Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Malpractice claims in interventional radiology: frequency, characteristics and protective measures Il contenzioso in radiologia interventistica: frequenza, caratteristiche ed azioni di tutela

interventistica \ue8 sensibilmente aumentato negli ultimi anni; di pari passo si \ue8 notato un incremento del contenzioso medico-legale ad esse associato. Questo studio mira a sottolineare i problemi all\u2019origine delle denunce per malapratica in radiologia interventistica, ed a valutare l\u2019importanza del consenso informato. Materiali e metodi. Sono state esaminate tutte le denunce assicurative causate da presunti errori in radiologia interventistica in un periodo di 14 anni, enuncleandole dal data-base assicurativo dei radiologi iscritti alla Societ\ue0 Italiana di Radiologia Medica (SIRM) dal 01/01/1993 al 31/12/2006. Risultati. Nel periodo in esame sono state sporte 98 denunce contro radiologi che avevano effettuato procedure interventistiche. In 21 casi (21,4%) l\u2019evento aveva causato la morte del paziente. In oltre l\u201980% dei casi l\u2019evento lesivo era occorso in una struttura pubblica. Il rischio di ricevere una denuncia per presunta malapratica per un radiologo che pratichi tecniche interventistiche \ue8 pari al 47 per mille, il che corrisponde ad una denuncia per ogni 21 anni di attivit\ue0. Discussione. La radiologia interventistica, attivit\ue0 sovrapponibile per profilo di rischio biologico alle procedure chirurgiche, espone gli operatori ad un elevato rischio di contenzioso medico-legale sia per problemi intrinseci alle tecniche usate, sia per la necessit\ue0 di operare su soggetti con gravi patologie, e in condizioni cliniche compromesse. Conclusioni. La prevenzione del contenzioso dipende in gran parte da una riduzione della percentuale di errore medico abbinata ad una corretta ed organica informazione del paziente. L\u2019adozione di buone pratiche radiologiche, la scrupolosa revisione delle procedure e dell\u2019efficienza tecnica degli strumenti usati, la verifica delle procedure organizzative e gestionali sono i fattori che riducono la probabilit\ue0 dell\u2019errore. Il miglioramento delle tecniche di comunicazione, nel rispetto dell\u2019autonomia del paziente, passa anche attraverso l\u2019adozione di procedure chiare e rigorose per l\u2019ottenimento del consenso all\u2019atto medico.Purpose. The use of interventional radiology procedures has considerably increased in recent years, as has the number of related medicolegal litigations. This study aimed to highlight the problems underlying malpractice claims in interventional radiology and to assess the importance of the informed consent process. Materials and methods. The authors examined all insurance claims relating to presumed errors in interventional radiology filed by radiologists over a period of 14 years after isolating them from the insurance database of all radiologists registered with the Italian Society of Medical Radiology (SIRM) between 1 January1993 and 31 December 2006. Results. In the period considered, 98 malpractice claims were filed against radiologists who had performed interventional radiology procedures. In 21 cases (21.4%), the event had caused the patient\u2019s death. In >80% of cases, the event occurred in a public facility. The risk of a malpractice claim for a radiologist practising interventional procedures is 47 per 1,000, which corresponds to one malpractice claim for each 231 years of activity. Discussion. Interventional radiology, a discipline with a biological risk profile similar to that of surgery, exposes practitioners to a high risk of medicolegal litigation both because of problems intrinsic to the techniques used and because of the need to operate on severely ill patients with compromised clinical status.Conclusions. Litigation prevention largely depends on both reducing the rate of medical error and providing the patient with correct and coherent information. Adopting good radiological practices, scrupulous review of procedures and efficiency of the instruments used and audit of organisational and management processes are all factors that can help reduce the likelihood of error. Improving communication techniques while safeguarding the patient\u2019s right to autonomy also implies adopting clear and rigorous processes for obtaining the patient\u2019s informed consent to the medical procedure