Introduction and validation of a surgical ward round checklist to improve surgical ward round performance in a tertiary vascular service.

BACKGROUND: Surgeons administer care in an increasingly complex clinical environment. Time constraints put strain on individual clinicians and the multidisciplinary team, increasing the risk of human errors. The World Health Organization surgical checklist has shown to mitigate this risk perioperatively. We describe the development, introduction and outcomes of a novel ward round safety checklist. METHODS: The vascular team ward rounds at Christchurch Hospital were assessed over a 2-week period for ward round quality indicators. A ward round safety checklist was developed and then introduced. Two further assessments were conducted to evaluate for improvement in the ward round quality indicators. Ward rounds were timed with the length of each consultation recorded and staff perception assessed. RESULTS: Significant gains across both clinical indicators and staff feedback measures were observed. Of the 21 ward round quality indicators, 20 showed statistically significant improvement, as did all subjective measures. Significant improvements included observation chart review (20% to 75% to 81%), drug chart review (10% to 54% to 78.6%) and anticoagulation/antiplatelet treatment (32% to 61% to 58.1%) (P < 0.05). Mean consultation time per patient did not increase (3 min 58 s to 3 min 48 s and 4 min 30 s) (P = 0.857 and P = 0.119). CONCLUSION: This study provides evidence that introducing a structured ward round safety checklist improved ward round quality, without adversely affecting consultation time. The familiar checklist structure promotes its acceptance and team cohesion. Whether the improvements observed translate to improved patient outcomes and reduced adverse events reporting is the subject of ongoing study.

Timeliness and outcomes of carotid endarterectomy for symptomatic carotid artery stenosis: a single centre audit.

BACKGROUND: For patients presenting with symptomatic internal carotid artery stenosis, carotid endarterectomy (CEA) surgery is recommended to be performed generally within a 48-hr to 14-day window. This study aimed to assess timeliness of delivery, and outcomes, of CEA surgery in a tertiary vascular centre. METHOD: Patients with symptomatic internal carotid artery stenosis who underwent CEA between 1 June 2014 and 31 June 2017 were identified and data were obtained from hospital records. The timeline of their journey from presentation to surgery was then mapped together with their outcomes. RESULTS: One hundred and seventy-two cases were included in the study. Overall, the median time from development of presenting symptoms to surgery was 9 days and 119 (69%) cases were operated on within 14 days. The median time from development of presenting symptoms to ultrasound imaging was 2 days and the median time from symptoms to vascular referral was also 2 days. There were no deaths, strokes or transient ischaemic attacks within 30 days of CEA. At 1 year, survival was 100% but 15 (8.7%) had experienced at least one transient ischaemic attack or stroke. In the 53 cases operated upon beyond 14 days the dominant cause of delay in 32 (60%) was accessing surgery after review by the vascular service. CONCLUSION: The aim of delivering CEA within 14 days of developing relevant symptoms was achieved in most cases with good outcomes. Nevertheless, points of delay in the patient journey that could be targeted for future quality improvement were identified.

Balloon control of the saphenofemoral junction during foam sclerotherapy: proposed innovation.

Venous obliteration using foam sclerosant is a relatively new procedure that holds great promise and may prove to be as effective as conventional surgical treatments in obliteration of the great saphenous vein. Foam sclerotherapy can have minor and major complications, most of which occur as a result of gas or sclerosant leakage into the systemic venous system. Conventionally, the saphenofemoral junction is occluded by digital pressure to prevent escape of sclerosant foam into the deep venous system. We propose balloon control of the saphenofemoral junction to prevent sclerosant leakage. This also promotes foam contact with the endothelium in a prolonged, controlled fashion. This method requires no anesthesia, is suitable for ambulatory care, and has been safe and successful in all five cases. Duplex examinations at 1 week and 3 months have shown complete obliteration of the great saphenous vein using this technique.