Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program.

BACKGROUND: Factors such as ethnicity, gender, and socioeconomic status may play a role in both access to and attrition from bariatric programs before surgery is undertaken. New Zealand (NZ) has high rates of obesity in its Pacific population and the indigenous Maori. These groups also experience poorer health outcomes and therefore have the greatest need for surgery. METHODOLOGY: A retrospective cross-sectional study of 704 people referred for and accepted onto a publicly funded bariatric surgery from 2007 to 2016. The demographic and clinical features of two groups were compared: those that completed surgery successfully (n = 326) and those that dropped out of the program before surgery (n = 378). We also attempted to identify factors associated with attrition. RESULTS: The attrition rate was high (54%), with a significant difference according to gender (men 66% vs 45% women, p < 0.001) and ethnicity (39% in NZ Europeans, 50% in Maori, and 73% in Pacific patients, p < 0.001). Two out of three European women proceeded to surgery, but fewer than one in seven Pacific men. Attrition was associated with having a higher mean BMI and being a smoker. Logistic regression modeling showed that while employment seemed to be protective against attrition for NZ Europeans (p < 0.004), it was not for Pacific patients. CONCLUSIONS: While there was no obvious bias in rates of referral, there is clearly a need for better ways to support Maori and Pacific people, and men in particular, to complete bariatric surgery. Further research is needed to clarify the socio-economic and cultural barriers that underlie this phenomenon.

Correction to: Attrition after Acceptance onto a Publicly Funded Bariatric Surgery Program.

Unfortunately, the original version of this article contained an error. The Methods section's first sentence and Table 1 both mistakenly contained the letters XXXX in place of the district health board and hospital city names.

Turning the tide on medical errors in intensive care units: a human factors approach.

Errors occur in all nursing settings. The current healthcare climate tends to focus on individuals as the cause of errors rather than addressing issues that may be inherently wrong with the healthcare system that predisposes the individual to make errors. Human factors engineering (HFE), which is focused on removing human factors as much as possible from errors, has the potential to greatly impact medical errors in intensive care units. Applied in other high-risk industries, HFE has been critical in understanding and preventing errors at a systems level. Knowledge concerning the role systems play in errors and improvements to medical systems using HFE is intended to empower nurses to be advocates for systems change, resulting in a safer work environment and a safer healthcare delivery system.