BMJ quality & safety
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BMJ quality & safety · Jul 2011
ReviewTowards a model of surgeons' leadership in the operating room.
There is widespread recognition that leadership skills are essential for effective performance in the workplace, but the evidence detailing effective leadership behaviours for surgeons during operations is unclear. ⋯ Ten relevant articles were identified and organised by method of investigation into (i) observation, (ii) questionnaire and (iii) interview studies. This review summarises the limited literature on surgeons' intraoperative leadership, and proposes a preliminary theoretically based structure for intraoperative leadership behaviours. This structure comprises seven categories with corresponding leadership components and covers two overarching themes related to task- and team-focus. Selected leadership theories which may be applicable to the operating room environment are also discussed. Further research is required to determine effective intraoperative leadership behaviours for safe surgical practice.
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BMJ quality & safety · Jul 2011
A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes.
Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraoperative non-routine events (NREs) can escalate to more serious situations and that effective teamwork can prevent the development of serious situations were examined to develop a method to assess these skills and to provide evidence for improvements in training and performance. ⋯ Structured observation of effective teamwork in the operating room can identify substantive deficiencies in the system and conduct of procedures, even in otherwise successful operations. High performing teams are more resilient displaying effective teamwork when operations become more difficult.
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BMJ quality & safety · Jul 2011
The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: a retrospective cohort study.
Patient safety studies have identified older adults as a high-risk group for adverse events (AEs). As frequent users of the emergency department (ED), they are vulnerable to the negative consequences of ED crowding. The study objective was to determine whether a prolonged ED stay is associated with an increased risk for the occurrence of AEs for older patients admitted to hospital. ⋯ A prolonged ED stay for older admitted patients is associated with an increased risk of an in-hospital AE. The longer hospital LOS associated with AEs further reduces the availability of acute care beds, thus exacerbating ED crowding.
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BMJ quality & safety · Jul 2011
Student-observed surgical safety practices across an urban regional health authority.
Recognising the global push for patient safety in healthcare, students in medicine and nursing participated in a project to compare surgical safety practices in the Winnipeg Regional Health Authority (WRHA) with the WHO surgical safety checklist. ⋯ Surgical safety practices in ORs across the WRHA are consistent with the guidelines established by the WHO in 2007, but most are not monitored or enforced. The use of a checklist in the preoperative briefing period may improve adherence to these guidelines and facilitate surgical team interaction, resulting in standardisation of practice and improvements in team communication. Student interprofessional team observers are an effective tool for monitoring safety and teamwork.
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BMJ quality & safety · Jul 2011
No-fault compensation for treatment injury in New Zealand: identifying threats to patient safety in primary care.
In 2005, the injury compensation legislation in New Zealand was reformed to extend coverage for medical injury removing both 'error' and 'severity' from eligibility criteria. This led to an increase in claiming and claims acceptance rate, thus enlarging the treatment injury claims database. This database provides an unusual 'no-fault' perspective of patient safety events. ⋯ New Zealand's no-fault treatment injury claims database provides information about primary care patient safety events from an unusual 'no-fault' perspective. This analysis reinforces previous research identifying medication as a high-risk primary care activity and further identifies other primary care activities (dental care, injections, venepuncture, cryotherapy and ear syringing) as carrying important risks for patient harm.