Practical Solutions to Improve Safety in the Obstetrics/Gynecology Office Setting and in the Operating Room
Section snippets
Office setting
There is increasing recognition that clinical patient care in the ambulatory arena is subject to a different pattern of risks to patient safety than that found in the hospital environment [7]. For example, errors resulting from missed diagnosis appear to be much more common in office practice than in the hospital, at least based on data from closed malpractice claims [8]. As another example, of the four types of medication errors— prescribing (physician ordering), transcription and verification
Surgical environment
At times it may seem as though women's health care has become a less surgical specialty than it may have been in the past. The risks of surgical error in this specialty may have increased with the increase in caesarean sections and minimally-invasive surgery, including robot-assisted laparoscopy, and the pressures for shorter lengths-of-stay post operatively, as well as more out-patient surgery. More than 70 million in-patient and out-patient surgeries are performed each year in the United
Summary
The impact of medical error in office practice has been less well studied than in the hospital environment, but appears to present a significant potential risk to patient safety. Some principles and solutions appropriate to patient safety in the hospital may apply to office practice, while others may not; therefore it is particularly important for individual practices to examine their own procedures and outcomes and evaluate possible steps for improvement and the outcome of those initiatives.
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Cited by (9)
Patient Safety in Outpatient Procedures
2019, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :If these were included the magnitude of the shift would be even greater. Despite that deficit, we do know that the percentage of total outpatient encounters that take place in physician offices has increased from 82.4% in 2008, to almost 89%.2,3 It was reported in 2007 that the number of procedures performed electively in ambulatory facilities essentially doubled to about 10 million cases.4
Patient safety in the obstetric and gynecologic office setting
2013, Obstetrics and Gynecology Clinics of North AmericaDetermining the state of knowledge for implementing the universal protocol recommendations: An integrative review of the literature
2010, AORN JournalCitation Excerpt :The review of the literature yielded 34 documents that met inclusion criteria for the study and were important to answering the research question. From the data analysis, the team identified significant trends, gaps, and areas of concern as the recurring themes throughout the literature (Table 2),5-7,10,11,13,20-47 which constituted the contributing factors for the study.19 We identified
The perioperative management of patients with gynaecological cancer undergoing major surgery: A debated clinical challenge
2010, Critical Reviews in Oncology/HematologyCitation Excerpt :Both amoxicillin–clavulanic acid and cefazolin have good in vitro activity against the microbes more frequently involved in postoperative infections, such as Gram-negative bacilli, but amoxicillin–clavulanic acid is more effective against anaerobes [85]. The Institute for Health care Improvement [IHI] has estimated that overuse, under use, improper timing, and misuse of antibiotics occurs in 25–50% of operations in the US [86] and has given adequate recommendations [72], such as: (i) to designate responsibility for preoperative prophylactic antibiotic administration (i.e. preoperative nurse, circulating nurse, anesthesiologist); (ii) to standardize the administration process to occur within 1 h before incision; (iii) to ensure systematic documentation of antibiotic administration on every patient chart; (iv) to improve screening for allergies to beta-lactam antibiotics to eliminate false positives; (v) to consider weight-based antibiotic dosing; and (vi) to redose for prolonged surgery. Serum, fat and pelvic tissue levels of piperacillin or mezlocillin were measured during surgery of 48 gynaecological cancer patients randomly assigned to receive a single dose of one of these broad-spectrum penicillins [81].
Regulatory and Legal Implications
2018, Quality and Safety in Women’s HealthSurgical manual of the korean gynecologic oncology group: Ovarian, tubal, and peritoneal cancers
2017, Journal of Gynecologic Oncology