Publications
260 results found
Nagpal K, Abboudi M, Fischler L, et al., 2011, Evaluation of Postoperative Handover Using a Tool to Assess Information Transfer and Teamwork, ANNALS OF SURGERY, Vol: 253, Pages: 831-837, ISSN: 0003-4932
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- Citations: 80
Nagpal K, Abboudi M, Fischler L, et al., 2011, Evaluation of postoperative handover using a tool to assess information transfer and teamwork., Ann Surg, Vol: 253, Pages: 831-837
OBJECTIVE: To assess the feasibility, validity, and reliability of a postoperative Handover Assessment Tool (PoHAT) and to evaluate the current practices of the postoperative handover at 2 large European hospitals. BACKGROUND: Postoperative handover is one of the most critical phases in the care of a patient undergoing surgery. However, handovers are largely informal and variable. A thorough understanding of the problem is necessary before safety solutions can be considered. METHODS: Postoperative Handover Assessment Tool (PoHAT) was developed through task analysis, semistructured interviews, literature review, and learned society guidelines. Subsequent validation was done by the Delphi technique. Feasibility and reliability were then evaluated by direct observation of handovers at 2 large European hospitals. Outcomes measures included information omissions, task errors, teamwork evaluation, duration of handover, and number of distractions. RESULTS: The tool was feasible to use and inter-rater reliability was excellent (r = 0.96, P < 0.001). Evaluation of handover at the 2 study sites revealed a median of 8 information omissions per handover at both the centers (IQR 7-10). There were a median of 3 task errors per handover (IQR 2-4). Thirty-five percent of handovers had distractions, which included competing demands for nurse attention, bleeps, and case-irrelevant communication. CONCLUSION: This study has established the feasibility, validity, and reliability of a tool for evaluating postoperative handover. In addition to serving as an objective measure of postoperative handover, the tool can also be used to evaluate the efficacy of any intervention developed to improve this process. The study has also shown that postoperative handover is characterized by incomplete transfer of information and failures in the performance of key tasks.
Healey AN, Nagpal K, Moorthy K, et al., 2011, Engineering the system of communication for safer surgery, COGNITION TECHNOLOGY & WORK, Vol: 13, Pages: 1-10, ISSN: 1435-5558
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- Citations: 9
Burns EM, Naseem H, Bottle A, et al., 2010, Introduction of laparoscopic bariatric surgery in England: observational population cohort study, BMJ-BRITISH MEDICAL JOURNAL, Vol: 341, ISSN: 1756-1833
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- Citations: 60
Nagpal K, Vats A, Lamb B, et al., 2010, Information Transfer and Communication in Surgery <i>A Systematic Review</i>, ANNALS OF SURGERY, Vol: 252, Pages: 225-239, ISSN: 0003-4932
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- Citations: 144
Lazzarino AI, Nagpal K, Bottle A, et al., 2010, Open Versus Minimally Invasive Esophagectomy <i>Trends of Utilization and Associated Outcomes in England</i>, ANNALS OF SURGERY, Vol: 252, Pages: 292-298, ISSN: 0003-4932
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- Citations: 87
Nagpal K, Vats A, Ahmed K, et al., 2010, An Evaluation of Information Transfer Through the Continuum of Surgical Care <i>A Feasibility Study</i>, ANNALS OF SURGERY, Vol: 252, Pages: 402-407, ISSN: 0003-4932
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- Citations: 81
Nagpal K, Vats A, Ahmed K, et al., 2010, An Evaluation of Information Transfer Through the Continuum of Surgical Care: A Feasibility Study, Ann Surg
Nagpal K, Arora S, Abboudi M, et al., 2010, Postoperative Handover <i>Problems</i>, <i>Pitfalls</i>, <i>and Prevention of Error</i>, ANNALS OF SURGERY, Vol: 252, Pages: 171-176, ISSN: 0003-4932
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- Citations: 104
Nagpal K, Vats A, Ahmed K, et al., 2010, A Systematic Quantitative Assessment of Risks Associated With Poor Communication in Surgical Care, ARCHIVES OF SURGERY, Vol: 145, Pages: 582-588, ISSN: 0004-0010
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- Citations: 67
Nagpal K, Vats A, Ahmed K, et al., 2010, A Systematic Quantitative Assessment of Risks Associated With Poor Communication in Surgical Care, Arch Surg, Vol: 145, Pages: 582-588
Vats A, Vincent CA, Nagpal K, et al., 2010, Practical challenges of introducing WHO surgical checklist: UK pilot experience, BRITISH MEDICAL JOURNAL, Vol: 340, ISSN: 0959-535X
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- Citations: 156
Nagpal K, Ahmed K, Vats A, et al., 2010, Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis, Surg Endosc
INTRODUCTION: Open esophagectomy for cancer is a major oncological procedure, associated with significant morbidity and mortality. Recently, thoracoscopic procedures have offered a potentially advantageous alternative because of less operative trauma compared with thoracotomy. The aim of this study was to utilize meta-analysis to compare outcomes of open esophagectomy with those of minimally invasive esophagectomy (MIE) and hybrid minimally invasive esophagectomy (HMIE). METHODS: Literature search was performed using Medline, Embase, Cochrane Library, and Google Scholar databases for comparative studies assessing different techniques of esophagectomy. A random-effects model was used for meta-analysis, and heterogeneity was assessed. Primary outcomes of interest were 30-day mortality and anastomotic leak. Secondary outcomes included operative outcomes, other postoperative outcomes, and oncological outcomes in terms of lymph nodes retrieved. RESULTS: A total of 12 studies were included in the analysis. Studies included a total of 672 patients for MIE and HMIE, and 612 for open esophagectomy. There was no significant difference in 30-day mortality; however, MIE had lower blood loss, shorter hospital stay, and reduced total morbidity and respiratory complications. For all other outcomes, there was no significant difference between the two groups. CONCLUSION: Minimally invasive esophagectomy is a safe alternative to the open technique. Patients undergoing MIE may benefit from shorter hospital stay, and lower respiratory complications and total morbidity compared with open esophagectomy. Multicenter, prospective large randomized controlled trials are required to confirm these findings in order to base practice on sound clinical evidence.
Symons NRA, Nagpal K, Mitra A, et al., 2010, Post-operative trigger events - an innovative method of quality of care analysis in surgical patients, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 16-16, ISSN: 0007-1323
Abboudi M, Nagpal K, Bicknell C, et al., 2010, Training and implementation of a structured team handover in complex surgery can reduce information omissions and error in task performance, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 15-16, ISSN: 0007-1323
Burns EM, Bottle A, Aylin P, et al., 2010, National outcomes following bariatric surgery in England, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 8-8, ISSN: 0007-1323
Arora S, Miskovic D, Hull L, et al., 2010, Self versus expert assessment of technical and non-technical performance in high fidelity simulation, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 3-3, ISSN: 0007-1323
Vats A, Vashist D, Franklin BD, et al., 2010, Equipment and technology problems in operating theatres - a disease of the surgical system, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 152-152, ISSN: 0007-1323
Vats A, Sacks M, Nagpal K, et al., 2010, Interactive gaming based e-learning modules - a novel technique to learn patient safety in medical schools, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 151-151, ISSN: 0007-1323
Vats A, Bicknell C, Blanco GA, et al., 2010, Teamwork errors in surgery lead to technical errors, disruption of surgery and patient harm, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 150-151, ISSN: 0007-1323
Burns E, Bottle A, Faiz O, et al., 2010, The role of volume in bariatric surgery, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 72-72, ISSN: 0007-1323
Burns E, Naseem H, Aylin P, et al., 2010, Trends in laparoscopic bariatric surgery and comparisons of outcomes with open surgery: a national study in England 2000-2008, Electronic Poster of Distinction in Association-of-Surgeons-of-Great-Britain-and-Ireland-International-Surgical-Congress, Publisher: WILEY-BLACKWELL, Pages: 40-40, ISSN: 0007-1323
Vincent C, Moorthy K, 2010, Safety in Surgery, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Editors: Athanasiou, Debas, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 255-269, ISBN: 978-3-540-71914-4
Nagpal K, Moorthy K, 2010, Information Transfer and Communication in Surgery: A Need for Improvement, KEY TOPICS IN SURGICAL RESEARCH AND METHODOLOGY, Editors: Athanasiou, Debas, Darzi, Publisher: SPRINGER-VERLAG BERLIN, Pages: 771-780, ISBN: 978-3-540-71914-4
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- Citations: 3
Vats A, Nagpal K, Moorthy K, 2009, Surgery: a risky business., J Perioper Pract, Vol: 19, Pages: 330-334, ISSN: 1750-4589
The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.
Weiser TG, Makary MA, Haynes AB, et al., 2009, Standardised metrics for global surgical surveillance., Lancet, Vol: 374, Pages: 1113-1117
Public health surveillance relies on standardised metrics to evaluate disease burden and health system performance. Such metrics have not been developed for surgical services despite increasing volume, substantial cost, and high rates of death and disability associated with surgery. The Safe Surgery Saves Lives initiative of WHO's Patient Safety Programme has developed standardised public health metrics for surgical care that are applicable worldwide. We assembled an international panel of experts to develop and define metrics for measuring the magnitude and effect of surgical care in a population, while taking into account economic feasibility and practicability. This panel recommended six measures for assessing surgical services at a national level: number of operating rooms, number of operations, number of accredited surgeons, number of accredited anaesthesia professionals, day-of-surgery death ratio, and postoperative in-hospital death ratio. We assessed the feasibility of gathering such statistics at eight diverse hospitals in eight countries and incorporated them into the WHO Guidelines for Safe Surgery, in which methods for data collection, analysis, and reporting are outlined.
Samee A, Moorthy K, Jaipersad T, et al., 2009, Evaluation of the role of laparoscopic ultrasonography in the staging of oesophagogastric cancers., Surg Endosc, Vol: 23, Pages: 2061-2065
INTRODUCTION: The role of laparoscopic ultrasound (LUS) during staging laparoscopy for pancreatic cancers is established but remains debatable in evaluating oesophagogastric cancers. METHODS: A retrospective consecutive case series consisting of patients undergoing staging laparoscopy in two centres (centre A and B) was carried out over a 5-year period (2000-2005). Patients in centre B underwent LUS following laparoscopic assessment using a 7.5-MHz probe. Staging laparoscopy in both centres was performed using a standardised three-port protocol using a 30 degrees laparoscope. All suspicious lesions were sent for histological assessment for confirmation of malignancy. RESULTS: There were 201 patients in centre A (83 gastric, 138 lower oesophageal/junctional cancers) and 119 patients in centre B (51 and 68, respectively). There were no differences between the two centres for patient demographics and tumour site. There was no difference between the two centres for the detection of metastatic disease using laparoscopic assessment alone (A 13% versus B 20%, p = 0.12). However, there was a significant difference (13% versus 28%, p = 0.001) with the additional use of LUS in centre B. The findings in the additional 8% (n = 9) were para-aortic lymphadenopathy (n = 5), liver metastasis (n = 3) and local extension (n = 1). Five had gastric and four lower oesophageal/junctional cancers. The negative predictive value was 6.4% for centre A and 4.5% for centre B. CONCLUSION: The addition of LUS increased the detection rate of metastasis by 8% but there was little impact on the false-negative rate. LUS is useful in detecting metastatic lymphadenopathy beyond the limits of curative resection and liver metastasis.
Hakky S, Moorthy K, Ahmed A, 2009, Laparoscopic Gastric Bypass: A Training Model, 14th World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders, Publisher: SPRINGER, Pages: 1066-1066, ISSN: 0960-8923
Nagpal K, Vats A, Vincent C, et al., 2009, A systems approach to errors, SURGERY, Vol: 145, Pages: 689-690, ISSN: 0039-6060
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- Citations: 3
Iqbal M, Batch AJ, Moorthy K, et al., 2009, Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux., Surg Endosc, Vol: 23, Pages: 557-561
BACKGROUND: The role of surgery in the management of extra-oesophageal symptoms of gastro-oesophageal reflux (EOR) is unclear. In this retrospective study we studied patients who had surgical fundoplication for EOR symptoms from 1995 to 2005. We analysed outcome with respect to symptomatic improvement and patient satisfaction. METHODS: From our database of 240 patients who had surgical fundoplication for gastro-oesophageal reflux disease, 51 patients who had predominantly EOR symptoms were identified. All the patients had objective evidence of reflux and had been offered surgery because of failure of medical therapy and/or of development of complications. Patients were asked to score their symptoms before and after surgery using the Reflux Symptom Index, and to record their use of medicine before and after operation, their experience with surgery and their overall quality of life using a written questionnaire. RESULTS: Forty of the 51 patients were available for analysis. Common symptoms were cough and breathlessness (32/40), throat clearing/postnasal drip (31/40), sensation of lump in the throat (29/40), and voice problems (22/40). Of these forty patients, 34 (85%) had associated classical symptoms as well. Mean follow up at the time of questionnaire was 53.3 (6-120) months. The mean Reflux Symptom Index score improved from 22.80 (SD 10.80) to 11.83 (SD 9.91) (p < 0.0001, paired t-test). Six of the 39 responders (15.3%) said they would not have had the operation knowing what they know now and that problems related to the operation outweighed any benefits. These problems included gas bloating, inability to retch and dysphagia lasting up to one year after surgery. Twenty-five percent of the 40 patients described their overall quality of life as excellent, 32.5% as good, 32.5% as satisfactory and 10% as bad. CONCLUSION: Surgery can be an effective treatment in the majority of patients with extra-oesophageal symptoms of reflux.
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