Adherence to the cardiac surgery checklist decreased mortality at a teaching hospital: A retrospective cohort study

Abstract Objectives To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital. Methods A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist "Five steps to safe cardiac surgery" in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson's coefficient was calculated using R software. Results Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%). Conclusion In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist "Five steps to safe cardiac surgery" was associated with decreased mortality after cardiac surgery. HIGHLIGHTS Checklists avoid human errors and are commonly used in high-reliability industries. The "InCor Checklist" was associated with decreased mortality over time. Adherence, completeness, and sustainability within public policies are necessary.

Construção e validação de conteúdo dos checklists de segurança do paciente no cuidado de enfermagem em unidades de terapia intensiva neonatal / Construction and validation of content of patient safety checklists in nursing care in neonatal intensive care units

Introdução: A segurança do paciente nas Unidades de Terapia Intensiva Neonatal (UTIN) é complexa, considerando os problemas concernentes com os eventos adversos (EA) e as lacunas quanto à falta de instrumentos que direcionem o cuidado de enfermagem. Objetivo: Validar o conteúdo de checklists de cuidados de enfermagem pautados na segurança do paciente internado em UTIN nos momentos da admissão, internação e preparação para a alta. Metodologia: Estudo metodológico, realizado entre 2017 e 2018. A primeira etapa incluiu a revisão integrativa para a construção dos instrumentos guiada pela pergunta norteadora: Quais elementos devem compor checklists de cuidados de enfermagem na admissão, internação e preparo para alta, com vistas à segurança do paciente internado em UTIN? A segunda foi a validação de conteúdo dos checklists por enfermeiros especialistas no tema, realizada em três rodadas. Foram avaliados conforme os critérios metodológicos propostos por Pasquali os títulos, os cabeçalhos, as orientações de preenchimento, os itens e as instruções de preenchimento correspondentes, baseados nas Metas Internacionais da Segurança do Paciente e no Programa Nacional de Segurança do Paciente, considerando para a validação o Índice de Validade de Conteúdo (IVC) ≥ 0,90. Utilizou-se a plataforma Survey Monkey® para desenvolvimento e análise descritiva dos dados. Na primeira rodada participaram 43 enfermeiros especialistas, 33 na segunda e 32 na terceira, os quais foram solicitados a considerar pertinência, objetividade, clareza e relevância dos itens. Resultados: Dentre os 111 itens avaliados no total dos três checklists, 110 foram validados com IVC (Índice de Validade de Conteúdo) ≥ a 0,90 após as modificações sugeridas e um único item foi excluído do checklist de admissão por ter apresentado o IVC=0,88. Conclusão: Concluiu-se que o conteúdo dos Checklists de segurança do paciente no cuidado de enfermagem nos momentos da admissão, internação e preparação para a alta da UTIN foi considerado válido pelo comitê de especialistas. Ressalta-se a necessidade de aperfeiçoamento constante dos checklists. Os resultados da pesquisa limitam-se à validade de conteúdo, recomendando, posteriormente, a validação clínica dos instrumentos.(AU)

Introduction: Introduction: Patient safety in Neonatal Intensive Care Units (NICUs) is complex, considering the problems related to adverse events (AEs) and gaps in the lack of instruments that guide nursing care. Objective: Validate the check-in of nursing care during hospitalization and preparation for discharge. Methodology: Methodological study, conducted between 2017 and 2018. The first stage included the integrative review for the construction of the instruments guided by the guiding question: Which elements should compose nursing care checklists at admission, hospitalization and preparation for discharge, with a view to safety of the patient admitted to a NICU? The second was the validation of content of the checklists by nurses specialists in the theme, held in three rounds. According to the methodological criteria proposed by Pasquali, the corresponding headings, headings, fill-in guidelines, items and instructions, based on the International Patient Safety Goals and the National Patient Safety Program, were considered for validation the Content Validity Index (IVC) ≥ 0.90. The Survey Monkey® platform was used for data analysis and descriptive analysis. The first round was attended by 43 specialist nurses, 33 in the second and 32 in the third, who were asked to consider the relevance, objectivity, clarity and relevance of the items. Results: Of the 111 items evaluated in the total of the three checklists, 110 were validated with IVC (Content Validity Index) ≥ 0.90 after the suggested modifications and a single item was excluded from the admission checklist for presenting the IVC = 0.88. Conclusion: It was concluded that the contents of the Patient Safety Checklists in the nursing care at the time of admission, hospitalization and preparation for discharge from the NICU were considered valid by the committee of specialists. The need for constant improvement of checklists is emphasized. The results of the research are limited to the content validity, recommending, later, the clinical validation of the instruments.(AU)

Listas de chequeo: crisis en sala de operaciones / Checklists: crisis in the operating room

A fines del 2017 el Depto.de Anestesiología del Hospital de Clínicas realizó la presentación del MANUAL: MANEJO de CRISIS en SALA de OPERACIONES. A continuación hacemos una síntesis de los fundamentos que llevaron a la elaboración-adaptación de dicho manual para nuestro país (basado en ''OR Crisis Checklists '' disponible en www.proyectcheck.org/crisis).

At late 2017`s the Anesthesiology Department of "Hospital de Clinicas" presented the manual named: Crisis Management in operation room. Following, we make a summary of the bases that lead to the making-adaptation of such manual for our country (based on "OR Crisis Checklists" available atwww.proyectcheck.org/crisis).

Instrumentos de evaluación del trastorno obsesivo compulsivo: revisión / Instruments for the evaluation of obsessive-compulsive disorder: review

El trastorno obsesivo compulsivo (TOC) es una perturbación mental común, cuyo diagnóstico es puramente clínico. Su prevalencia en población colombiana, oscila entre 3.6% en adultos, y 7.4% en adolescentes. La actual revisión pretende orientar al psicólogo clínico, en la elección de los instrumentos que le permitan evaluar exhaustivamente el TOC.

Obsessive compulsive disorder (OCD) is a common mental disorder, whose diagnose is purely clinical. Its prevalence in Colombian population ranges from 3.6% in adults and 7.4% in adolescents. This review aims to guide the clinical psychologist, regarding the choice of instruments to enable it to fully assess the OCD.

Utilización de la lista de chequeo como método de valoración de la radiografía de tórax en pacientes con trauma / Usage of the checklist as a method of valuation of chest X ray in patients with Trauma

Introducción: El traumatismo de tórax en el mundo occidental constituye la tercera causa de muerte. El diagnóstico oportuno de las lesiones requiere una adecuada y completa exploración clínica e imagenológica. En el curso ATLS (Advanced Trauma Life Support) se utiliza una sistemática para evaluar la radiología simple de tórax en trauma. Objetivos: identificar el espectro de lesiones posibles por trauma de tórax evaluables mediante radiografía simple; reconocer la importancia de emplear una sistemática para su valoración; investigar si el uso de listas de chequeo es de utilidad para su evaluación. Material y métodos: 52 evaluaciones mediante listas de chequeo a estudiantes de medicina del Internado Anual Rotatorio (IAR) y a residentes de cirugía general, durante la valoración yanálisis de estudios radiográficos de traumatismos torácicos, durante Marzo 2013/ Marzo 2014. Resultados: Se evaluaron 32 alumnos del IAR: utilizaron criterios anatómicos para la identificación de estructuras 23(71.87%); Ninguno utilizó el protocolo del ATLS. 31 (96.88%) mencionaron que les sería de ayuda tener una sistemática para la evaluación de la radiografía de tórax. Se evaluaron 20 residentes de Cirugía General: 11 (55%) utilizaron criterios anatómicos para la identificación de estructuras, 6 (30%) utilizaron la sistemática del ATLS. 20 (100%) mencionaron que les sería de ayuda tener una sistemática ordenada para la evaluación de la radiografía de tórax. Conclusión: La implementación de una sistemática para la correcta valoración de la radiografía simple de tórax y su inclusión en una lista de chequeo para la evaluación de losalumnos, podría ser una de muchas técnicas pedagógicas para evaluación del aprendizaje.

Introduction: Chest trauma is the third cause of death in the western world, after cancer and cardiovascular diseases. Early diagnosis of the lesions presented as a result of chest traumarequires adequate and complete clinical and imaging examination. At the ATLS (Advanced Trauma Life Support) asystematic is used to assess the chest Xray in trauma. Objectives: To identify the spectrum of possible injuries developed in patients with chest trauma by evaluating their radiographies; recognize the importance of using a systematic for its valuation; consider whether the use of checklists is useful for its assessment. Material and methods: 52 evaluations using checklists to students at their final year (Annual Rotating Internship ARI)and to general surgery residents, during their valuation and analysis of chest Xrays studies in trauma, between March 2013 March 2014. Results: 32 students from the ARI were evaluated: 23 (71.87 %) used anatomical criteria for the identification of structures. Noneused the ATLS protocol. 31 (96.88 %) mentioned that it would be helpful to have a systematic for the valuation of chest Xrays. 20 General Surgery residents were evaluated: 11 (55%) used anatomical criteria for the identification of structures. 6 (30 %)used ATLS systematic. 20 (100 %) mentioned that it would be helpful to have a systematic for the valuation of chest Xrays. Conclusion: The implementation of a systematic for the proper valuation of chest Xraysin trauma and its incorporation on achecklist for the students assessment could be one of many pedagogical teaching techniques.

Implementación de la Lista de verificación de seguridad quirúrgica postoperatoria en la sala general / Post-operative surgical safety checklist implementation in the surgery ward

Introducción: La iniciativa de la OMS ha demostrado que el conocimiento adecuado de los riesgos que pueden llegar a poner en peligro el bienestar y la vida del paciente pueden ser disminuidos a través de la implementación de listas de verificación durante el acto quirúrgico. Objetivos: Identificar las acciones destinadas a brindar mayor seguridad al paciente desde la implementación de listas de verificación en el período postoperatorio. Lugar de Aplicación: Hospital Aeronáutico Central. Diseño: prospectivo, observacional. Población: 200 actos quirúrgicos. Método: Se analizaron las fallas identificadas utilizando Listas de Verificación en 200 actos quirúrgicos entre Abril y Octubre de 2011. Resultados: Se identificaron 20 (57%) partes quirúrgicos incompletos o mal confeccionados, 4 (11%) pacientes con analgesia inadecuada o insuficiente, 4 (11%) con indicación postquirúrgica de oxígeno sin colocar o colocado a flujo inadecuado y 3 (8,6%) pacientes con indicación de faja corporal sin colocar o colocada de forma incorrecta. Conclusiones: La utilización de Listas de Verificación permiten reducir los riesgos y a evitar eventos adversos prevenibles. En este aspecto, es fundamental la educación continua en todas las áreas de trabajo con el fin de lograr una real política de seguridad para el paciente quirúrgico.

Introduction: WHO initiative has shown that adequate knowledge of the risks that may endanger patients’ lives and well-being is essential and they can be diminished by implementing surgical safety checklists during surgery. Objectives: Identify actions aimed at providing better patient safety through the implementation of safety checklists in the postoperative period. Place of implementation: Hospital Aeronáutico Central. Design: prospective, observational. Population: 200 surgeries. Method: Analysis of errors identified using Surgical Safety Checklists in 200 surgeries, between April and October 2011. Results: The following was identified: 20 (57%) incomplete or defective surgery reports, 4 (11%) patients with inadequate or insufficient analgesia, 4 (11%) patients with postoperative indication of oxygen therapy not administered or placed with inadequate flow, and 3 (8.6%) patients with indication to wear abdominal binder were without them or they were wrongly placed. Conclusions: The use of Safety Checklists reduces risks and prevents avoidable adverse events. In this regard, continuing education in all work areas is vital in order to achieve a real safety policy for the surgical patient.

Significance of Utilizing Checklists and Statements for Improvement of the Quality of Studies Concerning Hot Springs: evidence grading and various study designs of epidemiological and clinical studies / 日本温泉気候物理医学会雑誌

The purpose of this study was to review several kinds of checklists and statements of studies in human subjects, and to examine reporting methods in order to improve the quality of studies concerning hot springs.<br>For randomized controlled trials (RCTs), “the CONSORT Statement” (Moher et al. <i>JAMA</i> 2001) consisting of 22 terms is the most well known checklist. In addition, different versions and new checklists have been developed depending upon the content of the studies (such as intervention methods) or field of the studies. There is also “the QUOROM Statement” (Moher et al. <i>Lancet</i> 1999) for a systematic review (SR) of RCTs, “the TREND Statement” (Jarlais et al. <i>Am J Public Health</i> 2004) for nonrandomized controlled trials, “the STROBE Statement” (Elm et al. <i>Ann Inter Med</i> 2007) for observational studies, and “the MOOSE Checklist” (Stroup et al. <i>JAMA</i> 2000) as a SR of observational studies. With regard to studies on hot springs, however, terms in the checklists and the statements described above are insufficient or inappropriate because of difficulties in performing such studies in a blinded manner, and the diversity of intervention methods, such as the quellen charakter.<br>Improvement of the quality of reports is important for validation of evidence. In order to improve the quality of assessments and reports of studies on hot springs, it may be necessary to develop a unique checklist based on the above-described statements and checklists.

Recent World Trend in Performance-based Assessments and Application of the Standardized Patient Program in Korean Medical Education / 한국의학교육

As a criterion of competence, performance-based assessment methods have been used in the health professions for centuries, and dozens of studies of their psychometric characteristics have been reported over the last several decades. Performance-based assessment methods, commonly used in medical education, include written clinical simulations (PMPs), computer-based clinical simulations, role-playing oral examinations, and standardized patient (SP) simulations. The underlying rationale for utilizing performance-based assessments is that they are tools with which one can appropriately evaluate medical students and reinforce what they have learned throughout their undergraduate studies. SPs are being widely used across the curriculum because of their potential advantages: from medical interviewing and physical diagnosis courses to clinical clerkships to residency training. The primary objective for SP encounters is to assist in the formation of fundamental medical interviewing and to improve clinical skills. However, as the program matures, SPs could be used at more advanced levels of medical training and be used to evaluate examinees, as well as obtain feedback on how well the educational program is working, at all levels including residency, continuing medical education for physicians, and even as a way to assess the abilities of foreign medical school graduates. Implementing an SP program will permit Korean medical educators to prospectively identify critical skills for their students to learn and establish explicit performance criteria for clinical competence. This study demonstrates why Korean SP programs should be implemented in the early stages in the medical education program, how to train SPs, and how to apply an SP program in an innovative curriculum, how to study about it, and how to disseminate SP programs throughout the Korean medical educational system.