Characteristics and costs of surgical scheduling errors.

BACKGROUND: Errors that increase the risk of wrong-side/-site procedures not only occur the day of surgery but also are often introduced much earlier during the scheduling process. The frequency of these booking errors and their effects are unclear. METHODS: All surgical scheduling errors reported in the institution's medical event reporting system from January 1, 2011, to July 31, 2011, were analyzed. Focus groups with operating room nurses were held to discuss delays caused by scheduling errors. RESULTS: Of 17,606 surgeries, there were 151 (.86%) booking errors. The most common errors were wrong side (55, 36%), incomplete (38, 25%), and wrong approach (25, 17%). Focus group participants said incomplete and wrong-approach bookings resulted in the longest delays, averaging 20 minutes and costing at least $320. CONCLUSIONS: Although infrequent, scheduling errors disrupt operating room team dynamics, causing delays and bearing substantial costs. Further research is necessary to develop tools for more accurate scheduling.

Attitudes toward prenatal genetic testing for Treacher Collins syndrome among affected individuals and families.

Treacher Collins syndrome (TCS) is a craniofacial syndrome that is both phenotypically variable and heterogeneous, caused by mutations in the TCOF1, POLR1C, and POLR1D genes. We examined attitudes towards TCS prenatal genetic testing among affected families using a telephone questionnaire. Participants were 31 affected adults and relatives recruited primarily through families cared for in the mid-Atlantic region. Nineteen participants (65%) reported that they would take a TCS prenatal genetic test which could not predict degree of disease severity. Interest in TCS genetic testing was associated with higher income, higher concern about having a child with TCS, lower religiosity, lower concern about genetic testing procedures, and having a sporadic rather than familial mutation. Over half reported that their decision to have TCS genetic testing would be influenced a great deal by their desire to relieve anxiety and attitudes toward abortion. Ten participants (32%) reported that they would be likely to end the pregnancy upon receiving a positive test result; this was lower amongst TCS affected individuals and higher amongst participants with children with TCS. Genetics healthcare providers need to be aware of affected individuals' and families' attitudes and interest in prenatal genetic testing for TCS, and the possible implications for other craniofacial disorders, so that patients' information needs can be met.

Measuring quality of life in cleft lip and palate patients: currently available patient-reported outcomes measures.

BACKGROUND: Patient-reported outcomes in cleft lip and palate treatment are critical for patient care. Traditional surgical outcomes focused on objective measures, such as photographs, anatomic measurements, morbidity, and mortality. Although these remain important, they leave many questions unanswered. Surveys that include aesthetics, speech, functionality, self-image, and quality of life provide more thorough outcomes assessment. It is vital that reliable, valid, and comprehensive questionnaires are available to craniofacial surgeons. METHODS: The authors performed a literature review to identify questionnaires validated in cleft lip and palate patients. Qualifying instruments were assessed for adherence to guidelines for development and validation by the scientific advisory committee and for content. RESULTS: The authors identified 44 measures used in cleft lip and palate studies. After 15 ad hoc questionnaires, eight generic instruments, 11 psychiatric instruments, and one non-English language questionnaire were excluded, nine measures remained. Of these, four were never validated in the cleft population. Analysis revealed one craniofacial-specific measure (Youth Quality of Life-Facial Differences), two voice-related measures (Patient Voice-Related Quality of Life and Cleft Audit Protocol for Speech-Augmented), and two oral health-related measures (Child Oral Health Impact Profile and Child Oral Health Quality of Life). The Youth Quality of Life-Facial Differences, Child Oral Health Impact Profile, and Child Oral Health Quality of Life questionnaires were sufficiently validated. None was created specifically for clefts, resulting in content limitations. CONCLUSIONS: There is a lack of comprehensive, valid, and reliable questionnaires for cleft lip and palate surgery. For thorough assessment of satisfaction, further research to develop and validate cleft lip and palate surgery-specific instruments is needed.