Imperial College London
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DrRachaelLear

Faculty of Medicine, Department of Surgery & Cancer

Research Fellow
 
 
 
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Contact

 

r.lear12 CV

 
 
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Location

 

Digital Collaboration Space, 1A Sheldon Square, W2 6PYQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Lear:2016:10.1002/bjs.10275,
author = {Lear, R and Riga, C and Godfrey, AD and Falaschetti, E and Cheshire, NJ and Van, Herzeele I and Norton, C and Vincent, C and Darzi, AW and Bicknell, CD and LEAP, Study Collaborators},
doi = {10.1002/bjs.10275},
journal = {British Journal of Surgery},
pages = {1467--1475},
title = {Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes},
url = {http://dx.doi.org/10.1002/bjs.10275},
volume = {103},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. METHODS: Twenty vascular teams at ten English hospitals trained in structured self-reporting of intraoperative failures (phase I). Failures occurring in open and endovascular aortic procedures were reported in phase II. Failure details (category, delay, consequence), demographic information (patient, procedure, team experience) and outcomes were reported. RESULTS: There were strong correlations between the trainer and teams for the number and type of failures recorded during 88 procedures in phase I. In 185 aortic procedures, teams reported a median of 3 (i.q.r. 2-6) failures per procedure. Most frequent failures related to equipment (unavailability, failure, configuration, desterilization). Most major failures related to communication. Fourteen failures directly harmed 12 patients. Significant predictors of an increased failure rate were: endovascular compared with open repair (incidence rate ratio (IRR) for open repair 0·71, 95 per cent c.i. 0·57 to 0·88; P = 0·002), thoracic aneurysms compared with other aortic pathologies (IRR 2·07, 1·39 to 3·08; P < 0·001) and unfamiliarity with equipment (IRR 1·52, 1·20 to 1·91; P < 0·001). The major failure total was associated with reoperation (P = 0·011), major complications (P = 0·029) and death (P = 0·027). CONCLUSION: Failure in aortic procedures is frequently caused by issues with team-wo
AU  - Lear,R
AU  - Riga,C
AU  - Godfrey,AD
AU  - Falaschetti,E
AU  - Cheshire,NJ
AU  - Van,Herzeele I
AU  - Norton,C
AU  - Vincent,C
AU  - Darzi,AW
AU  - Bicknell,CD
AU  - LEAP,Study Collaborators
DO  - 10.1002/bjs.10275
EP  - 1475
PY  - 2016///
SN  - 1365-2168
SP  - 1467
TI  - Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes
T2  - British Journal of Surgery
UR  - http://dx.doi.org/10.1002/bjs.10275
UR  - http://hdl.handle.net/10044/1/40319
VL  - 103
ER  -
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