Clinical Interest and Economic Impact of Preoperative SMS Reminders before Ambulatory Surgery: A Propensity Score Analysis.

Patient contact by telephone the day before ambulatory surgery is considered as a best practice. The Short Message Service (SMS) could be a suitable alternative. The objective of this prospective study was to evaluate the interest of preoperative instruction (PI) reminders by SMS compared to telephone calls. This was a prospective single center before-and-after study. Patients scheduled in ambulatory surgery were included during 2 consecutive periods of 10 weeks. The "Call" group received a telephone call for preoperative instructions (PI) and the "SMS" group received an automated protocol SMS reminder. The primary endpoint was patient compliance with PI and time of convocation. The two populations were compared with a non-inferiority hypothesis and the impact of the contact modality on compliance with the PI was assessed using a propensity score. The analysis concerned 301 patients in the Call group and 298 in the SMS group. The absence of dysfunction was observed in 75% of patients in the SMS group compared with 61% in the Call group (Risk difference: 14% [95%CI: 7-21]). The use of SMS was associated with a significant improvement in compliance with the PI (Odds ratio: 1.90 [1.48-2.42]; p < 0.0001). Patient satisfaction was similar regardless of the method of PI reminders. The automation of preoperative SMS reminders is associated with a better respect of the PI compared to the conventional calling method. This PI reminder method satisfies the majority of patients and may have a favorable financial impact.

Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study.

BACKGROUND: Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts. METHODS: An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest). RESULTS: A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths. CONCLUSIONS: In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.

Pre-anaesthesia Telephone Consultation: A Safe Alternative for Anaesthesia Assessment in Case of Repeated Low or Intermediate Risk Surgeries: A Prospective Cohort Study.

Objective: Telemedicine has widely expanded during the coronavirus disease-2019 pandemic. Our objective was to evaluate the feasibility, safety, effectiveness, and satisfaction of pre-anaesthesia telephone consultation (PATC). Methods: From December 2015 to October 2016, a prospective survey was administered to anaesthesiologists, nurse anaesthetists, and patients of the ambulatory and maxillofacial departments. Patients having a pre-anaesthesia consultation (PAC) within the previous year in the department, whose health state was considered stable, and for whom the surgical procedure was related to the previous one, were eligible for PATC. Three questionnaires concerning the pre- (Q1), per- (Q2), and postoperative (Q3) periods were answered by the patient, the anaesthesiologist, and the anaesthesiologist nurse to evaluate the feasibility and satisfaction of the PATC. We collected the cancelation rate and any incident occurring during the surgery. Results: Over the study period, 210 patients were included. The response rate was 200/210 (95.2%) for Q1, 108/208 (51.9%) for Q2 and 146/208 (70.2%) for Q3. PATC was performed in a median (IQR) of 13 (7-20) days before the procedure. Patients answered directly in 73% of cases without the need for recall. During surgery, 4 incidents occurred and none were attributable to PATC. Patient satisfaction was 93.3% and 85.8% of them preferred PATC to conventional PAC. The kilometric saving was 74 (30-196) km per PATC. Conclusion: Both patients and professionals were satisfied with PATC, which did not impact safety. On the selected patients, PATC brings many practical benefits and increases organizational flexibility.

Insurance Claims for Wrong-Side, Wrong-Organ, Wrong-Procedure, or Wrong-Person Surgical Errors: A Retrospective Study for 10 Years.

OBJECTIVE: Serious adverse events, such as wrong-side, wrong-organ, wrong-procedure, or wrong-person errors, still occur despite the implementation of preventative measures. In France, we describe the claims related to such errors based on the database from one of the main insurance companies. METHODS: A retrospective analysis of claims declared between January 2007 and December 2017 to Relyens, a medical liability insurance company (Sham), was performed. Their database was queried using the following keywords: "wrong side," "wrong organ," and "wrong person." RESULTS: We collected 219 claims (0.4% of the total claims). The main specialties involved were orthopedics (34% of cases), neurosurgery (14%), and dentistry (14%). The claims were related to wrong organ (44%), side (39%), identity (13%), or procedure (4%). Juridical entity involved were mainly public facility (69%), followed by private facility (19%) or private physician (10%). The mean number of annual claims made has decreased of 20% since the mandatory implementation of the checklist in 2010 (22 versus 17.5 events per year). The main risk factors identified according to the ALARM protocol were factor related to the team (87%) or to the task to accomplish (78%). A direct causal factor was involved in 20% of the files, the main one being the organization (43%) closely related to the medical file (36%). The settlement was performed by conciliation in 69% of the claim and in court in 30%. The compensation was higher during a court settlement. CONCLUSIONS: Wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors are rare but fully preventable by the implementation of a safety culture.

Multitasking in postanesthesia care unit following nurse interruptions, an analysis of the causes and consequences using classification tree: an observational prospective study.

BACKGROUND: Postanesthesia Care Unit (PACU) is an environment associated with an important workload which is susceptible to lead to task interruption (TI), leading to task-switching or concurrent multitasking. The objective of the study was to determine the predictors of the reaction of the nurses facing TI and assess those who lead to an alteration of the initial task. METHODS: We conducted a prospective observational study into the PACU of a university hospital during February 2017. Among 18 nurses, a selected one was observed each day, documenting for each TI the reaction of the nurse (task switching or concurrent multitasking), and the characteristics associated with the TI. We performed classification tree analyses using C5.0 algorithm in order to select the main predictors of the type of multitasking performed and the alteration of the initial task. RESULTS: We observed 1119 TI during 132 hours (8.5 TI/hour). The main reaction was concurrent multitasking (805 TI, 72%). The short duration of the task interruption (one minute or less) was the most important predictor leading to concurrent multitasking. Other predictors of response to TI were the identity of the task interrupter and the number of nurses present. Regarding the consequences of the task switching, long interruption (more than five minutes) was the most important predictor of the alteration of the initial task. CONCLUSIONS: By analysing the predictors of the type of multitasking in front of TI, we propose a novel approach to understanding TI, offering new perspective for prevention strategies.

[Interest of enhanced recovery programs in the elderly during total hip arthroplasty A systematic review]. / Utilité des programmes de réhabilitation améliorée chez le sujet âgé lors des arthroplasties totales de hanche Revue systématique de la littérature.

Enhanced recovery after surgery (ERAS) is an evident advance in the management of patients. Its feasibility and its effectiveness have been little analyzed in elderly's orthopedics. The aim of this systematic review of the literature was to analyze the feasibility (realization of classic ERAS items) and the efficiency (length of stay, morbidity and mortality) of ERAS in the elderly during total arthroplasty hip. MATERIALS AND METHODS: A bibliographic search was performed with PubMed, Medline, CINAHL, Cochrane and Embase, using keywords "total hip arthroplasty", "orthopedics surgery", "fast track", "enhanced recovery after surgery", and" elderly ". Seventy-two articles were listed and 47 fully analyzed by 2 independent authors. RESULTS: Thirty-two articles were selected. All the articles demonstrated ERAS feasibility in the elderly. The most frequently performed items were: preoperative information, spinal anesthesia and local or regional anesthetic infiltrations, multimodal analgesia with opioids sparing. Early stand-up is desirable but more difficult to achieve than in younger. Compared with traditional management, ERAS decreases the average length of stay without increasing complications, re-admissions and mortality rates. Medico-economic analyzes would be in favor of a reduction in the overall cost. The elderly's adherence to ERAS program depends on information's quality provided at the time of the consultation. CONCLUSION: The application of ERAS program in total hip arthroplasty in the elderly is feasible and efficient to reduce hospital stay and morbidity without increasing the complication rates. Protocols must be adapted to the particularities of this population.

Multitasking in postanesthesia care unit following nurse interruptions, an analysis of the causes and consequences using classification tree: an observational prospective study

Abstract Background: Postanesthesia Care Unit (PACU) is an environment associated with an important workload which is susceptible to lead to task interruption (TI), leading to task-switching or concurrent multitasking. The objective of the study was to determine the predictors of the reaction of the nurses facing TI and assess those who lead to an alteration of the initial task. Methods: We conducted a prospective observational study into the PACU of a university hospital during February 2017. Among 18 nurses, a selected one was observed each day, documenting for each TI the reaction of the nurse (task switching or concurrent multitasking), and the characteristics associated with the TI. We performed classification tree analyses using C5.0 algorithm in order to select the main predictors of the type of multitasking performed and the alteration of the initial task. Results: We observed 1119 TI during 132 hours (8.5 TI/hour). The main reaction was concurrent multitasking (805 TI, 72%). The short duration of the task interruption (one minute or less) was the most important predictor leading to concurrent multitasking. Other predictors of response to TI were the identity of the task interrupter and the number of nurses present. Regarding the consequences of the task switching, long interruption (more than five minutes) was the most important predictor of the alteration of the initial task. Conclusions: By analysing the predictors of the type of multitasking in front of TI, we propose a novel approach to understanding TI, offering new perspective for prevention strategies.

[Surgeons-anesthetists relations: From an individual responsibility of the surgeon to a shared responsibility with the anesthetist]. / Relations chirurgiens/anesthésistes-réanimateurs : d'une responsabilité individuelle du chirurgien à une responsabilité partagée avec l'anesthésiste-réanimateur.

Throughout the perioperative period, anesthetists and surgeons jointly provide care for patients. The advances in medicine and surgery, the practice of perioperative quality medicine and the recent application of enhanced recovery program after surgery have necessitated strengthening the place of each in its area of expertise while developing the spirit team and communication. Thus, alongside the surgeon who was once considered the head of the surgical team, the anesthetist's role has been to consolidate for the management of the surgical patient and had his spot empower themselves in the eye of the patient with the birth an own contract with the patient (due in particular to the obligation to preanesthetic consultation by the decree of December 5, 1994). This has led to a new division of responsibility between these actors: jurisprudence has abandoned the exclusive responsibility of the surgeon, devoted own responsibility of the anesthetist with a division (if any) of responsibility between the anesthetist and the surgeon.

The liability of the anaesthesiologist in ambulatory surgery.

With the development of ambulatory surgery, there may be questions about the legal risk of this procedure. Indeed, the discharge of the patient from the hospital on the same day as the medical treatment raises the problem of monitoring and supervising potential complications, with a substantial delay in medical care, and the anaesthesiologists can be confronted with new areas of liability. This article specifies the French statutory and legal framework of the ambulatory surgery, and shows how the responsibility of the anaesthesiologist can be involved during patient care at all steps. The analysis of judicial precedent shows that the legal risk for the anaesthesiologist also exists in outpatient surgery. Surgery and anaesthesia are medical procedures involving a relatively high risk of damage for the patient. The damage can be attributed to malpractice from one or several health care professionals or to a medical complication (abnormal damage not related to malpractice and independent of past medical history of the patient). In the light of the ongoing and significant development in ambulatory surgery, there may be questions about the legal risk of this procedure. Indeed, the discharge of the patient from the hospital on the same day as the medical treatment raises the problem of monitoring and supervising potential complications, with a substantial delay in medical care. If the patient suffers any damage, the surgeon, the anaesthesiologist and in some cases, the hospital will have to answer in courts: the surgeon for the surgical procedure, the anaesthesiologist for the medical care and the hospital as the liable institution. After having specified the statutory framework of ambulatory surgery, we will see how the responsibility of the anaesthesiologist can be involved during patient care at all steps.