Assessment of the implementation of a national patient safety alert to reduce wrong site surgery.

BACKGROUND: In 2005, guidance on how to prevent wrong site surgery in the form of a national safety alert was issued to all NHS hospital trusts in England and Wales by the National Patient Safety Agency. OBJECTIVE: To investigate the response to the alert among clinicians in England and Wales 12-15 months after it had been issued. METHODS: A before-after study, using telephone/face-to-face interviews with consultant surgeons and senior nurses in ophthalmology, orthopaedics and urology in 11 NHS hospitals in England & Wales in the year prior to the alert and 12-15 months after. The interviews were coded and analysed thematically. RESULTS: The study revealed marked heterogeneity in organisational processes in response to a national alert. There was a significant change in surgeons' self-reported practice, with only 48% of surgeons routinely marking patients prior to the alert and 85% after (p<0.001). However, inter-specialty differences remained and change in practice was not always matched by change in attitude. Compliance with the detailed recommendations about how marking should be carried out was inconsistent. There were unintended consequences in terms of greater bureaucracy and concerns about diffusion of responsibility and hastily performed marking to enable release of patients from wards. CONCLUSION: The alert was effective in promoting presurgical marking and encouraging awareness of safety issues in relation to correct site surgery. However, care should be taken to monitor unintended consequences and whether change is sustained. Greater flexibility for local adaptation coupled with better design and early testing of safety alerts prior to national dissemination may facilitate more sustainable changes in practice.

Persistent otitis media with effusion: a new experimental model.

OBJECTIVES/HYPOTHESIS: Numerous mechanical animal models for the creation of otitis media with effusion (OME) have been described since the 1920s. However, there are many problems associated with these models, including high infection rates, unreliability, and high resolution rates. The aim of the current study was to create a suitable mechanical animal model that would produce a sterile and long-lasting effusion. STUDY DESIGN: A new technique using an external surgical approach on specific pathogen-free rats is described. METHOD: The eustachian tubes of 56 rats were obstructed in the mid portion along the skull base with gutta percha. RESULTS: All animals developed an effusion within 1 week of the procedure. The resolution rate was 8%, with 80% maintaining sterile effusions for up to 1 year. CONCLUSIONS: This new procedure for an OME model has proved consistently reliable in creating a persistent and long-lasting effusion. It has a low infection rate and should benefit future studies on the prolonged effects of OME on the tympanic membrane and middle ear.

Quantitative measurement of serum and plasma lysozyme: an automated method.

The demand for laboratory testing of blood lysozyme levels is increasing markedly. Although of limited value in the initial diagnosis of leukaemia, the importance of lysozyme levels in leukaemia management is rapidly being realised. An established manual method was examined in a successful attempt to develop an improved automated method using a centrifugal analyser. In comparison of serum and plasma the results showed no significant difference, indicating that the method described could use either material. The automated method was quicker, easier, more economical and more precise than the manual method it replaced.