Towards Better Patient Safety : The WHO Surgical Checklist in Otorhinolaryngology

TOWARDS BETTER PATIENT SAFETY: The WHO Surgical Checklist in Otorhinolaryngology More than one-half of adverse events in health care are related to surgery. Surgical patient injuries account for about 80% of patient injuries in otorhinolaryngology (ORL). The World Health Organisation (WHO) has developed a Surgical Safety Checklist to prevent errors in the operating theatre. Its use has been shown to reduce complications and mortality. The aims of the present study were to identify errors that may underlie those patient injuries that occur in operative ORL, to assess the effects of the WHO checklist on working processes in the operating theatre, including compliance, and to evaluate how it would fit into the specialty. Data of the patient injuries that were sustained during treatment by the ORL specialty between the years 2001 and 2011 were obtained from a search of the Finnish Patient Insurance Centre registry. The causes of the injuries were analysed, and whether the WHO checklist could have prevented the error was evaluated. The checklist was implemented in four Finnish hospitals as a pilot in 2009. A prospective before-versus-after-intervention study was conducted with a questionnaire for OT personnel in these four hospitals to evaluate the checklist. The checklist was subsequently implemented for regular use in the operative unit of the Department of Otorhinolaryngology of Helsinki University Central Hospital. After one-year of use, compliance and user attitudes were analysed by using data obtained from the operations database and a survey of operative ORL personnel. In the 10-year study period, 188 patient injuries were associated with operative ORL. A total of 142 (75.5%) of these injuries occurred due to errors that were made in the operating theatre, and in 125 cases (66.5%) a manual error in performing the surgery was the primary cause of the injury. Six injuries (3.2%) were caused by wrong site surgery. An error had some degree correspondence with a WHO checklist item for 18 injuries (9.6%) and it was determined that 9 of these injuries (4.8%) could have been prevented had the checklist been correctly used. The implementation of the checklist enhanced the communication between the surgical team members, improved verification of the patient s identity and of the correct operation site. Checklist compliance was 62.3% during first year of use. It was considered easy to use and the Safety Attitude Scores of the personnel were found to be on a high level. All check items on the list were considered important for ORL. However, a more compact checklist for outpatient surgery was requested. Patient injuries in ORL were strongly related to surgery. The WHO Surgical Safety Checklist seems to be a beneficial tool for preventing errors ORL and is highly relevant for the specialty.KOHTI PAREMPAA POTILASTURVALLISUUTTA: WHO:n kirurginen tarkistuslista korva-, nenä- ja kurkkutautien kirurgiassa Maailman terveysjärjestö WHO on kehittänyt leikkaussalikäyttöön kolmivaiheisen tarkistuslistan, jonka tarkoitus on ehkäistä virheitä leikkaussalityöskentelyssä. Tämän tutkimuksen tavoitteena oli kuvata ja analysoida korva-, nenä- ja kurkkutautien alan kirurgisesta hoidosta aiheutuneita potilasvahinkoja ja niihin johtaneita mekanismeja. Tavoitteena oli myös arvioida WHO:n tarkistuslistan käyttöönoton vaikutuksia leikkaussalityöhön, listan käyttömyöntyvyyttä sekä sisällön soveltuvuutta erikoisalalle. Tutkimuksessa analysoitiin Potilasvakuutuskeskuksen korvaamat potilasvahingot korva-, nenä- ja kurkkutautien erikoisalalta vuosilta 2001-2011. Samalla arvioitiin, olisiko kirurginen tarkistuslista voinut estää vahingon. WHO:n tarkistuslista otettiin pilottikäyttöön neljässä suomalaisessa sairaalassa vuonna 2009, samalla toteutettiin vertaileva tutkimus listan käyttöönoton vaikutuksista leikkaussalitoimintaan. Tarkistuslista otettiin vakituiseen käyttöön Helsingin Yliopistollisen Keskussairaalan korva-, nenä- ja kurkkutautien leikkausyksikössä vuonna 2010. Ensimmäisen käyttövuoden jälkeen analysoitiin listan käyttöaktiivisuutta sekä toteutettiin kyselytutkimus leikkaussalihenkilökunnalle. Kymmenen vuoden aikana Suomessa korvattiin 188 korva-, nenä- ja kurkkutautien alan leikkauksiin liittyvää potilasvahinkoa. Vahinkoon johtaneista virheistä 142 (75,6 %) tapahtui leikkaussalissa. Kaikkiaan 125 (66,5 %) vahinkoa aiheutui virheestä leikkauksen teknisessä suorituksessa. Kuusi (3,2 %) vahinkoa johtui väärän puolen tai kohteen leikkauksesta. Yhteensä 18 (9,6 %) tapauksessa virhe liittyi WHO:n tarkistuslistassa käsiteltyihin asioihin ja arviomme mukaan yhdeksän (4,8 %) vahinkoa olisi ollut estettävissä asianmukaisesti käytetyn tarkistuslistan avulla. Tarkistuslistan käyttöönoton todettiin parantavan leikkaustiimin kommunikaatiota, lisäävän potilaan henkilöllisyyden varmistamista sekä tietoa leikkauskohteesta. Ensimmäisenä käyttövuonna listaa käytettiin keskimäärin 62,3 %:ssa leikkauksista. Tarkistuslista koettiin helpoksi käyttää eikä sen koettu hidastavan työskentelyä. Listan sisällön arvioitiin sopivan hyvin korva-, nenä- ja kurkkutautien erikoisalalle, joskin päiväkirurgisiin toimenpiteisiin toivottiin lyhyempää listaa

Patient Injuries in Treatment of Peripheral Arterial Disease in Finland: Review of National Patient Insurance Charts

Background Patient injury claim data and insurance records constitute detailed sources of information on patient injuries and their contributing or causal factors. This study aimed to identify the unintended incidents that lead to patient injuries in vascular surgery in the treatment of peripheral arterial disease (PAD) in Finland. Methods The records of all accepted patient injury claims involving PAD between 2004 and 2017 inclusive were obtained from the nationwide Finnish Patient Insurance Centre registry and were reviewed. Factors contributing to injury were classified by patient careflow. Results Sixty-nine patient injury incidents were identified in 60 treated patients with PAD. Sixteen injuries (23.2%) were related to outpatient or preoperative care. Twenty-seven injuries (39.1%) were caused by incidents in performing open or endovascular procedures, and 26 injuries (37.7%) were related to postoperative care. Delay in treatment affected 11 (18.3%) patients. Incidents involving surgical technique were identified in the treatment of 13 (21.7%) patients. Retained foreign material caused injuries to four (6.7%) patients. Five (8.3%) patients suffered from postoperative hemorrhage and eleven (18.3%) from infection damage. Delay in treatment resulted in two major amputations. Technical problems in bypass operations led to the loss of the bypass graft and to reoperation. Three nerve injuries led to permanent disability. One (1.7%) patient died because of fatal postoperative bleeding after being discharged from the hospital. Conclusions Compensated patient injuries in the treatment of PAD are rare. Injuries occur during all stages of care and are caused by both surgical system procedural failures and common complications.Peer reviewe

Patient injuries in pediatric otorhinolaryngology

Objectives: Patient injuries in children can have lifelong effects on the patient and a marked impact on the whole family. The aim of this study was to identify the errors and incidents leading to patient injuries in pediatric otorhinolaryngology (ORL) by evaluating accepted patient injury claims. Methods: The records of all accepted patient injury claims in ORL between 2001 and 2011 were searched from the nationwide Patient Insurance Centre registry. Pediatric injuries were reviewed and evaluated in detail, and factors contributing to injury were identified. Results: In the 10-year study period, 17 (7.6%) of the 223 patient injuries occurred in children, and of these, 15 (88%) were considered operative care. The median age of the patients was 8 years (range 3-16 years). All operations were performed as daytime elective surgery and by a fully trained specialist in 93% of the cases. One-half of the cases were routine surgeries for common ORL diseases. The most common incidences were incomplete surgery, retained gauze or foreign body, injury to adjacent anatomic structure, and insufficient charts or instructions (each occurred in 3 cases). The most frequent consequence was burn (n = 4). One child died because of post-tonsillectomy hemorrhage. Conclusions: Patient injuries in pediatric ORL are strongly related to surgery. Most injuries occurred after routine operations by a fully trained specialist. Clinicians should be aware of the most likely scenarios resulting in claims.Peer reviewe

Major Lower Limb Amputations and Amputees in an Aging Population in Southwest Finland 2007-2017

Purpose: The aim of the present study was to describe and analyze changes in the incidences of lower extremity amputations (LEAs), patient characteristics, vascular history of amputees and survival in Southwest Finland. Patients and Methods: This is a retrospective patient study in the Hospital District of Southwest Finland. All consecutive patients with atherosclerosis and diabetes-caused LEA, between 1st January 2007 and 31st December 2017, were included. The annual incidences of major LEA patients were statistically standardized. Patients' diagnoses, functional status, previous revascularizations and minor amputations were recorded, and survival was analyzed. Results: During the 11-year-period major LEAs were performed on 891 patients, 118 (13.2%) were urgent operations. The overall incidence of major LEA was 17.2/100 000 and was age-dependent (3.1 for = 85 years). A decrease in incidence was detected in the Conclusion: Our results suggest that in an aging population, despite good availability of vascular services, a significant number of patients are not fit for active revascularization, and LEA is the only feasible treatment for critical limb ischemia.</p