Crisis Containment: Tools for Harm Mitigation in Surgery

TY - JOUR

T1 - Crisis Containment

T2 - Tools for Harm Mitigation in Surgery

AU - Gogalniceanu, Petrut

AU - Kessaris, Nicos

AU - Karydis, Nikolaos

AU - Loukopoulos, Ioannis

AU - Sevdalis, Nick

AU - Mamode, Nizam

N1 - Funding Information: Disclosures outside the scope of this work: Dr Sevdalis receives payments as the director of the London Safety and Training Solutions, Ltd. Dr Mamode is a paid consultant to Novartis, Hansa, Takeda, and Shire, and receives grant funding from Hansa. Other authors have nothing to disclose. Funding Information: Disclosures outside the scope of this work: Dr Sevdalis receives payments as the director of the London Safety and Training Solutions, Ltd. Dr Mamode is a paid consultant to Novartis, Hansa, Takeda, and Shire, and receives grant funding from Hansa. Other authors have nothing to disclose. Support: Dr Sevdalis' research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital National Health Service (NHS) Foundation Trust. Dr Sevdalis is a member of King's Improvement Science, which offers co-funding to the NIHR ARC South London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas' Charity and the Maudsley Charity. Dr Sevdalis' research is further supported by the Antibiotic use across Surgical Pathways - Investigating, Redesigning and Evaluating Systems (ASPIRES) research program, funded by the Economic and Social Research Council. Dr Sevdalis is further funded by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King's College London (GHRU 16/136/54). Funding Information: Support: Dr Sevdalis' research is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South London at King's College Hospital National Health Service (NHS) Foundation Trust. Dr Sevdalis is a member of King's Improvement Science, which offers co-funding to the NIHR ARC South London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), Guy's and St Thomas' Charity and the Maudsley Charity. Dr Sevdalis' research is further supported by the Antibiotic use across Surgical Pathways - Investigating, Redesigning and Evaluating Systems (ASPIRES) research program, funded by the Economic and Social Research Council. Dr Sevdalis is further funded by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King's College London (GHRU 16/136/54). Publisher Copyright: © 2021 American College of Surgeons

PY - 2021/12

Y1 - 2021/12

N2 - Background: Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined. Study design: A multimethods qualitative study identified crisis containment strategies and tools in commercial aviation. These were translated and clinically adapted in 3 stages: semi-structured observational fieldwork with commercial airlines, interviews with senior pilots, and focus groups with both healthcare and aviation safety experts. Thematic analysis and expert consensus methods were used to derive a framework for crisis containment. Results: Fieldwork with 2 commercial airlines identified 2 crisis containment concepts: the detrimental impact of surprising or startling events on operator performance; and the use of prioritization tools to take basic but critical actions (Aviate, Navigate and Communicate model). Twenty-two experts in aviation and healthcare practice informed the topic of crisis containment in 17 interviews and 3 focus groups. Three strategies were identified and used to form a crisis containment algorithm: 1. Manage the operators' startle response to facilitate meaningful mitigating actions (STOP tool); 2. Take priority actions to secure core functions. These included managing patients' physiologic shock, optimizing environmental risks, and mobilizing resources (Perfuse, Move and Communicate tool); 3. Deploy well-rehearsed drills targeting case-specific harms or errors (Memory Actions). This model requires validation in clinical practice. Conclusions: Crisis containment can be achieved by controlling operators' startle response, applying prioritization tools, and deploying drills against specific failures. The application of this model may extend to healthcare areas outside surgery.

AB - Background: Surgical crises represent unrecognized opportunities for improving patient safety and adding value in healthcare. The first step in a crisis response is to contain and mitigate harm. While the principles of damage control are well established in surgery, methods of containing harm on broader clinical and organizational levels are not clearly defined. Study design: A multimethods qualitative study identified crisis containment strategies and tools in commercial aviation. These were translated and clinically adapted in 3 stages: semi-structured observational fieldwork with commercial airlines, interviews with senior pilots, and focus groups with both healthcare and aviation safety experts. Thematic analysis and expert consensus methods were used to derive a framework for crisis containment. Results: Fieldwork with 2 commercial airlines identified 2 crisis containment concepts: the detrimental impact of surprising or startling events on operator performance; and the use of prioritization tools to take basic but critical actions (Aviate, Navigate and Communicate model). Twenty-two experts in aviation and healthcare practice informed the topic of crisis containment in 17 interviews and 3 focus groups. Three strategies were identified and used to form a crisis containment algorithm: 1. Manage the operators' startle response to facilitate meaningful mitigating actions (STOP tool); 2. Take priority actions to secure core functions. These included managing patients' physiologic shock, optimizing environmental risks, and mobilizing resources (Perfuse, Move and Communicate tool); 3. Deploy well-rehearsed drills targeting case-specific harms or errors (Memory Actions). This model requires validation in clinical practice. Conclusions: Crisis containment can be achieved by controlling operators' startle response, applying prioritization tools, and deploying drills against specific failures. The application of this model may extend to healthcare areas outside surgery.

UR - http://www.scopus.com/inward/record.url?scp=85116126333&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2021.08.676

DO - 10.1016/j.jamcollsurg.2021.08.676

M3 - Article

C2 - 34438080

AN - SCOPUS:85116126333

SN - 1072-7515

VL - 233

SP - 698-708.e1

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

IS - 6

ER -