ObjectivesSurgery is a high-risk hospital area for adverse events (AEs) occurrence. This study aims to develop an effectiveness and reactive methodology to manage an unexpected increase of AEs in the operating rooms (ORs) of a large Academic Hospital providing about 30 000 surgeries per year.MethodsThe study included three phases: 1. analysis of the AEs collected through the hospital incident reporting system from 2014 to 2015; 2. development of a programme to improve the surgical patient’s safety and 3. application and evaluation of the programme effectiveness.ResultsIn 2014, all hospital AEs were 825 (10.3% in ORs), while in the first 5 months of 2015, they were 645 (17.7% in ORs) [relative risk (RR) 2015 vs 2014=1.7; 95% CI=1.3 to 2.2; p<0.0001] with two sentinel events. Due to this increase, 177 real-time observations were planned in 12 ORs with external staff (n.25) during 1 week in June, July and November 2015 using a checklist with 14 items related to the patient’s pathway (surgical site, time-out, medical records and sponges count). After the observations, the AEs decreased from 11.4×1000 surgeries (January–June 2015) to 8.6×1000 (July–December 2015) (RR=0.7, 95% CI=0.6 to 0.9, p<0.05). Compliance to the correct procedures applied by ORs staff has improved during the year for all items.ConclusionsThe methodology of this study has been revealed effective to control an unexpected increase in AEs and to improve the healthcare workers’ adherence to correct procedures and it could be translated in other patients’ safety settings.

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Transferring essential information and responsibility for patient care from one health care provider to another is an integral component of patient safety in a hospital. This study aims to collect physician interests and needs about handover before introduction of a standardized tool in a North Eastern Italian Academic Hospital (AH). From October 2014 to December 2014 all physicians working in the AH were asked to fill a web-based questionnaire concerning currently adopted methods to clinical handover and their perception on its. Response rate was 10.5% (90/853). 63.3% (57/90) of physicians showed maximal agreement with the statement "communication failures are related to adverse events" and 40% (36/90) of them completely agreed that "improving handover makes work safer". Among actually used handover methods (total answers: 157), verbal communication was referred 45.2% times, written notes 26.1%, electronic supports 21.7%. The most frequently reported obstacles to an effective handover (107 answers) were interruptions (27.1%), absence of hospital written protocols (25.2%) and colleague's inability to provide further information when required (17.7%). Respondents interested to test a new handover procedure were 48.9% (44/90). The low response rate and the fact that only half of respondents were interested in experimenting a new procedure stress the little relevance given by physicians to handover as a key process for patient safety. Furthermore, hazardous methods of transferring information such as verbal communication and non-structured text, combined with referred handover obstacles, suggest the necessity of developing a hospital policy for clinical handover among physicians.

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