CLIMA DE SEGURIDAD EN EL CENTRO QUIRÚRGICO: ACTITUDES DE LOS PROFESIONALES DE SALUD

Objective: to evaluate the attitudes of healthcare professionals in an operating room regardingthe safety climate.Method: a cross-sectional study carried out in the operating room of a philanthropic hospitalin southern Brazil, with 107 healthcare professionals. Data collection was performed using theSafety Attitudes Questionnaire, operating room version, with a satisfactory score equal to orgreater than 75, from December 2016 to February 2017. For data analysis we used descriptivestatistics, correlation, and factor analysis.Results: the professionals’ perceptions of safety climate ranged from 36.24 to 77.99 perquestionnaire domain. A satisfactory score was obtained in the “Communication in theSurgical Environment” domain (77.9). The “Perception of professional performance”,“Safety climate”, “Working conditions” and “Perceptions of management” domains showedsignificant differences.Conclusion: weaknesses in values, attitudes and behaviors are evident, translated by scoresbelow satisfactory, determining a low safety climate among professionals.Objetivo: evaluar actitudes de los profesionales de salud de un centro quirúrgico en relaciónal clima de seguridad.Método: estudio transversal desarrollado en el centro quirúrgico de un hospital filantrópicode la región sur del Brasil, con 107 profesionales de la salud. Se obtuvieron los datos pormedio de Cuestionario de Actitudes de Seguridad, versión Centro Quirúrgico, con scoresatisfactorio igual o superior a 75, en el período de diciembre de 2016 a febrero de 2017.Análisis de datos hecha por estadística descriptiva, correlación y análisis factorial.Resultados: las percepciones de los profesionales acerca de clima de seguridad variaronde 36,24 a 77,99 por dominio del cuestionario. Se obtuvo score satisfactorio en el dominio“Comunicación en el Ambiente Quirúrgico” (77,9). Los dominios “Percepción del Desempeñoprofesional”, “Clima de Seguridad”, “Condiciones de Trabajo” y “Percepción de Gerencia”presentaron diferencias significativas.Conclusión: se evidencian fragilidades en los valores, actitudes y comportamientos,traducidos por scores abajo del satisfactorio, determinando bajo clima de seguridad entrelos profesionales.Objetivo: avaliar atitudes dos profissionais de saúde de um centro cirúrgico referentes ao clima de segurança.Método: estudo transversal desenvolvido no centro cirúrgico de um hospital filantrópico da região sul do Brasil, com 107 profissionais da saúde. Coleta de dados realizada com Questionário de Atitudes de Segurança, versão Centro Cirúrgico, com escore satisfatório igual ou superior a 75, no período de dezembro 2016 a fevereiro de 2017. Análise dos dados por estatística descritiva, correlação e análise fatorial.Resultados: as percepções dos profissionais sobre clima de segurança variaram de 36,24 a 77,99 por domínio do questionário. Foi obtido escore satisfatório no domínio “Comunicação no Ambiente Cirúrgico” (77,9). Os domínios “Percepção do Desempenho profissional”, “Clima de Segurança”, “Condições de Trabalho” e “Percepção de Gerência” apresentaram diferenças significativas.Conclusão: evidenciam-se fragilidades nos valores, atitudes e comportamentos, traduzidos por escores abaixo do satisfatório, determinando baixo clima de segurança entre os profissionais

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)