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Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study

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Title: Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study
Authors: Lear, R
Godfrey, AD
Riga, C
Norton, C
Vincent, C
Bicknell, CD
Item Type: Journal Article
Abstract: Background System factors contributing to preventable harm in vascular patients have not been previously reported in detail. The aim of this exploratory mixed-methods study was to describe vascular surgeons' perceptions of factors contributing to adverse events (AEs) in arterial surgery. A secondary aim was to report recommendations to improve patient safety. Methods Vascular consultants/registrars working in the British National Health Service were questioned about the causes of preventable AEs through survey and semi-structured interview (response rates 77% and 83%, respectively). Survey respondents considered a recent AE, indicating on a 5 point Likert scale the extent to which various factors from a validated framework contributed toward the incident. Semi-structured interviews were conducted to obtain detailed accounts of contributory factors, and to elicit recommendations to improve safety. Results Seventy-seven surgeons completed the survey on 77 separate AEs occurring during open surgery (n = 41) and in endovascular procedures (n = 36). Ten interviewees described 15 AEs. The causes of AEs were multifactorial (median number of factors/AE = 5, IQR 3-9, range 0–25). Factors frequently reported by survey respondents were communication failures (36.4%; n = 28/77); inadequate staffing levels/skill mix (32.5%; n = 25/77); lack of knowledge/skill (37.3%; n = 28/75). Themes emerging from interviews were team factors (communication failure, lack of team continuity, lack of clarity over roles/responsibilities); work environment factors (poor staffing levels, equipment problems, distractions); inadequate training/supervision. Knowledge/skill (p = .034) and competence (p = .018) appeared to be more prominent in causing AEs in open procedures compared with endovascular procedures; organisational structure was more frequently implicated in AEs occurring in endovascular procedures (p = .017). To improve safety, interviewees proposed team training programmes (5/10 interviewees); additional protocols/checklists (4/10); improved escalation procedures (3/10). Conclusion Vascular surgeons believe that AEs in arterial operations are caused by multiple, modifiable system factors. Larger studies are needed to establish the relative importance of these factors and to determine strategies that can effectively address system failures.
Issue Date: 15-Nov-2017
Date of Acceptance: 2-Oct-2017
URI: http://hdl.handle.net/10044/1/56969
DOI: 10.1016/j.ejvs.2017.10.003
ISSN: 1078-5884
Publisher: Elsevier
Start Page: 778
End Page: 786
Journal / Book Title: European Journal of Vascular and Endovascular Surgery
Volume: 54
Issue: 6
Copyright Statement: © 2017, Elsevier. 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
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
National Institute for Health Research
Funder's Grant Number: Presidents ECA 2011/12
RDB04 79560
RD207
RD407
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Patient safety
Communication
Endovascular procedures
CARDIAC-SURGERY
ADVERSE EVENTS
OPERATING-ROOM
REHEARSAL
MORTALITY
SAFETY
COMPLICATIONS
FAILURES
OUTCOMES
QUALITY
Communication
Endovascular procedures
Patient safety
Attitude of Health Personnel
Clinical Competence
Communication
Humans
Intraoperative Complications
Medical Errors
Risk Factors
Surveys and Questionnaires
United Kingdom
Vascular Surgical Procedures
Workload
Science & Technology
Life Sciences & Biomedicine
Surgery
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Patient safety
Communication
Endovascular procedures
CARDIAC-SURGERY
ADVERSE EVENTS
OPERATING-ROOM
REHEARSAL
MORTALITY
SAFETY
COMPLICATIONS
FAILURES
OUTCOMES
QUALITY
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation