Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training.

BACKGROUND: Although surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence. METHODS: In March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups. RESULT: The surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators. CONCLUSIONS: The results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare.

Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety.

Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor-patient alliance.

Definition of indicators of appropriateness in the management of neovascular age-related macular degeneration: An expert opinion.

Wet age-related macular degeneration is a chronic condition culminating, in most cases, in blindness. The introduction of anti-angiogenic agents in 2006 has represented a major breakthrough in the treatment of the disease, but timely and effective treatment with regular follow-up and monitoring is mandatory to stabilize and preserve visual acuity. In clinical practice, however, appropriate therapy provision is frequently challenged by economic and organizational issues that result in suboptimal visual outcomes and increased incidence of legal blindness. International Guidelines have defined a diagnostic and therapeutic pathway to ensure the best practice in wet age-related macular degeneration management, but reference parameters to evaluate and compare the performance of Retina Centers are lacking. To address the appropriateness of wet age-related macular degeneration management in Italy, a multidisciplinary panel of ten experts gathered in three meetings. They defined three sets of indicators and relative benchmark values that each Center should comply with to ensure patients optimal care already from the first access: (a) clinical intervention indicators, to determine the possible Center's deviation from the diagnostic and therapeutic pathway; (b) outcome indicator, to evaluate the socioeconomic impact of the healthcare systems' performance; (c) management indicators, to test the size of the gap between the Center's supply and demand. Once the indicators have been analyzed, healthcare systems can plan actions to improve appropriateness and monitor their effects. However, to put this in practice, a concerted effort by all parts involved in healthcare provision is required, together with adequate systems to analyze clinical and administrative documentation.

Good medical practices in the use of antibiotic prophylaxis in a surgery ward: Results of a 2013 Apulian study.

This study describes the changes in the performance of health care workers regarding the control of health care-associated infection in a surgical ward of University Hospital Policlinico, Bari, Italy, before and after a training program and adoption of bundles on antibiotic therapy. There were 194 patients recruited (pre: n = 98; post: n = 96), of which 149 (76.8%) had undergone surgery. We documented a change in the proportions of patients who received in-ward prophylactic antibiotics (from 46/98 to 22/96, P < .05), surgical patients undergoing antibiotic prophylaxis in the operating room (from 18/64 to 36/85, P < .05), and average duration of prophylaxis (from 5.9 ± 4.9 to 2.9 ± 2.7 days, P < .0001). Results confirmed correspondence between the intervention and results recorded.

Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009.

INTRODUCTION: In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences. MATERIAL AND METHODS: A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at "Policlinico of Bari" from 1990 to 2009. RESULTS: All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms); 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on); 116 uncertain discrepant diagnoses; 82 unclear diagnoses. CONCLUSIONS: The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.