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December 3, 2019
Overlapping Surgery Back in the News
We’ve long been critical of overlapping surgery. It’s now been over 4 years since the Boston Globe’s Spotlight investigative series (Abelson 2015) ignited the controversy on double-booked surgery and led to a subsequent review by the Senate Finance Committee (Senate Finance Committee 2016). It didn’t take long for everyone to agree that concurrent surgery (where critical parts of two surgeries might be taking place simultaneously) should be banned but we’ve been left with the debate about “overlapping” surgery.
Over subsequent years there have been multiple retrospective cohort studies purporting to demonstrate the safety of overlapping surgery and very few noting an increased risk of complications with overlapping surgery. So, the debate has largely stayed out of the media. That is, until the last few weeks. Once again, the Boston Globe Spotlight team brought renewed attention to the issue with 3 new stories.
In the first (Saltzman 2019a), it was revealed that the Massachusetts General Hospital paid a settlement of $13 million for wrongful termination to the surgeon who was dismissed from the MGH who had been critical of the practice of double-booked surgery. The settlement included offering that surgeon his old job back at the MGH (which he has declined) and naming a patient safety initiative for him.
A day later, it was revealed that a second major hospital chain agreed to a multi-million dollar settlement to resolve concerns over concurrent surgery (Saltzman 2019b). The claim was paid in part to three whistle-blowers who claimed that a urologist allowed trainees to perform surgery without proper supervision while he operated on patients in another room. And part was paid to the federal government because the hospital system had billed Medicare for operations performed by the trainees. And yet another malpractice settlement was announced recently against a surgeon who did as many as 14 operations a day, sometimes 3 at one time (Taylor 2019, Mulder 2019).
The third Boston Globe story (Saltzman 2019c) cited materials from the court file of the recently settled wrongful termination lawsuit against MGH. You’ll recall that, after the first Spotlight report, the MGH responded with a fact sheet and multiple posts on its website. It noted that it had done a review of concomitant surgery cases done in calendar year 2014 and found that the rate of complications was no higher than for cases of single (non-overlapping) surgery. The MGH did revise its policy and procedure on concomitant surgery in 2012. But the materials from the recent wrongful termination suit do appear to identify several cases in which complications happened while primary surgeons were off in different OR’s. See that last Boston Globe article for details. The Globe had also reported earlier in 2019 (Saltzman 2019d) on a settlement in a malpractice made by former major league baseball pitcher, Bobby Jenks, regarding complications of spine surgery in which had had not been told his surgeon was overseeing a second simultaneous operation.
The Seattle Times has done a series of articles on overlapping surgery at Seattle’s Swedish Cherry Hill Hospital. The initial article described a case in which a young woman with Ehlers-Danlos Syndrome died from post-operative complications of spine surgery (Baker 2017a). The primary problems described centered more around lack of physical presence of the primary surgeon post-operatively and failure to rescue. But subsequent articles focused on the practice of double-booked surgeries. In one article (Baker 2017b), the newspaper interviewed 13 patients who were treated in double-booked procedures and found that none recalled being told the surgeon would not be in the room for the entire procedure. The Times reported some detailed time schedules showing 4 surgeons routinely participating in overlapping in 50-70+ percent of their cases and showed that some cases had significant overlapping. Following the series of articles, the hospital CEO and a top neurosurgeon resigned, and the hospital revised its policy on overlapping surgery.
Pennsylvania Patient Safety Authority analysts queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for events involving concurrent and overlapping surgery and procedures in hospitals and ambulatory surgical facilities that occurred during calendar year 2017 (PPSA 2019). They identified 15 events in which the narrative or recommendations indicated that the surgeon was operating in more than one room at the same time (i.e., overlapping); for example, the attending surgeon started the second case while the resident was closing the first case. Eleven of these events indicated that the overlap contributed to the reason for which the event was reported; for example, the overlap contributed to a delay in starting the next case. None of the 15 events resulted in patient harm.
In our March 12, 2019 Patient Safety Tip of the Week “Update on Overlapping Surgery” we discussed multiple large retrospective studies (Sun 2019, Ponce 2018, Hyder 2018, Goldfarb 2018, Dy 2018) that were supportive of overlapping surgery, noting that overall complication rates or mortality rates were as good or better than those from non-overlapping cases.
Since that last column on overlapping surgery, there have been several more studies published in the medical literature touting the safety of overlapping surgery. Howard and colleagues (Howard 2018) did a retrospective cohort study of patients who underwent neurosurgical procedures at Emory University Hospital over a 2 year period. A total of 2275 patients underwent neurosurgery, 42.7% were nonoverlapping and 57.3% were overlapping. Overlapping surgery (OS) was more frequently elective. Regression analysis failed to demonstrate an association between OS and complications, As we’ve seen in almost all prior studies, median surgical times were significantly longer for patients in the OS cohort vs the nonoverlapping surgery cohort (in-room time, 219 vs 188 minutes; skin-to-skin time, 141 vs 113 minutes). The authors conclude their data suggest that OS can be safely performed if appropriate precautions and patient selection are followed.
Another study on 1018 neurosurgical and spine patients found no significant difference in overall or serious complications between those having overlapping surgery and those having non-overlapping surgery (Guan 2016). Another study (DiGiorgio 2018) compared before and after results when the neurosurgery service at an academic, safety-net hospital transitioned from routinely allowing one room per day (period one) to overlapping rooms (period two), with the second room being staffed by the same attending surgeon. Allowing overlapping rooms significantly reduced length of stay and complication rate and increased the rate of discharges to home in a population significantly weighted toward uninsured and Medicaid patients.
While most studies on overlapping surgery have looked at orthopedic, spine, or neurosurgical procedures, a recent study analyzed patients undergoing plastic surgery. Parikh et al. (Parikh 2019) did a retrospective cohort study of 866 consecutive patients undergoing plastic surgery procedures (35.9% overlapping, 64.1% non-overlapping) at a tertiary academic center over a 2 year period. They found no differences in complications, reoperations, readmissions, or emergency room visits between the 2 groups.
So, how do we reconcile all these studies showing that overlapping surgery seems to be safe and not associated with more complications with those isolated or anecdotal reports of complications that appear to be related to the practice? The answer is clear to us: statistical dilution.
We think the recent disclosures about the MGH experience hit home on a point we have made over and over. The MGH review of concomitant surgery cases done in calendar year 2014 probably really did show that the rate of complications was no higher than for cases of single (non-overlapping) surgery. Yet, the recent revelations appear to show that there were complications. Complications, particularly ones with serious patient consequences, are not common events. So, when anyone reports on a large series of overlapping surgery, the serious events are likely to get “buried” or “diluted out”. In fact, the bigger the series, the less likely we are to identify cases in which the overlap contributed to an adverse outcome. Given that a randomized controlled trial is not likely to ever take place, the only real way to determine whether overlapping surgery caused or contributed to such events is to perform root cause analysis of all cases with adverse events, a time- and resource-intensive process.
There is a second problem with those retrospective reviews: even in those studies that used propensity score adjustments to minimize bias, there is likely an element of selection bias. There is really no way from administrative data or even chart review to fully understand why non-overlapping surgery was chosen over overlapping surgery or vice versa. It is quite likely that surgeons may avoid overlapping surgery in patients they consider to be at more risk. Note that the subgroup analysis in the Sun study (Sun 2019) did indicate that complications may be more common with overlapping surgery in more complex cases. So, when we see a retrospective cohort study that says patients undergoing overlapping surgery do better than those with non-overlapping surgery, we are not at all surprised. If they are less at risk, they should have fewer complications. And, in our March 12, 2019 Patient Safety Tip of the Week “Update on Overlapping Surgery” we also speculated there might be an element of publication bias as well.
Those of us involved in patient safety have all seen instances in which overlapping surgery was a contributing factor to or root cause of an adverse event. And just because the population-based studies seem to show a relative safety of overlapping surgery, it does not mean we don’t need to pay attention to the dangers. Wrong-site surgery and retained surgical items are also relatively rare events. Yet we strive to prevent all such cases of those. Why should events related to overlapping surgery be treated differently?
Our December 19, 2017 Patient Safety Tip of the Week “More on Overlapping Surgery” had our detailed comments on the following considerations for overlapping surgery:
We hope you’ll go back to that column (and all our columns listed below) to see our arguments against the practice of overlapping surgery. However, even though we personally would not consent to undergo overlapping surgery, we are pragmatic and understand the practice is not likely to go away any time soon. Therefore, we developed our “Overlapping Surgery Checklist” to help guide you in planning for safe implementation.
AORN (Association of periOperative Registered Nurses) also recently noted 3 tips from Pat Turner, RN, BSN, MPA on patient safety actions nurses can take in relation to overlapping surgery (AORN 2019):
See our previous columns on double-booked, concurrent, or overlapping surgery:
And our “Overlapping Surgery Checklist”
References:
Abelson J, Saltzman J, Kowalcyzk L, Allen S. Clash in the Name of Care. Boston Globe October 26, 2015
http://apps.bostonglobe.com/spotlight/clash-in-the-name-of-care/story/
Senate Finance Committee. Concurrent and Overlapping Surgeries: Additional Measures Warranted. A Senate Finance Committee Staff Report 2016; December 6, 2016
http://www.finance.senate.gov/imo/media/doc/Concurrent%20Surgeries%20Report%20Final.pdf
Saltzman J. MGH settles for $13m with doctor who challenged double-booked surgeries. Boston Globe 2019; November 7, 2019
Saltzman J. Second major hospital chain agrees to pay millions to resolve concerns over concurrent surgery. Boston Globe 2019; November 8, 2019
Taylor A. Jury: Orthopedic Surgeon's Routine of Performing 14 Concurrent Surgeries a Day Negligent. $2M verdict in 'assembly line' surgery case. Outpatient Surgery 2019; Published: August 6, 2019
Mulder JT. CNY malpractice case reveals 'assembly line’: 14 operations a day, 3 at one time. Syracuse.com 2019; Jul 30, 2019
Saltzman J. Double-booked surgery cited in death at Mass. General, records indicate
Boston Globe 2019; November 23, 2019
Saltzman J. Former Red Sox pitcher settles claim with doctor, MGH for $5.1 million. Boston Globe 2019; May 8, 2019
Baker M. A Lost Voice. Seattle Times 2017; Published February 10, 2017
https://projects.seattletimes.com/2017/quantity-of-care/talia/
Baker M, Mayo J. Swedish double-booked its surgeries, and the patients didn’t know. Seattle Times 2017; May 28, 2017
PPSA (Pennsylvania Patient Safety Authority). Incidence of Concurrent Surgery in Pennsylvania . Pa Patient Saf Advis 2019; 16(1) March 2019
http://patientsafety.pa.gov/ADVISORIES/Pages/201903_ConcurrentSurgery.aspx
Sun E, Mello MM, Rishel CA, et al. Association of Overlapping Surgery With Perioperative Outcomes. JAMA 2019; 321(8): 762-772
https://jamanetwork.com/journals/jama/article-abstract/2725689
Ponce BA, Wills BW, Hudson PW, et al. Outcomes With Overlapping Surgery at a Large Academic Medical Center. Annals of Surgery 2018; Publish Ahead of Print - February 1, 2018
Hyder JA, Hanson KT, Storlie CB, et al. Assessing the Safety of Overlapping Surgery at a Children's Hospital. Annals of Surgery 2018; Publish Ahead of Print – January 25, 2018
Goldfarb CA, Rizzo MG, Rogalski BL, et al. Complications Following Overlapping Orthopaedic Procedures at an Ambulatory Surgery Center. The Journal Of Bone And Joint Surgery 2018; 100(24): 2118-2124
Dy CJ, Osei DA, Maak TG, et al. Safety Of Overlapping Inpatient Orthopaedic Surgery. The Journal Of Bone And Joint Surgery 2018; 100(22): 1902-1911
Howard BM, Holland CM, Mehta CC, et al. Association of Overlapping Surgery With Patient Outcomes in a Large Series of Neurosurgical Cases. JAMA Surg 2018; 153(4): 313-321
https://jamanetwork.com/journals/jamasurgery/fullarticle/2661297
Guan J, Brock A, Karsy M, et al. Managing overlapping surgery: An analysis of 1018 neurosurgical and spine cases. Journal of Neurosurgery 2016; 127: 1-9
https://thejns.org/view/journals/j-neurosurg/127/5/article-p1096.xml
DiGiorgio A. Change in Policy Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-net Hospital. Paper presented during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting. As noted in:
American Association of Neurological Surgeons. Press release: Change in Policy Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-net Hospital. 26-Apr-2018
Parikh RP, Sharma K, Thornton M, et al. Overlapping Surgery in Plastic Surgery
An Analysis of Patient Safety and Clinical Outcomes. Plast Reconstr Surg 2019; 143(6): 1787-1796
Our own “Overlapping Surgery Checklist”.
http://www.patientsafetysolutions.com/docs/Overlapping_Surgery_Checklist.htm
AORN (Association of periOperative Registered Nurses). Overlapping Surgeries: 3 Patient Safety Actions Nurses Can Take. AORN 2019; September 25, 2019
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December 2019
Texas Tech University Health Sciences Center (TTUHSC), in 2018, transitioned from a traditional 24-hour surgeon on-call shift to a 12-hour one, in part to help promote physician well-being and reduce burnout. Researchers have now looked at some patient and fiscal outcomes that occurred after this transition (Caballero 2019). They chose to look at patients admitted with acute appendicitis, because that is the most frequent condition for which the on-call surgeon would provide urgent surgery.
Patients treated by surgeons in the 12-hour shift model had an average length of stay of 0.73 days vs. 2 days for those treated under the traditional 24-hour model and had no reported cases of organ space infection vs. a rate of 7.1 percent in the traditional group. On average, ACS patients were seen by a surgeon more than an hour sooner after they arrived at the hospital: 2 hours, 9 minutes vs. 3 hours, 14 minutes. Per-patient costs with the 12-hour model were $1,452 vs. $9,834 per patient. They also found a decrease in perforation rates of appendicitis with the shorter surgeon on-call shift (ACS 2019).
Subjectively, faculty satisfaction was better with the new model. They also felt that continuity of care was improved, mainly because when the attending surgeon is working 12-hour shifts on consecutive days, he/she is more likely to be in the hospital and follow-up with the patient on the day after surgery than he/she would be doing 24-hour call. Also, the handoff between surgeons and surgical teams is more efficient with the 12-hour shift.
We’ve discussed some of the logistical and personnel issues that may lead to worse outcomes for surgery done “after hours” (see list below). The 12-hour surgeon on-call shift does improve upon several of those factors. It would also be interesting to know how other members of the surgical team (nurses, OR techs, anesthetists, etc.) were deployed when urgent cases were done under the new protocol. Additionally, we suspect factors pertinent to the rest of the team might be less impacted for general surgery cases, like acute appendicitis. It would be very interesting to see whether the 12-hour surgeon on-call shift also improves outcomes for other surgical specialties, where composition of the surgical team is more complicated.
This is a very interesting finding and merits consideration for other surgical specialties.
Some of our previous columns on “after-hours” surgery:
References:
Caballero B, Puckett Y, Chung C, et al. Improved Patient Outcomes and Reduced Cost in Treating Acute Appendicitis with a Shift-Based Acute Care Surgery Model Compared with Traditional General Surgery Call. Scientific Forum Abstracts. J Am Coll Surg 2019; 229(4 Supplement 1): S99
https://www.journalacs.org/article/S1072-7515(19)30682-9/fulltext
ACS (American College of Surgeons) Press Release. Surgeons report that 12-hour shifts improve patient outcomes, lower costs vs. 24-hour call shifts. American College of Surgeons October 30, 2019
https://www.facs.org/media/press-releases/2019/caballero103019
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In this month’s What's New in the Patient Safety World column “Surgeon On-Call Shifts” we noted how the length of a surgeon’s on-call shift can impact patient outcomes and costs of care. It turns out that shifts of hospitalists, likewise, are important in influencing patient outcomes.
A recent study showed that patients receiving care from hospitalists with schedules that promote inpatient continuity of care may experience better outcomes of hospitalization (Goodwin 2019). Goodwin and colleagues note that discontinuous schedules, such as 24 hours on and 48 hours off, result in several hospitalists providing care during a patient’s hospital stay and hypothesized that poor continuity of care during hospitalization may be associated with poor patient outcomes. They then did a retrospective study, using a formula with a weighted mean of schedule continuity for the treating hospitalists, assessed as the percentage of all their working days in that year that were part of a block of 7 or more consecutive working days,
In the lowest quartile for continuity, hospitalists providing care worked 0% to 30% of their total working days as part of a block of 7 or more consecutive days, compared to 67% to 100% in the highest quartile for continuity. Compared to those in the lowest quartile, admitted patients cared for by hospitalists in the highest quartile had lower 30-day mortality after discharge (adjusted odds ratio 0.88), lower readmission rates (adjusted odds ratio 0.94), higher rates of discharge to the home (adjusted odds ratio 1.08), and lower 30-day post-discharge costs (−$223). The findings were consistent in several sensitivity analyses.
Hospitalists offer several important contributions to patient care. Since they are in the hospital, they are particularly good at steering patients through the complex world of testing and consults, thus promoting more efficient care and shorter lengths of stay. They also are more readily available to attend promptly to changing patient conditions and to interact with families of hospitalized patients. But, at the same time, several studies have shown care by hospitalists compared with care by primary care physicians is associated with higher readmission rates, higher costs after discharge and lower rates of discharge home (we discussed one of those papers by Kuo and Goodwin (Kuo 2011) in our September 2011 What's New in the Patient Safety World column “Shiftwork and Patient Safety”).
Handoffs are critical when inpatient hospital care is rendered by someone other than the physician who will be primarily managing the patient after discharge. A good hospitalist keeps the PCP (or other physician who will have primary responsibility after discharge) apprised of the patient’s status not just at discharge, but throughout the course of the hospitalization. We’ve also noted the critical importance of communicating tests pending at discharge so that significant test results do not “fall through the cracks”. Also, in our December 20, 2016 Patient Safety Tip of the Week “End of Rotation Transitions and Mortality” we speculated that an increase in mortality was noted for patients hospitalized around the end of rotation for medical housestaff might also be seen with similar transitions for hospitalists.
Note that it’s not just continuity through shift assignments that may impact patient outcomes. How patients are assigned to hospitalists may also play a role. A recent study looked at the impact of geographic cohorting on hospitalist activity (Kara 2019). By geographic cohorting we mean assigning hospitalists to patients on one or two units. The researchers hypothesized that geographic cohorting would increase direct patient interactions, a positive phenomenon, but would also increase interruptions, a negative phenomenon. They then did a time-motion study study that proved them to be right. Geographic cohorting was associated with longer durations of patient visits. Interruptions were pervasive. Morning interruption rates were comparable between the two groups, but the highest interruption rate of once every eight minutes in the afternoon was noted in the geographic cohorting group (compared to once every 17 minutes in the non-geographic cohorting group). However, they also found changes in workload might have a significant impact. Increasing patient loads were associated with shorter visits, but geographic cohorting, increasing patient loads, and increasing numbers of units visited were associated with increased indirect care time. Geographic cohorting hospitalists were observed spending 56% of the day in computer interactions vs 39% for non-geographic cohorting hospitalists. The percentage of time spent multitasking was 18% for geographic cohorting hospitalists and 14% for non-geographic cohorting hospitalists.
We also discussed the impact of hospitalist workload on patient care and costs in our May 2014 What's New in the Patient Safety World column “Hospitalist Workload Impact on Care and Cost”.
References:
Goodwin JS, Li S, Kuo Y. Association of the Work Schedules of Hospitalists with Patient Outcomes of Hospitalization. JAMA Intern Med. Published online November 25, 2019
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2755292
Kuo Y-F, Goodwin JS. Association of Hospitalist Care with Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study. Ann Intern Med 2011; 155: 152-159
http://www.annals.org/content/155/3/152.abstract?aimhp
Kara A, Flanagan ME, Gruber R, et al, A Time Motion Study Evaluating the Impact of Geographic Cohorting of Hospitalists. J Hosp Med 2019; Published Online First November 20, 2019
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A patient with difficulty swallowing had a nasogastric tube inserted for feeding (Kang-chun 2019). He pulled out his nasogastric tube. After the tube was reinserted, an X-ray examination was performed, and the patient’s gastric juices were also tested for acidity in accordance with the prevailing protocol at the hospital. “No abnormalities were detected,” said the hospital spokeswoman. Nasogastric tube feeding was restarted on the same night and in the early hours of the next morning. But the patent subsequently developed cardiac arrest and had to be sent to the intensive care unit after resuscitation by clinical staff. It was at this stage that the earlier X-ray results were reviewed, and it was found that the nasogastric tube was inserted into the patient’s left lung. The patient’s condition deteriorated and he died.
In our November 1, 2011 Patient Safety Tip of the Week “So What’s the Big Deal About Inserting an NG Tube?” we noted numerous reports from the UK’s NPSA of incidents and bad outcomes related to NG (nasogastric) tubes and we mentioned some of our own observations. NG tube insertion is viewed by many as a simple and routine procedure. But we have seen NG tubes in patient’s lungs, the pleural space, and even in a cerebral ventricle! So, we have a great respect for proper NG tube insertion.
Then, our October 2016 What's New in the Patient Safety World column “AACN Alert on Feeding Tube Placement” discussed American Association of Critical-Care Nurses practice alert “Initial and Ongoing Verification of Feeding Tube Placement in Adults”. And our June 2019 What's New in the Patient Safety World column “Guidelines for NG Tube Placement” discussed a new systematic review (Metheny 2019) of guidelines and recommendations to distinguish between gastric and pulmonary placement of nasogastric tubes.
We’ve stressed that particular attention be paid to the x-ray requisition, which should clearly state the x-ray is for determination of tube placement. All too often we still see x-ray requisitions filled out with something like the admission diagnosis rather than the real reason for the x-ray. And you need to make sure that the person doing the interpretation is appropriately credentialed to do so (for example, if someone other than the radiologist is doing the interpretation). And feeding should not be commenced via that tube until the radiologist (or appropriately credentialed person) has documented the tube is in the correct location. We’ve also noted that correct placement of a blindly inserted small-bore or large-bore tube should be confirmed with a radiograph that visualizes the entire course of the tube prior to its initial use for feedings or medication administration. Once correct tube placement is confirmed, the exit site from the patient’s nose or mouth should be immediately marked and documented to assist in subsequent determinations of tube location. After feedings are started, tube location should be checked at four-hour intervals.
A hospital trust in the UK undertook a performance improvement project after it had 2 incidents of NG tube misplacement (Earley 2019). They first performed a gap analysis and found nursing and medical staff sometimes worked in silos without necessarily understanding each others’ responsibilities. There was a lack of standardized documentation. There was no formally agreed dataset to audit compliance with practice. They also found that 90% of advanced nurses and doctors who were involved in confirming the NG tube position on X-ray had received no specific training. They also noted lack of an escalation process for challenging decisions.
After the gaps were identified, they took a multicomponent implementation approach that included education and training, development of a new e-learning tool designed to educate staff and assess their competence, standardization in the approach to care for patients with an NG tube, and monitoring and reporting systems to assure the trust’s board. One of their educational strategies is our old favorite – stories, not statistics. They included the story from relatives of a deceased patient who had experienced a never event.
But one interesting approach they took was development and use of a novel mnemonic to make things easier and more memorable for staff, The mnemonic was “NEX, 2C’s and 2D’s” to highlight the required areas to review on chest X-ray:
NEX = Nose to Ear to Xyphoid process measurement
2C’s = anatomical landmarks Carina, Clavicle
2D’s = Diaphragm and Deviation
Documentation of these findings was standardized, first as a sticker in the notes and later digitally as part of the electronic patient record.
Several parameters of the training improved after implementation, and satisfaction with the e-learning tool was high. They also implemented rigorous monitoring and reporting. The e-learning tool has subsequently been adopted by several other trusts in the National Health Service.
Obviously, a culture change and staff buy-in were key elements of success.
It’s too bad when it takes a “never event” related to NG tube insertion and placement to get the attention of a hospital’s staff. Use of NG tubes is ubiquitous in most hospital settings, yet you’d be surprised at how often we see lack of knowledge, training, and standardization regarding NG tube insertion and verification of accurate placement. Do you know what gaps exist in your organization?
See our prior columns on NG tube placement and positioning:
November 1, 2011 “So What’s the Big Deal About Inserting an NG Tube?”
October 2016 “AACN Alert on Feeding Tube Placement”
June 2019 “Guidelines for NG Tube Placement”
References:
Kang-chun N. Patient in Hong Kong hospital dies after medical tube wrongly inserted into his lung. South China Morning Post 2019; November 27, 2019
AACN (American Association of Critical-Care Nurses). Feeding Tubes Require Initial and Ongoing Verification to Minimize Complications. American Association of Critical-Care Nurses updates Practice Alert on feeding tube placement. Press Release 15-Sep-2016
AACN (American Association of Critical-Care Nurses). AACN Practice Alert: Initial and Ongoing Verification of Feeding Tube Placement in Adults. CriticalCareNurse 2016; 36(2): e8-e13 April 2016
http://www.aacn.org/wd/practice/content/feeding-tube-practice-alert.pcms?menu=practice
Metheny NA, Krieger MM, Healey F, Meert KL. A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart & Lung 2019; 48(3): 226-235
https://www.heartandlung.org/article/S0147-9563(18)30562-4/fulltext
Earley T. Improving safety with nasogastric tubes: a whole-system approach. Nursing Times 2019 [online]; 115: 12, 50-51 December 2019
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Two of the most trusted and respected patient safety organizations have agreed to join forces. ISMP (Institute for Safe Medication Practices) and ECRI Institute announced on November 13, 2019 an affiliation agreement, which is expected to become effective January 2, 2020 (ISMP 2019). ISMP will become an ECRI Institute subsidiary, Current leadership of both organizations is expected to remain active after the affiation becomes formalized.
The two nonprofit organizations have long been pillars of the patient safety movement. While both organizations will retain their core missions, it is expected that their pooled resources will allow them to share even more vital information with the healthcare community.
Our best wishes to both organizations. Continue the great work you’ve been doing for years!
References:
ISMP (Institute for Safe Medication Practices). ECRI Institute and Institute for Safe Medication Practices Join Forces to Enhance Patient Safety. ISMP News Release November 13, 2019
ISMP (Institute for Safe Medication Practices)
ECRI Institute
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Print “December 2019 What's New in the Patient Safety World (full column)”
Print “December 2019 Surgeon On-Call Shifts”
Print “December 2019 Hospitalist Shifts Matter, Too”
Print “December 2019 Mnemonic to Help NG Tube Placement”
Print “December 2019 ISMP and ECRI Institute Join Forces”
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