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Results for “Surgical Error”

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At least 109 records · Page 6Linked to original sources
PubMed2005

How surgeons disclose medical errors to patients: a study using standardized patients.

BACKGROUND: Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients. METHODS: Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference. RESULTS: Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon. CONCLUSIONS: The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.

Communication↗
PubMed1994

Experimental reproduction of free flap errors: a new model of thrombosis.

Surgical errors in the length and orientation of a flap pedicle can result in kinks, twists, or tension on the pedicle vessels. When these errors occur together with the microvascular repairs associated with free flap transfer, thrombosis and flap failure may be the outcome. A model was designed to simulate these events. The rabbit central ear artery and vein were dissected and all other tissue connections were severed in a near-complete amputation. The artery was transected, shortened by 2 mm, and repaired standardly. The ear was then rotated 360 degrees, twisting the vein around the repaired artery. The ear cartilage was shortened by 6 mm, then sutured, and the skin was closed. In a series of 20 ears, 95% necrosed, 18 from arterial thrombosis and 1 from venous thrombosis. Several other groups were used in which aspects of the basic model were modified to determine the factors influencing failure. When the arterial anastomosis was not performed and the vascular pedicle was rotated with cartilage shortening, all ears survived; when the cartilage was not resected in this paradigm, leaving tension on the pedicle, 50% of the ears necrosed from venous thrombosis. In counterpoint, when the artery was repaired without twisting the pedicle, all ears survived, whether or not the cartilage was shortened. When the artery was repaired without shortening it and with rotation of the ear, 50% of the ears necrosed when the cartilage was shortened, 40% from venous thrombosis and 10% from arterial thrombosis; all ears necrosed (of venous thrombosis) when the cartilage was not shortened.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed2004

Analysis of errors in laparoscopic surgical procedures.

BACKGROUND: The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis. METHODS: After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the end of this phase was 84-96%. Fourteen study videotapes of gallbladder excision were then observed independently by expert reviewers blinded to surgical team identity. Procedures were assessed using a scoring matrix of 1-min segments with each error reported each minute. RESULTS: Interrater agreement was 84-100% for all error categories. CONCLUSIONS: The present study demonstrates that excellent interrater agreement of procedural errors can be achieved by carefully defining and training recognition of targeted events. Extension of this simple and reliable analysis tool to other procedures should be feasible to define behaviors leading to adverse clinical outcomes.

Burns↗
PubMed2006

Nature of human error: implications for surgical practice.

BACKGROUND: As the attitude to adverse events has changed from the defensive "blame and shame culture" to an open and transparent healthcare delivery system, it is timely to examine the nature of human errors and their impact on the quality of surgical health care. METHODS: The approach of the review is generic rather than specific, and the account is based on the published psychologic and medical literature on the subject. CONCLUSIONS: Rather than detailing the various "surgical errors," the concept of error categories within the surgical setting committed by surgeons as front-line operators is discussed. The important components of safe surgical practice identified include organizational structure with strategic control of healthcare delivery, teamwork and leadership, evidence-based practice, proficiency, continued professional development of all staff, availability of wireless health information technology, and well-embedded incident reporting and adverse events disclosure systems. In our quest for the safest possible surgical health care, there is a need for prospective observational multidisciplinary (surgeons and human factors specialists) studies as distinct for retrospective reports of adverse events. There is also need for research to establish the ideal system architecture for anonymous reporting of near miss and no harm events in surgical practice.

Delivery of Health Care↗