Patients' questions about joint rep...

Patients' questions about joint replacement surgery

BMC Health Services Research

June 2003

Furnishing information to patients is an important constituent in the quest for the best possible consequence of any surgical procedure. The goal of this consideration was to determine what information patients want when they confer an orthopedic surgeon about undergoing either a total hip arthroplasty (THA) or a total knee arthroplasty (TKA). (1) Forty-eight patients considering THA (ie, 29) or TKA (ie, 19) who were seen at a university-affiliated tertiary care center orthopedic clinic or from an orthopedic surgeon at a community practice clinic, the one and the other in southern California, were asked to perfect a written questionnaire. The questionnaire asked them to rate 30 questions upon a five-point Likert scale in which united was the least important and five the most numerous important. Common statistical methods, including percentages and medians, were used to analyze the results

Findings. Overall, there was disagreement onward question importance and variability in patients' selections The mean percentage of disagreement was 42% for questions answered according to patients considering TKA and 47% for patients considering THA. There was enough agreement, however, to define a core establish of four questions rated as most numerous important (ie, with a score of five) that should be addressed.

* Am I going to ne physical therapy?

* Will surgery affect my abilities to care for myself?

* by what means mobile will I be after surgery?

* When will I be able to walk normally again?

Clinical implications. This thought showed that although there was enough agreement to define a core place of questions that should be addressed with the majority of patients considering THA or TKA, several of the remaining questions also were rated actual important by some patients. The inquiry authors suggest that the Internet may be single in kind resource that is sufficiently flexible to accommodate the large variety of information indigenceed Perioperative nurses may find the 30 questions, especially the core questions identified on the study, useful as a framework for developing effective preoperative and postoperative educational tools for patients scheduled for these procedures

Use of interviews to analyze surgical errors

Surgery

June 2003

Surgical errors present itself frequently; however, not enough is known about the factors that cause them. Identifying and understanding the circumstances that cause these errors are tonic components in developing and implementing sustainable corrective actions. foundation cause analysis as a orderly disposition of identifying causative factors is labor intensive, time consuming, and consequently difficult to replicate in succession a large scale. This research was undertaken to test the feasibility and usefulness of conducting confidential interviews as a course of identifying patterns of surgical error causation. (2) A single surgeon interviewer mannersed confidential interviews structured to gather detailed information about incident reports. Thirty-eight surgeon randomly selecteded from three teaching hospitals in Massachusetts agreed to participate and provided information about 146 incidents. The surgeon personally were aware of the circumstances that l to the errors about which they were interviewed. In each case, surgeon were asked to provide an open-end description of an incident and recall factors that contributed to the error. They also were queried about the part of 15 possible contributing factors:

* administrative complexity/bureaucracy,

* communication breakdown among staff members,

* emergent versus elective setting,

* ergonomic problems

* errors in judgment

* excessive workload/inadequate staffing,

* failure of memory,

* failure of vigilance,

* fatigue,

* inappropriate protocols,

* interruption/distraction,

* lack of experience/competence at a task,

* lack of trainee supervision,

* technology failure, and

* time of day.

usual statistical methods were used to analyze the data gathered from the interviews.

Findings. Sixty percent of the incidents occurr in the OR, and 77% involved non-emergency care. Fifty-four percent be deriveded in temporary disability, 33% in permanent disability, and 13% in death. The mostly common factors contributing to errors were inexperience/lack of sufficient fortune (ie, 53%), communication breakdown among staff members (ie, 43%) and fatigue or excessive workload (ie, 33%) Failure of good sense was directly associated with inadequate supervision (odd ratio [OR] = 34; 95% confidence interval [CI] = 12-96) while failure of vigilance was erect to be inversely associated with inexperience as a reported contributing factor (OR = 051; 95% CI = 03-10)

Clinical implications. This thought showed that confidential interviews with surgeon can generate detailed reports in succession a large number of surgical adverse occurrences resulting from errors, consequently allowing important underlying factors to be identified. Perioperative managers should consider adding confidential interviews to their armaments of quality improvement processes