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

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.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Johnston MJ,Arora S,King D,Darzi A

doi

10.1097/SLA.0000000000002089

subject

Has Abstract

pub_date

2018-01-01 00:00:00

pages

73-80

issue

1

eissn

0003-4932

issn

1528-1140

journal_volume

267

pub_type

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