A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety

Rodriguez-Paz, Jose M.; Mark, Lynette; Herzer, Kurt; Michelson, James D.; Grogan, Kelly L.; Herman, Joseph M.; Hunt, David; Wardlow, Linda; Armour, Elwood P.; Pronovost, Peter J.

doi:10.1213/ane.0b013e31818ca423

Cited by 42 publications

(27 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, videolaryngoscopes are not currently part of DART carts because they were selectively available throughout the hospital. With experience and use of the hospital-based airway registry, we developed five in situ simulations 14,15 that were modeled after actual DART events and proactively addressed complex airway management in various hospital settings. These simulations were videotaped and used in our multidisciplinary airway courses and in our teamwork and communcation workshops.…”

Section: Discussionmentioning

confidence: 99%

“…These simulations were carried out in the clinical space where care was delivered, rather than in a simulation center. 14,15 We conducted five in situ simulations in different clinical areas of the hospital in the first year. In a surgical intensive care unit, the labor and delivery unit, and an inpatient floor, we simulated codes to test DART processes, such as activation of the universal paging system and ideal locations for airway carts.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Difficult Airway Response Team

Mark¹,

Herzer

Cover

et al. 2015

Anesthesia &Amp; Analgesia

Self Cite

110

View full text Add to dashboard Cite

Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which more than 200 providers were trained. Conclusions DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Difficult Airway Response Team

Mark¹,

Herzer

Cover

et al. 2015

Anesthesia &Amp; Analgesia

Self Cite

110

View full text Add to dashboard Cite

show abstract

“…As the applicator was stitched into the patient’s pelvis, a specific plan for responding to loss of control of the radiation source was developed. Literature reports were consulted in developing staff safety responsibilities [7]. Staff from radiation oncology, surgery, and intensive care unit all had specified roles for responding to an incident should it occur, in accordance with the local regulations [8].…”

Section: Methodsmentioning

confidence: 99%

Pediatric peri-operative fractionated high-dose-rate brachytherapy for recurrent Wilms’ tumor using a reconstructed Freiburg flap

Flower¹,

Tran²,

Zanjani³

et al. 2016

jcb

View full text Add to dashboard Cite

PurposeTo report peri-operative fractionated high-dose-rate (HDR) brachytherapy with a 3D customized Freiburg flap applicator to treat locally recurrent Wilms’ tumor, followed by immediate hyperthermic intraperitoneal chemotherapy for a 16-year-old with a second recurrence of nephroblastoma (Wilms’ tumor).Material and methodsThe tumor was excised and surgical bed was treated with fractionated HDR brachytherapy using a Freiburg flap applicator. Hyperthermic intraperitoneal chemotherapy was performed immediately after the removal of brachytherapy applicator.ResultsThe Freiburg flap was successfully reconstructed to enable delivery of conformable peri-operative HDR brachytherapy. The clinical target volume (CTV) D90 was 26 Gy in 5 fractions.ConclusionsPeri-operative fractionated HDR brachytherapy with a customized Freiburg flap applicator was delivered successfully across a large multi-disciplinary team.

show abstract

“…In 2006, the Johns Hopkins Department of Radiation Oncology, in collaboration with the Weinberg Perioperative Clinical Services Team, introduced HDR-IORT to the institution [13]. A systematic approach was developed to safely deliver IORT through multiple methods including workflow grids (Fig.…”

Section: Methodsmentioning

confidence: 99%

High-dose-rate intraoperative radiation therapy: the nuts and bolts of starting a program

Moningi

Armour

Terezakis

et al. 2014

jcb

Self Cite

View full text Add to dashboard Cite

High-dose-rate intraoperative radiation therapy (HDR-IORT) has historically provided effective local control (LC) for patients with unresectable and recurrent tumors. However, IORT is limited to only a few specialized institutions and it can be difficult to initiate an HDR-IORT program. Herein, we provide a brief overview on how to initiate and implement an HDR-IORT program for a selected group of patients with gastrointestinal and pelvic solid tumors using a multidisciplinary approach. Proper administration of HDR-IORT requires institutional support and a joint effort among physics staff, oncologists, surgeons, anesthesiologists, and nurses. In order to determine the true efficacy of IORT for various malignancies, collaboration among institutions with established IORT programs is needed.

show abstract

A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety

Cited by 42 publications

References 40 publications

Difficult Airway Response Team

Difficult Airway Response Team

Pediatric peri-operative fractionated high-dose-rate brachytherapy for recurrent Wilms’ tumor using a reconstructed Freiburg flap

High-dose-rate intraoperative radiation therapy: the nuts and bolts of starting a program

Contact Info

Product

Resources

About