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Development and application of an inpatient traffic lights classification to improve the surgical ward round quality

Published:October 20, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.10.012
      Interventions such as the World Health Organization (WHO) surgical safety checklist and national surgical databases have been developed to reduce surgical errors and standardize the operative patient care in order to improve postoperative outcomes. Nevertheless, these measures to upgrade care in the operating room (OR) have not been carried over to the surgical ward round in the same manner.
      • Pucher P.H.
      • Aggarwal R.
      • Darzi A.
      Surgical ward round quality and impact on variable patient outcomes.
      Zegers et al. reported that more than 50% of the adverse events (AE) were related to surgical procedures, taking place on the ward rather than in the OR and 12.8% resulted in permanent disability or contributed to death. The proportion of adverse events and their impact increased with age. Among deceased hospital patients, 10.7% (95% CI 9.8%–11.7%) had experienced an AE. Preventable AEs that contributed to death occurred in 4.1% (95% CI 3.5%–4.8%) of all hospital deaths.
      • Zegers M.
      • de Bruijne M.C.
      • Wagner C.
      • et al.
      Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study.
      Recent evidence showed that short-term surgical outcomes are determined in a half by the quality of postoperative care. The variability in the processes of perioperative care are directly proportional to the incidence of AEs and poor outcomes of inpatients. Some factors such as hospital resources, teaching hospital status and nurse staff have been identified to be related with inpatients' negative outcomes.
      • Pucher P.H.
      • Aggarwal R.
      • Darzi A.
      Surgical ward round quality and impact on variable patient outcomes.
      • Zegers M.
      • de Bruijne M.C.
      • Wagner C.
      • et al.
      Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study.
      • Kmietowicz Z.
      Restore ward rounds to former glory to improve patient care, say colleges.
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