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The impact of system factors on quality and safety in arterial surgery: a systematic review

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Title: The impact of system factors on quality and safety in arterial surgery: a systematic review
Authors: Lear, R
Godfrey, AD
Riga, C
Norton, C
Vincent, C
Bicknell, CD
Item Type: Journal Article
Abstract: Objective A systems approach to patient safety proposes that a wide range of factors contribute to surgical outcome, yet the impact of team, work environment, and organisational factors, is not fully understood in arterial surgery. The aim of this systematic review is to summarize and discuss what is already known about the impact of system factors on quality and safety in arterial surgery. Data sources A systematic review of original research papers in English using MEDLINE, Embase, PsycINFO, and Cochrane databases, was performed according to PRISMA guidelines. Review methods Independent reviewers selected papers according to strict inclusion and exclusion criteria, and using predefined data fields, extracted relevant data on team, work environment, and organisational factors, and measures of quality and/or safety, in arterial procedures. Results Twelve papers met the selection criteria. Study endpoints were not consistent between papers, and most failed to report their clinical significance. A variety of tools were used to measure team skills in five papers; only one paper measured the relationship between team factors and patient outcomes. Two papers reported that equipment failures were common and had a significant impact on operating room efficiency. The influence of hospital characteristics on failure-to-rescue rates was tested in one large study, although their conclusions were limited to the American Medicare population. Five papers implemented changes in the patient pathway, but most studies failed to account for potential confounding variables. Conclusions A small number of heterogenous studies have evaluated the relationship between system factors and quality or safety in arterial surgery. There is some evidence of an association between system factors and patient outcomes, but there is more work to be done to fully understand this relationship. Future research would benefit from consistency in definitions, the use of validated assessment tools, measurement of clinically relevant endpoints, and adherence to national reporting guidelines.
Issue Date: 11-May-2017
Date of Acceptance: 18-Mar-2017
URI: http://hdl.handle.net/10044/1/50726
DOI: https://dx.doi.org/10.1016/j.ejvs.2017.03.014
ISSN: 1078-5884
Publisher: Elsevier
Start Page: 79
End Page: 93
Journal / Book Title: European Journal of Vascular and Endovascular Surgery
Volume: 54
Issue: 1
Copyright Statement: Crown Copyright © 2017 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: The Circulation Foundation
National Institute for Health Research
Funder's Grant Number: Presidents ECA 2011/12
RD407
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Quality
Safety
Arterial surgery
System factors
ABDOMINAL AORTIC-ANEURYSM
TEAMWORK ASSESSMENT
VASCULAR-SURGERY
VASCUNET REPORT
OPERATING-ROOM
REPAIR
VOLUME
METAANALYSIS
MORTALITY
FAILURES
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer