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1.
J Clin Neurosci ; 92: 67-74, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509265

RESUMO

Errors in communication are a major source of preventable medical errors. Neurosurgical patients frequently present to the neuro-intensive care unit (NICU) postoperatively, where handoffs occur to coordinate care within a large multidisciplinary team. A multidisciplinary working group at our institution started an initiative to improve postoperative neurosurgical handoffs using validated quality improvement methodology. Baseline handoff practices were evaluated through staff surveys and serial observations. A formalized handoff protocol was implemented using the evidence based IPASS format (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, Synthesis by receiver). Cycles of objective observations and surveys were employed to track practice improvements and guide iterative process changes over one year. Surveys demonstrated improved perceptions of handoffs as organized (17.1% vs 69.7%, p < 0.001), efficient (27.0% vs. 72.7%, p < 0.001), comprehensive (17.1% vs. 66.7%, p < 0.001), and safe (18.0% vs. 66.7%, p < 0.001), noting improved teamwork (31.5% vs. 69.7%, p < 0.001). Direct observations demonstrated improved communication of airway concerns (47.1% observed vs. 92.3% observed, p < 0.001), hemodynamic concerns (70.6% vs. 97.1%, p = 0.001), intraoperative events (52.9% vs. 100%, p < 0.001), neurological examination (76.5% vs. 100%, p < 0.001), vital sign goals (70.6% vs. 100%, p < 0.001), and required postoperative studies (76.5% vs. 100%, p < 0.001). Receiving teams demonstrating improved rates of summarization (47.1% vs. 94.2%, p = 0.005) and asking questions (76.5% vs 98.1%, p = 0.004). The mean handoff time during long-term follow-up was 4.4 min (95% confidence interval = 3.9-5.0 min). Standardization of handoff practices yields improvements in communication practices for postoperative neurosurgical patients.


Assuntos
Transferência da Responsabilidade pelo Paciente , Comunicação , Humanos , Unidades de Terapia Intensiva , Erros Médicos , Período Pós-Operatório
2.
J Clin Anesth ; 22(6): 460-5, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20868969

RESUMO

The management of a patient who had previously undergone surgical palliation of tricuspid atresia at the age of two, and who required right parietal craniotomy for resection of seizure focus, is presented. The anesthetic considerations in patients with Fontan physiology are also presented, as well as the impact on patients undergoing neurosurgical procedures, specifically, craniotomy for seizure focus resection. The physiologic demands of modern surgical practice requires that there is a thorough understanding of the complex circulations that exist in patients with congenital heart disease.


Assuntos
Craniotomia/métodos , Técnica de Fontan/métodos , Cardiopatias Congênitas/complicações , Convulsões/cirurgia , Anestesia/métodos , Feminino , Humanos , Convulsões/fisiopatologia , Adulto Jovem
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