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Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.

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Revised manuscript=Johnston-Darzi.docxAccepted version71 kBMicrosoft WordView/Open
Table 1.docxSupporting information135.14 kBMicrosoft WordView/Open
Table 2.docxSupporting information94.76 kBMicrosoft WordView/Open
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Revised Abstract.docxAccepted version102.58 kBMicrosoft WordView/Open
Title: Improving the Quality of Ward-based Surgical Care With a Human Factors Intervention Bundle.
Authors: Johnston, MJ
Arora, S
King, D
Darzi, A
Item Type: Journal Article
Abstract: Objective: This study aimed to explore the impact of a human factors intervention bundle on the quality of ward-based surgical care in a UK hospital. Summary of Background Data: Improving the culture of a surgical team is a difficult task. Engagement with stakeholders before intervention is key. Studies have shown that appropriate supervision can enhance surgical ward safety. Methods: A pre-post intervention study was conducted. The intervention bundle consisted of twice-daily attending ward rounds, a "chief resident of the week" available at all times on the ward, an escalation of care protocol and team contact cards. Twenty-seven junior and senior surgeons completed validated questionnaires assessing supervision, escalation of care, and safety culture pre and post-intervention along with interviews to further explore the impact of the intervention. Patient outcomes pre and postintervention were also analyzed. Results: Questionnaires revealed significant improvements in supervision postintervention (senior median pre 5 vs post 7, P = 0.002 and junior 4 vs 6, P = 0.039) and senior surgeon approachability (junior 5 vs 6, P = 0.047). Both groups agreed that they would feel safer as a patient in their hospital postintervention (senior 3 vs 4.5, P = 0.021 and junior 3 vs 4, P = 0.034). The interviews confirmed that the safety culture of the department had improved. There were no differences in inpatient mortality, cardiac arrest, reoperation, or readmission rates pre and postintervention. Conclusion: Improving supervision and introducing clear protocols can improve safety culture on the surgical ward. Future work should evaluate the effect these measures have on patient outcomes in multiple institutions.
Issue Date: 30-Nov-2016
Date of Acceptance: 1-Nov-2016
URI: http://hdl.handle.net/10044/1/48312
DOI: https://dx.doi.org/10.1097/SLA.0000000000002089
ISSN: 0003-4932
Publisher: Lippincott, Williams & Wilkins
Start Page: 73
End Page: 80
Journal / Book Title: Annals of Surgery
Volume: 267
Issue: 1
Copyright Statement: © 2017 Wolters Kluwer Health, Inc. All rights reserved. This is a non-final version of an article published in final form in Annals of Surgery. Publish Ahead of Print():, NOV 2016. DOI: 10.1097/SLA.0000000000002089 and is available at https://dx.doi.org/10.1097/SLA.0000000000002089
Sponsor/Funder: Imperial College Healthcare NHS Trust
National Institute for Health Research
Funder's Grant Number: N/A
Keywords: 11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer
Institute of Global Health Innovation