Acute general surgery in Canada: a survey of current handover practices

Johner, Amanda; Merchant, Shaila J.; Aslani, Nava; Planting, Anneke; Ball, Chad G.; Widder, Sandy; Pagliarello, Giuseppe; Parry, Neil; Klassen, Dennis; Hameed, S. Morad

doi:10.1503/cjs.035011

Cited by 12 publications

(8 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Poor communication is a well-known hazard in clinical care, particularly at points of handover between providers. 22,23 We found problems in interdepartmental working were a key factor in many of the incidents in our study, particularly the transfer of fetal remains from maternity departments to the mortuary. Misidentification of patients is a common cause of wrong site surgery 24 and other patient safety incidents.…”

Section: Discussionmentioning

confidence: 69%

Serious incidents after death: content analysis of incidents reported to a national database

2017

View full text Add to dashboard Cite

SummaryObjectives: To describe serious incidents occurring in the management of patient remains after their death. Design: Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting: The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants: All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures: The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results: One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions: Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.

show abstract

Section: Discussionmentioning

confidence: 69%

Serious incidents after death: content analysis of incidents reported to a national database

2017

View full text Add to dashboard Cite

show abstract

“…18,19 Care may be compromised by frequent suboptimal transfers of care and a high turnover of busy nursing staff, surgeons and trainees. 20 Older adults cared for on these services commonly have evolving medical needs and multiple comorbidities. If undergoing urgent surgery, their health status often cannot feasibly be optimized preoperatively as would be done for patients undergoing elective operations.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use among older adults on an acute care general surgery service

Pollmann

Bailey

Davis³

et al. 2017

CJS

View full text Add to dashboard Cite

Background: Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital.Methods: Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines.Results: During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second-or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion:Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.Contexte : Les antibiotiques jouent un rôle important dans de nombreux cas de chirurgie chez les adultes âgés, et le risque d'utilisation inappropriée de ces médicaments est élevé. Notre objectif était de décrire l'utilisation des antibiotiques chez les patients âgés admis au service chirurgical d'urgence d'un centre hospitalier universitaire de soins tertiaires.Méthodes : Nous avons recueilli de manière rétrospective les données détaillées sur le diagnostic, les comorbidités, la chirurgie et l'utilisation d'antibiotiques chez les patients de 70 ans et plus admis dans un service chirurgical d'urgence. Nous avons évalué le bien-fondé du recours aux antibiotiques (prophylaxie et traitement périopératoire) en fonction des lignes directrices publiées.

show abstract

“…In such an environment, disagreements over clinical management have the potential to significantly impact patient care – positively or negatively. A recent evaluation of acute care surgery handover practices indicated that problematic handovers could have a negative impact on patient outcomes, and the experience of learners [ 15 ]. In that study residents felt, that on average, inadequate handover contributed to at least a minor harm in 2.7 individual patients, and a major harm in 0.6 individual patients over the course of their training [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent evaluation of acute care surgery handover practices indicated that problematic handovers could have a negative impact on patient outcomes, and the experience of learners [ 15 ]. In that study residents felt, that on average, inadequate handover contributed to at least a minor harm in 2.7 individual patients, and a major harm in 0.6 individual patients over the course of their training [ 15 ]. With this evidence in mind, we feel that the clinical disagreements which occur when key patient care providers change over have the greatest potential to impact continuity of care, and ultimately affect patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgeon agreement at the time of handover, a prospective cohort study

et al. 2016

Self Cite

View full text Add to dashboard Cite

BackgroundAcute Care Surgical Teams are responsible for emergent surgical patients, and as such require regular handover and coordination between different surgeons. Despite the recent emergence of this model of care, minimal research has been conducted on the quality of patient handover and no research has attempted to determine the rate of clinical agreement or disagreement among surgeons participating in these teams.MethodsA prospective cohort study was carried out with our acute care surgical service at a tertiary care teaching hospital from January 2 to March 31 2012. At the conclusion of the daily morning handover, receiving surgeons were asked to indicate, on provided handover sheets, whether they agreed with the proposed management plan for each patient that was discussed. The specific aspects of care over which they disagreed were also described, and disagreements were classified a priori as major or minor. The primary outcome was the rate of disagreement over the handed over management plan.ResultsSix staff surgeons agreed to participate and a total of 417 unique patients were handed over during the study period. For the primary outcome, a total of 41 disagreements were recorded for a disagreement rate of 9.8 %. 15 of the 41 disagreements were classified as major, for a major disagreement rate of 3.6 %. Consultant to consultant disagreements were classified as major disagreements 63 % of the time, whereas consultant to resident disagreements were classified as major 31 % of the time (P = 0.217). On average, the age of patients for which a clinical disagreement occurred were older; 63 vs. 57 (P < 0.05).ConclusionsDespite the frequency of handovers in clinical practice, little research has been conducted to determine the rate of disagreement over patient management among surgeons participating working in academic centers. This study demonstrated that the rate of clinical disagreement is low among surgeons working in an tertiary care teaching hospital.

show abstract

Acute general surgery in Canada: a survey of current handover practices

Cited by 12 publications

References 10 publications

Serious incidents after death: content analysis of incidents reported to a national database

Serious incidents after death: content analysis of incidents reported to a national database

Antibiotic use among older adults on an acute care general surgery service

Surgeon agreement at the time of handover, a prospective cohort study

Contact Info

Product

Resources

About