Background Communication breakdowns are a common threat to surgical safety, but there are little data to guide initiatives to improve communication. Study design In surgeon-review of 444 surgical malpractice claims from 4 liability insurers, we identified 60 cases involving communication breakdowns resulting in harm to patients. Two surgeon-reviewers analyzed these cases to identify common characteristics and associated factors. Based on identified patterns, potential interventions to prevent communication breakdowns were developed and their potential impact was assessed. Results The 60 cases involved 81 communication breakdowns, occurring in the preoperative (38%), intraoperative (30%), and postoperative periods (32%). Seventy-two percent of cases involved one communication breakdown. The majority of breakdowns were verbal communications (92%) involving 1 transmitter and 1 receiver (64%). Attending surgeons were the most common team member involved. Status asymmetry (74%) and ambiguity about responsibilities (73%) were commonly associated factors. Forty-three percent of communication breakdowns occurred with handoffs and 39% with transfers in the patient's location. The most common communication breakdowns involved residents failing to notify the attending surgeon of critical events and a failure of attending-to-attending handoffs. Proposed interventions could prevent 45% to 73% of communication breakdowns in this cases series. Conclusions Serious communication breakdowns occur across the continuum of care, typically result from a failure in verbal communication between a surgical attending and another caregiver, and often involve ambiguity about responsibilities. Interventions to prevent these breakdowns should involve: defined triggers that mandate communication with an attending surgeon; structured handoffs and transfer protocols; and standard use of read-backs.

http://www.atulgawande.com/documents/2007JACS--CommunicationBreakdowns.pdf

Patterns of Communication Breakdowns Resulting in Injury to Surgical Patients

Non-technical skills for surgeons in the operating room: a review of the literature

Family caregiving affects millions of Americans every day, in all walks of life. At least 17.7 million individuals in the United States are caregivers of an older adult with a health or functional limitation. The nation's family caregivers provide the lion's share of long-term care for our older adult population. They are also central to older adults' access to and receipt of health care and community-based social services. Yet the need to recognize and support caregivers is among the least appreciated challenges facing the aging U.S. population. Families Caring for an Aging America examines the prevalence and nature of family caregiving of older adults and the available evidence on the effectiveness of programs, supports, and other interventions designed to support family caregivers. This report also assesses and recommends policies to address the needs of family caregivers and to minimize the barriers that they encounter in trying to meet the needs of older adults.

Families Caring for an Aging America

Ultrasonography (US) with a high-frequency (7.5–10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed. © RSNA, 2003

Sonography of the Scrotum

Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation.

A prospective study of patient safety in the operating room.

Acceptance and use of health information technology by community-dwelling elders

This study was performed to determine if sonography can assist in predicting testicular viability in the setting of testicular torsion. Sixteen patients with sonographically diagnosed and surgically proved testicular torsion were studied. The preoperative sonograms were reviewed retrospectively to determine testicular echogenicity and homogeneity, testicular size and vascularity, scrotal skin thickness and vascularity, and the presence or absence of a hydrocele. These findings were correlated with the viability of the testis at surgery. All nine patients with normal homogeneous testicular echogenicity had viable testes at surgery. All seven patients with hypoechoic or inhomogeneous testes had nonviable testes at surgery and pathologic evidence of necrosis. The other findings were less helpful in predicting viability. In the setting of testicular torsion, normal testicular echogenicity is a strong predictor of viability. Immediate surgical detorsion in these patients carries a very high likelihood of salvaging the affected testis.

Sonographic prediction of viability in testicular torsion: preliminary observations.

With the increasing demand for health care, hospitals are looking for ways to optimize their care processes in order to increase efficiency, while guaranteeing the quality of the care. Process modeling is a crucial step for process improvement, since it provides a process model that can be analyzed and optimized. Process mining is a recent promising methodology to discover process models based on data from event logs. However, early applications of process mining to health care has produced overly complex models, which have been attributed to the complexity of the health care domain. In this paper, we argue that existing process mining methods fail to identify good process models, even for well-defined clinical processes. We identify a number of reasons for this shortcoming and discuss a few directions for extending process mining methods in order to make them more suitable for the clinical domain.

On process mining in health care

Importance Elderly patients often share control of their personal health information and decision making with family and friends when needed. Patient portals can help with information sharing, but concerns about privacy and autonomy of elderly patients remain. Health systems that implement patient portals would benefit from guidance about how best to implement access to portals for caregivers of elderly patients. Objective To identify how patients older than 75 years (hereinafter, elders) and family caregivers of such patients approach sharing of health information, with the hope of applying the results to collaborative patient portals. Design, Setting, and Participants A qualitative study was conducted from October 20, 2013, to February 16, 2014, inviting participants older than 75 years (n = 30) and participants who assist a family member older than 75 years (n = 23) to 1 of 10 discussion groups. Participants were drawn from the Information Sharing Across Generations (InfoSAGE) Living Laboratory, an ongoing study of information needs of elders and families based within an academically affiliated network of senior housing in metropolitan Boston, Massachusetts. Groups were separated into elders and caregivers to allow for more detailed discussion. A professional moderator led groups using a discussion guide. Group discussions were audiotaped, transcribed, and analyzed inductively using immersion/crystallization methods for central themes. Main Outcomes and Measures Central themes regarding sharing of health information between elderly patients and family caregivers. Results Seven lessons emerged from 2 main themes. First, sharing information has consequences: (1) elders and caregivers have different perspectives on what is seen as the “burden” of information, (2) access to medical information by families can have unintended consequences, and (3) elders do not want to feel “spied on” by family. Second, control of information sharing is dynamic: (4) elders wish to retain control of decision making as long as possible, (5) transfer of control occurs gradually depending on elders’ health and functional status, (6) control of information sharing and decision making should be fluid to maximize elders’ autonomy, and (7) no “one-size-fits-all” approach can satisfy individuals’ different preferences. Conclusions and Relevance Information sharing and control are complex issues even under the most well-meaning circumstances. While elders may delegate control and share information with family, they want to retain granular control of their information. When using patient portals, simple proxy access may not adequately address the needs and concerns of aging patients.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/2363023/ioi150057.pdf

Meghan Dierks

Papers

A prospective study of patient safety in the operating room.

Acceptance and use of health information technology by community-dwelling elders

Sonographic prediction of viability in testicular torsion: preliminary observations.

On process mining in health care

Information Sharing Preferences of Older Patients and Their Families