Publications
276 results found
Olsen S, Neale G, Schwab K, et al., 2007, Hospital staff should use more than one method to detect adverse events and potential adverse events: incident reporting, pharmacist surveillance and local real-time record review may all have a place, QUALITY & SAFETY IN HEALTH CARE, Vol: 16, Pages: 40-44, ISSN: 1475-3898
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- Citations: 134
Vincent C, 2007, Incident reporting and patient safety, BRITISH MEDICAL JOURNAL, Vol: 334, Pages: 51-51, ISSN: 0959-8146
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- Citations: 95
Woloshynowych M, Davis R, Brown R, et al., 2007, Communication Patterns in a UK Emergency Department, Annals of Emergency Medicine, Vol: 50, Pages: 407-413
Woloshynowych M, Vincent C, 2007, Patient safety and iatrogenesis, Cambridge Handbook of Psychology, Health and Medicine, Editors: Ayers, Baum, McManus, Newman, Wallston, Weinman, West, Cambridge UK, Publisher: Cambridge University Press, Pages: 472-477, ISBN: 978-0-521-60510-6
Amalberti R, Vincent C, Auroy Y, et al., 2006, Violations and migrations in health care: a framework for understanding and management, Canadian Healthcare Safety Symposium, Publisher: BMJ PUBLISHING GROUP, Pages: I66-I71, ISSN: 1475-3898
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- Citations: 120
Vincent C, Davy C, Esmail A, et al., 2006, Learning from litigation. The role of claims analysis in patient safety, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Vol: 12, Pages: 665-674, ISSN: 1356-1294
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- Citations: 43
Kneebone R, Nestel D, Wetzel C, et al., 2006, The human face of simulation: Patient-focused simulation training, ACADEMIC MEDICINE, Vol: 81, Pages: 919-924, ISSN: 1040-2446
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- Citations: 132
Healey AN, Undre S, Sevdalis N, et al., 2006, The complexity of measuring interprofessional teamwork in the operating theatre., J Interprof Care, Vol: 20, Pages: 485-495, ISSN: 1356-1820
Surgery depends on interprofessional teamwork, which is becoming increasingly specialized. If surgery is to become a highly reliable system, it must adapt and professionals must learn from, and share, tested models of interprofessional teamwork. Trainers also need valid measures of teamwork to assess individual and team performance. However, measurement and assessment of interprofessional teamwork is lacking and interprofessional team training is scarce in the surgical domain. This paper addresses the complexity of measuring interprofessional teamwork in the operating theatre. It focuses mainly on the design and properties of observational assessment tools. The report and analysis serves to inform the researcher or clinician of the issues to consider when designing or choosing from alternative measures of team performance for training or assessment.
Undre S, Healey AN, Darzi A, et al., 2006, Observational assessment of surgical teamwork: a feasibility study., World J Surg, Vol: 30, Pages: 1774-1783, ISSN: 0364-2313
BACKGROUND: Teamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings. METHOD: We observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS (Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co-operation, co-ordination, shared-leadership and monitoring. RESULTS: Ratings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one-eighth of the cases and delays or changes occurred in over two-thirds of the cases. CONCLUSIONS: This study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However, for these measures to be used for formal assessment, more research is needed to make them robust and standardized.
Vincent CA, Lee ACH, Hanna GB, 2006, Patient safety alerts: a balance between evidence and action, ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, Vol: 91, Pages: 314-315, ISSN: 1359-2998
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- Citations: 3
Healey AN, Undre S, Vincent CA, 2006, Defining the technical skills of teamwork in surgery., Qual Saf Health Care, Vol: 15, Pages: 231-234
Developments in surgical technology and procedure have accelerated and altered the work carried out in the operating theatre/room, but team modelling and training have not co-evolved. Evidence suggests that team structure and role allocation are sometimes unclear and contentious, and coordination and communication are not fully effective. To improve teamwork, clinicians need models that specify team resources, structure, process and tasks. They also need measures to assess performance and methods to train teamwork strategically. An effective training strategy might be to incorporate teamwork with other technical skills training in simulation. However, the measures employed for enhancing teamwork in training and practice will need to vary in their object of analysis, level of technical specificity, and system scope.
Moorthy K, Munz Y, Forrest D, et al., 2006, Surgical crisis management skills training and assessment - A stimulation-based approach to enhancing operating room performance, ANNALS OF SURGERY, Vol: 244, Pages: 139-147, ISSN: 0003-4932
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- Citations: 116
Sarker SK, Hutchinson R, Chang A, et al., 2006, Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 20, Pages: 636-640, ISSN: 0930-2794
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- Citations: 35
Undre S, Sevdalis N, Healey AN, et al., 2006, Teamwork in the operating theatre: cohesion or confusion?, JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Vol: 12, Pages: 182-189, ISSN: 1356-1294
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- Citations: 138
Sarker SK, Chang A, Vincent C, et al., 2006, Development of assessing generic and specific technical skills in laparoscopic surgery, AMERICAN JOURNAL OF SURGERY, Vol: 191, Pages: 238-244, ISSN: 0002-9610
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- Citations: 43
Healey AN, Vincent CA, 2006, Enhancing Safety in Surgery - Report of a series of studies funded by the National Patient Safety Research Programme, University of Birmingham, Publisher: Department of Public Health and Epidemiology UK
Tighe CM, Woloshynowych M, Brown R, et al., 2006, Incident reporting in one UK accident and emergency department., Accid Emerg Nurs, Vol: 14, Pages: 27-37, ISSN: 0965-2302
Greater focus is needed on improving patient safety in modern healthcare systems and the first step to achieving this is to reliably identify the safety issues arising in healthcare. Research has shown the accident and emergency (A&E) department to be a particularly problematic environment where safety is a concern due to various factors, such as the range, nature and urgency of presenting conditions and the high turnover of patients. As in all healthcare environments clinical incident reporting in A&E is an important tool for detecting safety issues which can result in identifying solutions, learning from error and enhancing patient safety. This tool must be responsive and flexible to the local circumstances and work for the department to support the clinical governance agenda. In this paper, we describe the local processes for reporting and reviewing clinical incidents in one A&E department in a London teaching hospital and report recent changes to the system within the department. We used the historical data recorded on the Trust incident database as a representation of the information that would be available to the department in order to identify the high risk areas. In this paper, we evaluate the internal processes, the information available on the database and make recommendations to assist the emergency department in their internal processes. These will strengthen the internal review and staff feedback system so that the department can learn from incidents in a consistent manner. The process was reviewed by detailed examination of the centrally held electronic record (Datix database) of all incidents reported in a one year period. The nature of the incident and the level and accuracy of information provided in the incident reports was evaluated. There were positive aspects to the established system including evidence of positive changes made as a result of the reporting process, new initiatives to feedback to staff, and evolution of the programme
Sarker SK, Chang A, Vincent C, 2006, Technical and technological skills assessment in laparoscopic surgery., JSLS, Vol: 10, Pages: 284-292, ISSN: 1086-8089
OBJECTIVES: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. METHODS: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. RESULTS: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=<0.05. Construct validity for both technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=<0.05. CONCLUSIONS: Our study demonstrates that technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations.
Rakow T, Vincent C, Bull K, et al., 2005, Assessing the likelihood of an important clinical outcome: New insights from a comparison of clinical and actuarial judgment, MEDICAL DECISION MAKING, Vol: 25, Pages: 262-282, ISSN: 0272-989X
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- Citations: 5
Sarker SK, Chang A, Vincent C, et al., 2005, Technical skills errors in laparoscopic cholecystectomy by expert surgeons, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 19, Pages: 832-835, ISSN: 0930-2794
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- Citations: 25
Woloshynowych M, Rogers S, Taylor-Adams S, et al., 2005, The investigation and analysis of critical incidents and adverse events in healthcare, HEALTH TECHNOLOGY ASSESSMENT, Vol: 9, Pages: 1-+, ISSN: 1366-5278
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- Citations: 73
Woloshynowych M, Rogers S, Taylor-Adams S, et al., 2005, The investigation and analysis of critical incidents and adverse events in healthcare., Health Technol Assess, Vol: 9, Pages: 1-iii
OBJECTIVES: To carry out a review of published and unpublished work on the analysis on methods of accident investigation in high-risk industries, and of critical incidents in healthcare. To develop and pilot guidelines for the analysis of critical incidents in healthcare for the hospital sector, mental health and primary care. DATA SOURCES: Literature already available in the Clinical Risk Unit, University College London. Work by known experts in the field of accident investigation and analysis. Electronic databases including PsycINFO and MEDLINE. Websites for accident investigation reports. REVIEW METHODS: Twelve techniques from other high-risk industries were reviewed in detail using criteria developed for the purpose. This review provided a conceptual framework for the healthcare review and appraisal process, as well as providing a critical assessment of the industry techniques. Rigorous searching and screening identified 138 papers for formal appraisal and a further 114 were designated as providing potentially useful background information. A formal appraisal instrument was designed, piloted and modified until acceptable reliability was achieved. From the 138 papers, six techniques were identified as representing clearly definable approaches to incident investigation and analysis. All relevant papers were reviewed for each of the six techniques: Australian Incident Monitoring System, the Critical Incident Technique, Significant Event Auditing, Root Cause Analysis, Organisational Accident Causation Model and Comparison with Standards approach. RESULTS: All healthcare techniques had the potential of being applied in any specialty or discipline related to healthcare. While a few studies looked solely at death as an outcome, most used a variety of outcomes including near misses. Most techniques used interviewing and primary document review to investigate incidents. All techniques included papers that identified clinical issues and some attempt to assess underlying e
Sarker SK, Vincent C, Darzi AW, 2005, Assessing the teaching of technical skills, AMERICAN JOURNAL OF SURGERY, Vol: 189, Pages: 416-418, ISSN: 0002-9610
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- Citations: 7
Sarker SK, Chang A, Vincent C, et al., 2005, Assessment of technical skills in open and laparoscopic surgery, Annual Meeting of the Association-of-Surgeons-of-Great-Britian-and-Ireland, Publisher: JOHN WILEY & SONS LTD, Pages: 22-23, ISSN: 0007-1323
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- Citations: 1
Moorthy K, Vincent C, Darzi A, 2005, Simulation based training, BMJ-BRITISH MEDICAL JOURNAL, Vol: 330, Pages: 493-494A, ISSN: 1756-1833
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- Citations: 36
Sarker SK, Vincent C, 2005, Errors in surgery., Int J Surg, Vol: 3, Pages: 75-81
Making errors is part of normal human behaviour. However when errors have significant consequences or occur in high risk industries they become of paramount importance. There has been little research in why and how errors occur in the healthcare industry. Errors occur throughout healthcare, but in particular, surgery as a high risk speciality. Surgery is a dynamic speciality with a milieu of possible mishaps waiting to happen. So to understand and prevent errors in surgery we must explore this intricate multi-cogwheel process. This article will summarise the epidemiology of surgical errors, factors which influence them in the patient pathway, explain concepts and models of why errors occur, technical skill error assessment and possible strategies to prevent or reduce surgical errors. Practicing surgery in the new millennium will embrace new innovations, medications, technologies, equipment, operations, all which aim to improve the treatment and care of patients. However we must remember with this constant evolution in healthcare the error goalposts are forever moving, so we must be vigilant not to take our eye off the error ball.
Franklin BD, Vincent C, Schachter M, et al., 2005, The incidence of prescribing errors in hospital inpatients - An overview of the research methods, DRUG SAFETY, Vol: 28, Pages: 891-900, ISSN: 0114-5916
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- Citations: 91
Healey AN, Undre S, Vincent CA, 2004, Developing observational measures of performance in surgical teams, QUALITY & SAFETY IN HEALTH CARE, Vol: 13, Pages: I33-I40, ISSN: 1475-3898
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- Citations: 151
Vincent C, Saunders A, 2004, [Patients and doctors experiences of iatrogenic injury]., Z Arztl Fortbild Qualitatssich, Vol: 98, Pages: 593-599, ISSN: 1431-7621
Iatrogenic injury has been recognised and studied systematically in the past twenty years. However, whilst studies have examined the frequency, causes and prevention of adverse events, very little attention has been given to their impact on patients and staff. Staff may experience shame, guilt and depression after making a mistake with litigation and complaints imposing an additional burden. Patients and relatives suffer in two distinct ways from the injury. Firstly, they suffer from the injury itself, and secondly they may suffer further trauma through the incident being insensitively and inadequately handled: In particular they may not receive an explanation, apology or reassurance that steps are being taken to prevent future incidents. Patients and families often experience prolonged distress, a loss of trust in healthcare professionals and sometimes more serious psychological problems. We believe that the care of injured patients and traumatised staff needs to be given a much higher priority, both in terms of research and in practical efforts to help those affected. How these events are dealt with, both for the staff and patients, can help lessen the negative experience for all involved, particularly a proactive, open and empathetic approach to these problems will bring great benefits to both patients and staff alike.
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