The effects of surgical checklists on morbidity and mortality: a pre- and post-intervention study.

BACKGROUND: Surgical checklists (SCs) have been developed to enhance teamwork and facilitate handovers, thereby improving the safety of surgical patients in health care organisations. The aim of this study was to determine whether the implementation of a 39-item SC reduced mortality and surgical adverse events (AEs) in patients undergoing inpatient surgery. METHODS: A retrospective pre- and post-intervention study of two cohorts of surgical patients was conducted (n = 1602) in a tertiary teaching hospital. The patients' homogeneity was confirmed by studying 40 comorbidities, 13 analytical determinations and 14 patient- and intervention-related variables. A 39-item SC adapted from one by the World Health Organization was used. The primary endpoint was the occurrence of any AE, including death, within 30 days of the operation. Twenty-three types of AEs were analysed. RESULTS: Following implementation of the checklist, the rate of AEs per 100 patients decreased from 31.5% to 26.5% (P = 0.39), the rate of infectious AEs decreased from 13.9 to 9.6 (P = 0.037) and non-infectious AEs decreased from 17.5 to 16.8 (P = 0.82). For non-elective patients, total AEs decreased from 60.4 to 37.0 (P = 0.017). The proportion of patients with one or more AE decreased from 18.1% to 16.2% (P = 0.35), and the death rate at 30 days decreased from 1.5% to 0.9% (P = 0.35). CONCLUSION: The overall AE rate did not decrease significantly between the two periods. However, the rate of infectious AEs and overall AEs in patients with non-elective admissions had statistically significant reductions. Further research is needed to determine how and in which patients SC introduction can work successfully.

Comparación de las cánulas VAMA(R) y Berman(R) para la intubación fibroscópica orotraqueal en pacientes anestesiados / Comparison between VAMA(R) and Berman(R) cannulas for fibroscopic orotracheal intubation in anaesthetised patients

Objetivos. En la intubación fibroscópica, el hecho de gozar de una visión directa y en tiempo real, no nos asegura el correcto avance del tubo endotraqueal (TET) hasta su posición intratraqueal. El empleo de cánulas orales ayuda a la consecución de una vía aérea libre para el paso del fibroscopio y el TET. Comparamos la cánula VAMA(R) y la cánula Berman(R) en cuanto a tiempo necesario para la intubación, visión fibroscópica y facilidad de paso del TET. Pacientes y método. Noventa pacientes sin criterios de vía aérea difícil fueron randomizados en dos grupos, B y V, según el tipo de cánula empleada. Tras inducir anestesia general, se procedió a la intubación con fibroscopio flexible, midiendo tiempos de fibroscopia e intubación, intentos de fibroscopia, calidad de visión fibroscópica y grado de dificultad en el paso del TET. Resultados. No se obtuvieron diferencias estadísticamente significativas entre ambas cánulas, si bien, la tendencia apuntaba a menores tiempo de intubación (p=0,292) y menor dificultad al paso del TET (p=0,447). Con ambos dispositivos, la calidad de visión fue buena, encontrando únicamente algún grado de obstrucción en la vía aérea en el 22% de los pacientes. En ningún caso esta obstrucción fue total, por lo que todos los pacientes pudieron ser intubados correctamente. Conclusiones. La cánula VAMA® representa una alternativa eficaz a las clásicas cánulas de intubación fibroasistida. Además, su novedoso diseño ofrece ciertas ventajas para la correcta orientación del fibroscopio y la retirada de la cánula tras la intubación (AU)

Objectives. In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA® (V) and Berman® (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. Patients and methods. 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(R) (B) and VAMA(R) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. Results. No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA® group compared to the Berman® group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. Conclusions. The VAMA® cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation(AU)

[Comparison between VAMA(®) and Berman(®) cannulas for fibroscopic orotracheal intubation in anaesthetised patients]. / Comparación de las cánulas VAMA(®) y Berman(®) para la intubación fibroscópica orotraqueal en pacientes anestesiados.

OBJECTIVES: In fibroscopic intubation, the fact of achieving a direct view in real time does not guarantee the correct advance of the endotracheal tube (ET) to its intratracheal position. The use of oral cannulas helps in achieving a free airway in order to pass the fibroscope and the ET. This study compares the VAMA(®) (V) and Berman(®) (B) cannulas as regards the time required for the intubation, fibroscopic view, and the ease in positioning the ET. PATIENTS AND METHODS: 90 patients with no signs of difficult airway were randomised into 2 groups, Berman(®) (B) and VAMA(®) (V), depending on the type of cannula employed. After inducing general anaesthesia, they were intubated using a flexible fibroscope. The fibroscope and intubation times were recorded, as well as the quality of the fibroscopic view, and the level of difficulty in positioning the ET. RESULTS: No statistically significant differences were observed between the cannulas, although the intubation time (P=.292) and the difficulty found in positioning the ET were slightly less (P=.447) in the VAMA(®) group compared to the Berman(®) group. The vision quality was good with both devices, with only some degree of obstruction being encountered in only 22% of the patients. In no case was there complete obstruction, thus all the patients could be intubated correctly. CONCLUSIONS: The VAMA(®) cannula is an effective alternative to the classic cannulas for fibreoptic assisted intubation. Furthermore, the novel design provides advantages for the correct orientation of the fiberscope and the withdrawal of the cannula after intubation.

Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica / The healthcare professional's perceptions on the implementation and usefulness of the surgical safety checklist

Objetivo. Conocer la percepción de los profesionales sobre el grado de utilización y la utilidad del listado de verificación quirúrgica (LVQ) tras su implantación en un hospital terciario. Material y métodos. Estudio descriptivo transversal. Cuestionario autocumplimentado con 5 preguntas sobre utilidad, 5 sobre utilización, 1 pregunta abierta y 4 preguntas de control. La población objetivo: cirujanos, anestesiólogos, enfermeras de planta y de quirófano del hospital. Resultados. La tasa de respuesta fue del 73% (entre el 51 y el 88%, según perfil profesional). El 95,7% de los profesionales manifestó utilizar siempre o casi siempre el LVQ cuando se interviene a un paciente quirúrgicamente. Los profesionales otorgaron al LVQ una utilidad media de 6,6 puntos (escala, 0-10), el 11,6% manifestó que gracias al LVQ se habían evitado errores, el 32,5% consideró que es una herramienta que mejora la comunicación entre los profesionales, y al 68% le gustaría que se cumplimentase el LVQ si ellos mismos fuesen a ser intervenidos. Los profesionales que contestaron que gracias al LVQ se consiguió evitar errores otorgaron valores de utilidad 1,4 puntos por encima de la media, en este mismo grupo, al 100% de los profesionales les gustaría que se utilizase el LVQ en ellos mismos y el 63,2% consideró que mejoraba la comunicación. No hubo diferencias en la utilidad en función de la experiencia profesional o el sexo. Conclusiones. Los profesionales utilizan casi siempre el LVQ y le otorgan una utilidad moderada. Los profesionales que experimentaron que gracias al LVQ se había conseguido evitar errores confirieron al LVQ una utilidad mayor que los que no lo experimentaron(AU)

Objective. To find out the perception of the health care professionals on the level of implementation and the usefulness of the surgical safety checklist (LVQ) after its introduction in a tertiary care hospital. Material and method. A descriptive cross-sectional study was conducted using a specially designed self-completion questionnaire. This consisted of 5 questions on the usefulness, 5 questions on the use of the LVQ, one open question and 4 control questions. The target population was hospital surgeons, anaesthetists, ward nurses, and surgical nurses. Results. The response rate was 73%, ranking from 51% to 88% depending on the respondent profile. Almost all (95.7%) of the respondents declared they always or almost always used the LVQ when performing a surgical operation. The health care professionals rated the usefulness of the LVQ with a mean of 6.6 (scale, 1-10); 11.6% mentioned that actual errors had been avoided through the use of the LVQ; 32.5% considered the LVQ as a tool that improves communication between professionals; and 68% of the respondents declared they would like the LVQ to be used if they were surgical patients. Those respondents who answered that the LVQ had prevented errors gave higher usefulness scores, 1.4 above the mean. In this same group, 100% of the respondents would like the LVQ to be used on themselves and 63.2% considered that communication had improved. There were no differences in usefulness scores as regards professional experience or gender. Conclusions. The health care professionals use the LVQ very frequently, and consider that it has a moderate usefulness. Those professionals with experience of the LVQ preventing errors considered it to be more useful than those who did not experience an error being prevented(AU)

Intubación orotraqueal con laringoscopio óptico Airtraq(R) en pacientes acromegálicos / Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope

Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación (AU)

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route (AU)

[Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope]. / Intubación orotraqueal con laringoscopio óptico Airtraq en pacientes acromegálicos.

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route.

Intubación orotraqueal con laringoscopio óptico Airtraq(R) en pacientes acromegálicos / Orotracheal intubation of patients with acromegaly using the AirTraq laryngoscope

Un exceso de hormona de crecimiento es el responsable del fenotipo característico en los sujetos acromegálicos. La hipertrofia y crecimiento de tejidos también afecta a la vía aérea, con posible dificultad para su tratamiento perioperatorio. Si ya en la población sana los tests predictivos de vía aérea difícil tienen una validez limitada en cuanto a sensibilidad, especificidad y valores predictivos, en pacientes acromegálicos su fiabilidad es aún más dudosa. En la actualidad, los videolaringoscopios y laringoscopios ópticos podrían representar una opción a tener en cuenta para facilitar la intubación en este tipo de pacientes. Presentamos tres pacientes acromegálicos programados para cirugía hipofisaria transesfenoidal, en los que el empleo del laringoscopio óptico Airtraq® permitió la completa visualización de las cuerdas vocales consiguiendo una fácil intubación(AU)

An excess of growth hormone is responsible for the phenotypical characteristics of acromegaly. Tissue hypertrophy and growth also affect the airway, potentially making perioperative management difficult. If tests to foresee the likelihood of difficult airway have limitations affecting their sensitivity, specificity and predictive value even in the normal population, their reliability in patients with acromegaly is still more doubtful. At this time, videoassisted or optical laryngoscopes can offer a way to facilitate intubation in these patients. We report 3 cases in which the AirTraq optical laryngoscope was used to gain a full view of the vocal cords in acromegalic patients scheduled for pituitary surgery by the transsphenoidal route(AU)

[The healthcare professional's perceptions on the implementation and usefulness of the surgical safety checklist]. / Percepción de los profesionales sobre la utilización y la utilidad del listado de verificación quirúrgica.

OBJECTIVE: To find out the perception of the health care professionals on the level of implementation and the usefulness of the surgical safety checklist (LVQ) after its introduction in a tertiary care hospital. MATERIAL AND METHOD: A descriptive cross-sectional study was conducted using a specially designed self-completion questionnaire. This consisted of 5 questions on the usefulness, 5 questions on the use of the LVQ, one open question and 4 control questions. The target population was hospital surgeons, anaesthetists, ward nurses, and surgical nurses. RESULTS: The response rate was 73%, ranking from 51% to 88% depending on the respondent profile. Almost all (95.7%) of the respondents declared they always or almost always used the LVQ when performing a surgical operation. The health care professionals rated the usefulness of the LVQ with a mean of 6.6 (scale, 1-10); 11.6% mentioned that actual errors had been avoided through the use of the LVQ; 32.5% considered the LVQ as a tool that improves communication between professionals; and 68% of the respondents declared they would like the LVQ to be used if they were surgical patients. Those respondents who answered that the LVQ had prevented errors gave higher usefulness scores, 1.4 above the mean. In this same group, 100% of the respondents would like the LVQ to be used on themselves and 63.2% considered that communication had improved. There were no differences in usefulness scores as regards professional experience or gender. CONCLUSIONS: The health care professionals use the LVQ very frequently, and consider that it has a moderate usefulness. Those professionals with experience of the LVQ preventing errors considered it to be more useful than those who did not experience an error being prevented.