Management of Monophasic Synovial Sarcoma of the Small Intestine

Although prognosis for patients with intraabdominal synovial sarcoma is poor, laparoscopic wide regional excision may allow for a more prolonged disease-free survival

Surgical Flow Disruptions, a Pilot Survey with Significant Clinical Outcome Implications

PURPOSE OF REVIEW: Surgical flow disruptions (SFD) are deviations from the progression of a procedure which can be potentially compromising to the safety of the patient. Investigators have previously demonstrated that SFDs can increase the likelihood of error. To date, there has been no investigation into flow disruptions through the eyes of clinicians in the operating room. This study, therefore, attempted to better understand SFDs and their impact from the perspective of operating room team members. RECENT FINDINGS: After Institutional Review Board approval, a survey was sent to operating room team members including surgeons, anesthesia providers, nurses, and surgical technologists. The survey was developed to assess the perceived frequency and consequences of SFDs, and the ability to report and perceive the efficacy of reporting to management. Among 111 survey participants, 65% reported that surgical flow disruptions happen either several times a day or every procedure. Forty percent ranked poor communication as the most frequent cause of SFDs. Ten percent reported equipment failure was the most frequent cause of SFDs. Respondents who identified as attending surgeons felt impacts on patient safety and staff burnout was the most likely consequence of SFDs. Scrub technicians and nurses felt that economic consequences were the most likely result. Forty-four percent did not feel reporting led to effective change. Thirty-five percent did not believe they could report issues without adverse consequences. Flow disruptions represent patterns or accumulations of disruptions which may highlight weak points in surgical systems and potential causes of staff burnout and medical error. The data in the present investigation demonstrate that OR team members recognize surgical flow disruptions are an important issue and believe poor communication and equipment problems are a significant factor. Our data additionally suggest the groups surveyed do not feel safe or productive in reporting flow disruptions

Team training to establish a safety culture in dialysis access surgery.

Operating room (OR) team safety training and learning in the field of dialysis access is well suited for the use of simulators, simulated case learning and root cause analysis of adverse outcomes. The objectives of OR team training are to improve communication and leadership skills, to use checklists and to prevent errors. Other objectives are to promote a change in the attitudes towards vascular access from learning through mistakes in a nonpunitive environment, to positively impact the employee performance and to increase staff retention by making the workplace safer, more efficient and user friendly

Impact of hyperkalemia on surgery case cancellation: A call for increased reliability

Introduction: Hyperkalemia (HK) is known to be associated with increased risk of adverse outcomes related to anesthesia and surgery. The overall impact of hyperkalemia on surgery delay or cancellation is not known. This study was designed to assess the impact of HK on surgery case cancellation and to determine if any standards existed with respect to the management of surgical patients with HK in a large health system. Methods: There were two phases of the study. Phase 1 was a structured survey was distributed to electronically to clinicians within the 26-hospital health system regarding HK knowledge and treatment paradigms. Phase 2 consisted of electronic health record data of patients treated between 1/1/2015-12/31/2020 who had an elevated serum K+ (\u3e 5 mEq/L) ≤ 24 hours (an indication of preoperative HK) prior to a scheduled surgery. Results: HK was clinically significant by 47% of respondents with a serum K+ level at 5.6-5.9 mEq/L and by 39% at K+ \u3e 6 mEq/L thresholds. Only 50% of respondents recognized Renin-angiotensin-aldosterone system inhibitors as a risk factor for HK. Of 645,073 surgical cases 1.4% (n = 9,166) had a documented pre-operative HK. Black and Hispanic patients were more likely to have preoperative HK (≥ 6.0 mEq/L) compared to White (p = 0.01). Patients with a K+ value ≥ 6.0 mEq/L within 24 hrs. Of a scheduled surgery were 2.40 times more likely to have a cancelled surgery compared to patients with a K+ between 5.1-5.9 mEq/L (p \u3c 0.0001). Conclusion: There is a lack of consensus as to what constitutes significant preoperative HK, and whether to cancel or delay elective surgery due to HK, and no standard treatment when preoperative HK was identified. This study indicates a need for improved perioperative standards and greater reliability in the approach to surgical patients with HK

Team Training to Establish a Safety Culture in Dialysis Access Surgery

Operating room (OR) team safety training and learning in the field of dialysis access is well suited for the use of simulators, simulated case learning and root cause analysis of adverse outcomes. The objectives of OR team training are to improve communication and leadership skills, to use checklists and to prevent errors. Other objectives are to promote a change in the attitudes towards vascular access from learning through mistakes in a nonpunitive environment, to positively impact the employee performance and to increase staff retention by making the workplace safer, more efficient and user friendly