine pre-operative screening for HBV infection has not yet practiced in many Nigerian hospitals. This study assessed the prevalence and associations of hepatitis B seropositivity in a rural south-eastern Nigerian population of ophthalmic surgical patients. Methods: This was a prospective cross-sectional survey of ophthalmic surgical patients at the Presbyterian Joint Hospital—a rural missionary eye care facility in south-eastern Nigeria, conducted between December 2012 and June 2013. Participant’s socio-demographic and clinical data and result of screening for hepatitis B surface antigen (HbSAg) were collected. Results: The participants (n = 100;males, 40;females, 50) were aged 52.9 SD ± 15.4 (range 1 - 88 years). They were predominantly farmers—45% and traders—26% who had cataract—58% and glaucoma—16% as their leading clinical diagnosis indicating ophthalmic surgical intervention. Of them only 2 (2.0%) were sero-positive for HbSAg. HBV seropositivity was not associated with age, gender or occupation. Conclusion: Though the prevalence of hepatitis B viral infection is low in this study, universal measures to prevent cross infection of the healthcare worker is indicated.