RESUMO
BACKGROUND: Communication failure is a common cause of medical errors and adverse events. Within the operating room (OR), there are many barriers to good communication, which can adversely affect patient outcome. OBJECTIVE: Implementing a simple, cost-neutral tool aimed at improving intraoperative communication and engagement. METHODS: Three anaesthesiology residents collected data using a data sheet and tailored surveys distributed to OR staff. Data were collected over a 2-week period in 2019, with 1 week each of preintervention and postintervention data collection. The intervention consisted of wearing OR caps displaying the first name and role of the anaesthesia resident clearly on the front. RESULTS: A total of 20 data sheets and 48 preintervention and postintervention surveys were collected for a response rate of 57%. There was a statistically significant increase in OR staff knowledge of the anaesthesia resident's name (66% vs 100%, p=<0.001), an increase in the mean number of times the surgical providers addressed the anaesthesia residents (3.6 vs 7.8, p=0.0074) and an increase in the mean number of times the surgical providers addressed them by their first name (0.7 vs 4, p=0.0067). Comments received during the intervention were positive with overwhelming support. CONCLUSIONS: This study demonstrated that a simple, cost-effective intervention can result in dramatic improvement in intraoperative communication and engagement between teams.
Assuntos
Anestesiologia/educação , Comunicação , Apresentação de Dados , Comunicação Interdisciplinar , Internato e Residência , Complicações Intraoperatórias/prevenção & controle , Salas Cirúrgicas/organização & administração , Anestesia/métodos , Visualização de Dados , Pesquisa sobre Serviços de Saúde , Humanos , Cuidados Intraoperatórios/métodos , Equipe de Assistência ao Paciente/organização & administração , Melhoria de Qualidade , Procedimentos Cirúrgicos Operatórios/métodosRESUMO
Veno-veno extracorporeal membrane oxygenation (VV ECMO) is used as a bridge to recovery in acute respiratory distress syndrome (ARDS) patients who have reversible lung failure. We present a complication of ECMO cannula placement/position resulting in hemodynamic and oxygenation alterations. These demonstrate principles related to the interaction of the VV ECMO circuit and patient cardio-pulmonary physiology. Consideration and comprehension of pulmonary shunt fraction, ECMO cannula recirculation ratio and ECMO blood flow to cardiac output (CO) ratio are central to continuous assessment and diagnosis of cardio-pulmonary changes encountered during management of VV ECMO.