Journal of perioperative practice
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Preoperative briefings and the 'time out' component of the WHO surgical safety checklist offer unique opportunities to improve the technical and non-technical skills of surgical trainees. The addition of a training briefing--a succinct adjunct to these processes--offers a novel method by which training opportunities can be maximised and learning needs better understood by theatre staff. However, more training is needed for staff in the use of briefings and checklists to achieve the best possible benefit for trainees and patients.
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The military hospital at camp bastion Afghanistan is reputed to be the world's busiest trauma centre. Much has been learnt there in the field of managing massive haemorrhage, the protocols used by the military show a significantly higher survival rate than might be expected of such injuries. This article aims to explain the use of rotational thromboelastometry (ROTEM) monitoring and its role in reducing mortality in battle injured trauma patients.
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The World Health Organisation Surgical Safety Checklist (WHO SSC) is a validated tool for reducing in-patient surgical morbidity and mortality. It is not performed universally with full compliance. Two audit cycles were completed at two different trauma and orthopaedic units and compliance was measured. ⋯ Following a change in practice the compliance significantly increased (p>0.00001) at Site 1. The team de-brief was found to be consistently poorly complied with. We recommend regular audit of compliance and change in practice for all surgical units, and suggest national monitoring to ensure the benefits of the WHO checklist are applied to all in-patient surgery.
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This retrospective audit evaluates the compliance of our operation notes with the British Orthopaedic Society Primary Hip Arthroplasty 'A guide to good practice' using a 24-data point question (BOA 2006). Ninety-nine notes reviewed, of which 94% had patient identifiers, the surgical team was documented in 92.5%, post-operative instruction in 97%, and prosthesis stability in 97% of cases. Despite high standards, we did not achieve the 100% gold standard. We suggest that increased awareness of the 24-point BOA guideline via education and proformas would help to ensure better practice
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Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. ⋯ The review concludes that there is a need for guidelines concerning diagnosis and treatment of ED. Risk factors should be investigated further in the clinical setting in the future.