Journal of the American College of Surgeons
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The Surgical Safety Checklist (SSC) has been introduced as an effective tool for reducing perioperative mortality and complications. Although reported completion rates are high, objective compliance is not well defined. The purpose of this retrospective analysis is to determine SSC compliance as measured by accuracy and completion, and factors that can affect compliance. ⋯ Our data indicate that although implementation of an SSC results in a high level of overall participation and completion, accuracy remained poor. Identification of barriers to effective use is needed, as improper checklist use can adversely affect patient safety.
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The traditional American Association for the Surgery of Trauma (AAST) grading of renal injury does not adequately identify the subset of patients who are most likely to require intervention for bleeding. Recently, several high-risk criteria (HRC) for bleeding after renal injury were identified, and we sought to externally validate these criteria among patients with grade 4 renal injury. ⋯ Among patients with blunt grade 4 renal injury, the presence of ≥ 2 HRC effectively predicts the need for intervention for hemodynamic instability and can be used to identify patients who require intensive monitoring. The AAST grading system for renal injury should be modified to better reflect injury severity.
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The Japan Advanced Trauma Evaluation and Care (JATEC) education program was introduced in 2002. To examine its effect on the survival of trauma patients, we investigated changes in trauma mortality in Japan in the years after JATEC was introduced. ⋯ Since 2007, mortality has decreased in patients with mild trauma injury; however, mortality was significantly worse for severely injured patients or patients requiring surgical procedures. These findings suggest that definitive trauma care in Japan should be strengthened.