ABSTRACT
BACKGROUND: Retained foreign objects (RFOs) after surgical procedures are an infrequent but potentially devastating medical error. The Mayo Clinic, Rochester (MCR), undertook a quality improvement program to reduce the incidence of surgical RFOs. METHOD: A multidisciplinary, multiphase approach was initiated in 2005. The effort, led by surgical, nursing, and administrative institutional leaders, was divided into three phases. The first phase included a defect analysis and policy review. A detailed analysis of all RFOs (both true and near misses) was undertaken to identify patterns of failures unique to our institution and operating room culture. Simultaneously, a review of all relevant institutional policies was performed, with comprehensive revisions focusing on increased clarity and inter- and intrapolicy consistency. The second phase involved increasing awareness and communication among all operating room personnel, including surgeons, residents, nursing, and allied health staff. The education program included all-staff conferences, team training, simulation videos, and daily education reminders and in-room audits. Finally, a monitoring and control phase involved rapid leadership response teams to any events, enhanced staff communication, and policy reviews. RESULTS: When the program started, MCR was averaging a surgical RFO every 16 days. After the intervention, the average interval between RFO events increased to 69 days, a level of performance that has been sustained for more than two years. DISCUSSION: MCR experienced a significant and sustained reduction in the incidents of RFOs, attributed to the multidisciplinary nature of the initiative, the active engagement of institutional leadership, and use of the principles of enhanced communication between operating room staff members to improve operating room situational awareness.
Subject(s)
Foreign Bodies/prevention & control , Medical Errors/prevention & control , Patient Care Team/standards , Surgical Procedures, Operative/adverse effects , Foreign Bodies/epidemiology , Foreign Bodies/etiology , Humans , Inservice Training/methods , Interprofessional Relations , Medical Errors/statistics & numerical data , Operating Rooms/organization & administration , Organizational Case Studies , Patient Care Team/organization & administration , Program Evaluation , Quality Assurance, Health Care/methods , WorkforceABSTRACT
PURPOSE: Hospital practices in academic medical centers have fewer medical residents available to provide hospital care, necessitating alternative models for patient care. This article reports a new model for care of inpatients with cardiovascular diseases. METHOD: In 1998, a new nonresident cardiovascular patient care (Cardiology IV) service was implemented that used a team approach of staff attending cardiologists, cardiovascular fellows, midlevel practitioners (nurse practitioners and physician's assistants), and nurses to evaluate and treat patients. Standard dismissal information was collected for all patients dismissed in 1998 to compare diagnosis-related group, length of stay, in-hospital mortality, and 30-day readmission rates for Cardiology IV. These characteristics were compared with those for the remaining resident teaching services. Patients' satisfaction surveys from 1997 and 1998 were compared. Attending physicians' and internal medicine residents' satisfaction before and after the implementation of the new service was also compared. RESULTS: Staff and resident physicians were more satisfied with their hospital rotations after this intervention was introduced. Optimal patient care was maintained, and efficiency enhanced. Patients on Cardiology IV had a shorter length of stay compared with patients on the resident teaching service. CONCLUSIONS: This new hospital model has provided an alternative to patient care without the need for residents and protects education on the conventional teaching services. This model maintains optimal patient care and has resulted in enhanced satisfaction of attending staff and residents.
