Critical errors in infrequently performed trauma procedures after training.
Axillary Artery
/ injuries
Benchmarking
/ methods
Brachial Artery
/ injuries
Cadaver
Clinical Competence
/ statistics & numerical data
Educational Measurement
/ methods
Fasciotomy
/ adverse effects
Femoral Artery
/ injuries
Humans
Internship and Residency
/ organization & administration
Medical Errors
/ prevention & control
Prospective Studies
Surgeons
/ education
Vascular Surgical Procedures
/ adverse effects
Wounds and Injuries
/ surgery
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
04
03
2019
revised:
24
05
2019
accepted:
27
05
2019
pubmed:
30
7
2019
medline:
25
2
2020
entrez:
30
7
2019
Statut:
ppublish
Résumé
Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.
Sections du résumé
BACKGROUND
Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors.
METHODS
In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts.
RESULTS
Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error.
CONCLUSION
Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.
Identifiants
pubmed: 31353081
pii: S0039-6060(19)30296-X
doi: 10.1016/j.surg.2019.05.031
pii:
doi:
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
835-843Investigateurs
Amechi Anazodo
(A)
Brandon Bonds
(B)
Guinevere Granite
(G)
George Hagegeorge
(G)
Megan Holmes
(M)
Peter Hu
(P)
Elliot Jessie
(E)
Nyaradzo Longinaker
(N)
Alexys Monoson
(A)
Mayur Narayan
(M)
Jason Pasley
(J)
Joseph Pielago
(J)
Eric Robinson
(E)
Anna Romagnoli
(A)
Babak Sarani
(B)
Nicole Squyres
(N)
William Teeter
(W)
Shiming Yang
(S)
Informations de copyright
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.