A pilot study of non-routine events in gynecological surgery: Type, impact, and effect

Law, Katherine E.; Hildebrand, Emily A.; Hawthorne, Hunter J.; Hallbeck, M. Susan; Branaghan, Russell J.; Dowdy, Sean C.; Blocker, Renaldo C.

doi:10.1016/j.ygyno.2018.11.035

Cited by 11 publications

(16 citation statements)

References 26 publications

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“…Sixteen studies used real‐time, in‐person prospective surveillance of events, whilst the other nine studies used retrospective video review. Five studies used the term “NRE” to describe events, whilst the others used language such as “potential adverse events,” “distractions,” and “interruptions” to describe NREs 5,8,12,13,37 . The most common setting was the OR (n = 19), followed by the ICU (n = 5).…”

Section: Resultsmentioning

confidence: 99%

“…Two papers included an analysis of NREs occurring in the setting of trauma resuscitation in the ED 5,16 . Studies that focused on NREs in the OR included procedures performed in a range of specialty areas, including urology (n = 1), cardiac surgery (n = 7), general surgery (n = 3), trauma surgery (n = 1), surgical oncology (n = 1), orthopaedic surgery (n = 1), otolaryngology (n = 1), gynaecology (n = 2), and paediatric surgery (n = 1) 12,14,20‐22,25,28,29,31‐37 . Four papers with a focus on NREs in the OR included only those related to anaesthesiology providers 8,13,26,30 …”

Section: Resultsmentioning

confidence: 99%

“…In 13 studies, observers had a medical background, including nurses, medical students, residents, fellows, or attending physicians who were familiar with or worked in the setting 5,8,13,14,20,21,23,25‐27,30,32,36 . Four studies included only observers without medical experience 12,24,35,37 . Fourteen studies included more than one observer 5,14,22‐27,29,32,34‐37 .…”

Section: Resultsmentioning

confidence: 99%

“…“Impact” classification was assigned to articles that assessed outcomes or effects of the NREs, typically reported as harm to the patient or delay in care. 5,12,14,16,20‐22,24‐26,28,30,32‐34,37 “Type” classification was assigned to articles that classified NREs by the underlying mechanism by which the event was affected, such as communication or teamwork, or by a specific error type, such as omission or commission 5,8,12,14,16,17,20,21,24,27,32,35,36 . The “domain” of the articles included in the review was pre‐determined at the time of article selection as “high‐risk” but was further defined when the analysis was restricted to specific parts or phases of the setting in which the NREs occurred 5,8,13,22,23,31,32,34 .…”

Section: Methodsmentioning

confidence: 99%

“…The “domain” of the articles included in the review was pre‐determined at the time of article selection as “high‐risk” but was further defined when the analysis was restricted to specific parts or phases of the setting in which the NREs occurred 5,8,13,22,23,31,32,34 . “Cause” classification was assigned to articles that identified and reported contributing factors or agents (eg, patient or practitioner) that led to NREs 5,8,12,14,16,17,21‐26,28,30‐37 . Finally, the “prevention and mitigation” classification was assigned to the articles that evaluated measures (eg, checklists) to reduce NREs 8,14,31,33 …”

Section: Methodsmentioning

confidence: 99%

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Classification strategies for non‐routine events occurring in high‐risk patient care settings: A scoping review

Alberto

Jagannath

McCusker

et al. 2020

Evaluation Clinical Practice

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Introduction Non‐routine events (NREs) are atypical or unusual occurrences in a pre‐defined process. Although some NREs in high‐risk clinical settings have no adverse effects on patient care, others can potentially cause serious patient harm. A unified strategy for identifying and describing NREs in these domains will facilitate the comparison of results between studies. Methods We conducted a literature search in PubMed, CINAHL, and EMBASE to identify studies related to NREs in high‐risk domains and evaluated the methods used for event observation and description. We applied The Joint Commission on Accreditation of Healthcare Organization (JCAHO) taxonomy (cause, impact, domain, type, prevention, and mitigation) to the descriptions of NREs from the literature. Results We selected 25 articles that met inclusion criteria for review. Real‐time documentation of NREs was more common than a retrospective video review. Thirteen studies used domain experts as observers and seven studies validated observations with interrater reliability. Using the JCAHO taxonomy, “cause” was the most frequently applied classification method, followed by “impact,” “type,” “domain,” and “prevention and mitigation.” Conclusions NREs are frequent in high‐risk medical settings. Strengths identified in several studies included the use of multiple observers with domain expertise and validation of the event ascertainment approach using interrater reliability. By applying the JCAHO taxonomy to the current literature, we provide an example of a structured approach that can be used for future analyses of NREs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Classification strategies for non‐routine events occurring in high‐risk patient care settings: A scoping review

Alberto

Jagannath

McCusker

et al. 2020

Evaluation Clinical Practice

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Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies

et al. 2023

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Background Technological advancements in the operating room (OR) have sparked new challenges for surgical workflow, OR professionals, and patient safety. Disruptive events are frequent across all surgical specialties, but little is known about their effects on patient outcomes and the influence of systemic factors. The aim was to explore the associations of intraoperative flow disruptions (FDs) with patient outcomes, staff workload, and surgery duration. Methods Prospective, single-center, and multi-source study comprising direct and standardized OR observations of urologic surgical procedures, clinical patient outcomes, and staff- and patient-reported outcome data (PROMs; 3-month follow-up). All data were recorded between 01/2020 and 10/2021. FDs were assessed using standardized procedure observations. Linear and logistic regression analyses including multiple system factors were used to explore the effects of FDs on surgical outcomes. Results 61 robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). High rates of FDs were observed; however, our analyses did not show significant relationships with patient complication rates. Equipment- and patient-related FDs were associated with increased staff workload. No association was found between higher rates of FDs and procedure duration. Conclusions FDs were not related to inferior patient outcomes. Our findings may inform future OR investigations that scrutinize the complex interplay of human, team, process, and technological components that mitigate the effects of FDs during surgery. Graphical abstract

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A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement

Schremp¹,

Rhodes²,

Slagle³

et al. 2022

Journal of Pediatric Surgery

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A pilot study of non-routine events in gynecological surgery: Type, impact, and effect

Cited by 11 publications

References 26 publications

Classification strategies for non‐routine events occurring in high‐risk patient care settings: A scoping review

Classification strategies for non‐routine events occurring in high‐risk patient care settings: A scoping review

Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies

A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement

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