Patient safety improvement interventions in children's surgery: A systematic review.

BACKGROUND: Adult surgical patient safety literature is plentiful; however, there is a disproportionate paucity of published safety work in the children's surgical literature. We sought to systematically evaluate the nature and quality of patient safety evidence pertaining to pediatric surgical practice. METHODS: Systematic search of MEDLINE and EMBASE databases and gray literature identified 1399 articles. Data pertaining to demographics, methodology, interventions, and outcomes were extracted. Study quality was assessed utilizing formal criteria. RESULTS: 20 studies were included. 14 (70%) comprised peer-reviewed articles. 18 (90%) were published in the last 4years. 13 (65%) described a novel intervention, and 7 (35%) described a modification of an existing intervention. Median patient sample size was 79 (29-1210). A large number (n=55) and variety (n=35) of measures were employed to evaluate the effect of interventions on patient safety. 15 (75%) studies utilized a checklist tool as a component of their intervention. 9 (45%) studies [comprising handoff tools (n=7); checklists (n=1); and multidimensional quality improvement initiatives (n=1)] reported a positive effect on patient safety. Quality assessment was undertaken on 14 studies. Quantitative studies had significantly higher quality scores than qualitative studies (61 [0-89] vs 44 [11-78], p=0.03). CONCLUSIONS: Pediatric surgical patient safety evidence is in its early stages. Successful interventions that we identified were typically handoff tools. There now ought to be an onus on pediatric surgeons to develop and apply bespoke pediatric surgical safety interventions and generate an evidence base to parallel the adult literature. LEVEL OF EVIDENCE: Level IV, Case series with no comparison group.

Learning Curves in Pediatric Minimally Invasive Surgery: A Systematic Review of the Literature and a Framework for Reporting.

AIMS: There exists a learning curve (LC) with the adoption of any minimally invasive surgical (MIS) technique with implications for training, implementation, and evaluation. A standardized approach to describing and analyzing LCs in pediatric MIS is lacking. We sought to determine how pediatric MIS LCs are quantified and present a framework for reporting. METHODS: Systematic search of MEDLINE and EMBASE 1985-October 2015 for articles describing MIS in the pediatric population and presenting formal analysis of the LC. Articles screened by two independent reviewers. RESULTS: Twenty-nine articles (n = 17 general abdominal/thoracic, n = 12 urological) from an 18-year period (1997-2015) were included representing 3345 procedures (n = 3116 laparoscopic, n = 10 thoracoscopic, n = 219 robotic). Seven (24%) were prospective, three multicenter. Twenty-two (76%) presented data pertaining to >1 operating surgeon. Operative time was the most commonly employed surrogate of proficiency (n = 26 [90%] studies). Twenty (69%) described >1 LC outcome measure. Sixteen additional measures were described, including conversion (n = 12 studies); blood loss (n = 4 studies); complications (n = 10 studies); and postoperative outcomes (n = 14 studies). Three studies assessed impact of LC on trainees and one considered economic impact. LCs were presented in tabular form (n = 14 studies) and graphically (n = 19). Eleven (38%) studies undertook statistical appraisal utilizing comparative statistics (n = 8 studies) and regression analysis (n = 4 studies). CONCLUSIONS: Multiple outcome measures of proficiency are employed in reporting pediatric MIS experience and analysis of LCs is inconsistent. A standardized multioutcome approach to reporting should be encouraged. In addition, attempts should be made to quantify the impact on trainee involvement. We present an idealized framework for reporting.

Contemporary pediatric surgical training in the UK.

INTRODUCTION: Pediatric surgical trainees worldwide face pressures from expansion of programs and training positions, subspecialization, regionalization, restrictions of working hours, and rigid training criteria. The era of apprenticeship training has long gone, and surgical education needs to be responsive and adapt to newer challenges. The aim of this study was to examine the teaching provision component of pediatric surgical training in the UK. METHOD: A national teaching survey was sent to UK pediatric surgery trainees in 2010 and compared to results of a repeat survey in 2015. Analysis was carried out to compare type of teaching, trends in teaching delivery, quality, and attendance over time. RESULTS: Regional variability was noted in teaching programs. Both provision of educational activities and ability to attend teaching improved between 2010 and 2015. Despite this, overall trainee satisfaction remained low, with 50% and 52% of respondents describing their teaching as "good" or "excellent" in 2010 and 2015, respectively (P=0.84). Seventy-five percent of centers provided simulation training, and 25% of respondents had regional teaching provided. Survey response rate was comparable between 2010 and 2015. CONCLUSION: Variability in national educational provision was observed. We suggest regular national audit of educational activity and responsive adaption to external pressures on training if competent surgeons are to be the product of contemporary pediatric surgery training programs.

Outcome of abstracts presented at the British Association of Paediatric Surgeons congresses (1999-2008).

BACKGROUND: Abstracts presented at the British Association of Paediatric Surgeons annual congress have the potential to influence practice. However, it is not known what percentage of accepted abstracts actually go on to withstand peer review and be published in the literature. METHODS: Abstract books were reviewed for the period 1999 to 2008. A MEDLINE search using keywords from title and authors' names was used to identify subsequent publication. Categorical analysis for variation and trend with P < .05 was accepted as significant. Data were expressed as median (interquartile range). RESULTS: During the 10-year period, 862 abstracts were presented orally and were derived from 36 countries, with a median of 18 (17-19) countries represented each year. Of these, 375 (43%) abstracts originated from 25 United Kingdom (UK) institutions with most (45%) from London and specifically the Institute of Child Health/Great Ormond Street Hospital (n = 118, 14%). The annual median number of presentations was 81 (74-97). This fell during the first half of the decade but is now rising with a significant increase in the UK proportion (P = .001). Thirty (27-35) abstracts per year (overall, n = 302) were subsequently published with the proportion (36% [33%-39%]) remaining remarkably consistent over the period. Abstracts were published in a range of 26 journals, but most (69%) were published in the Journal of Pediatric Surgery. CONCLUSIONS: The publication rate of the British Association of Paediatric Surgeons congress and hence entry into the "evidence base" as published material is consistent at just over one third of submissions. Whether this represents a waste of scientific endeavor or further refinement of quality is a moot point.