Critical errors in infrequently performed trauma procedures after training

the Retention and Assessment of Surgical Performance Group of Investigators

Research output: Contribution to journalArticle

Abstract

Background: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. Methods: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Results: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Conclusion: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.

Original languageEnglish (US)
Pages (from-to)835-843
Number of pages9
JournalSurgery (United States)
Volume166
Issue number5
DOIs
StatePublished - Nov 2019

Fingerprint

Wounds and Injuries
Axillary Artery
Surgeons
Benchmarking
Brachial Artery
Femoral Artery
Cadaver
Blood Vessels
Lower Extremity
Prospective Studies
Morbidity
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

the Retention and Assessment of Surgical Performance Group of Investigators (2019). Critical errors in infrequently performed trauma procedures after training. Surgery (United States), 166(5), 835-843. https://doi.org/10.1016/j.surg.2019.05.031

Critical errors in infrequently performed trauma procedures after training. / the Retention and Assessment of Surgical Performance Group of Investigators.

In: Surgery (United States), Vol. 166, No. 5, 11.2019, p. 835-843.

Research output: Contribution to journalArticle

the Retention and Assessment of Surgical Performance Group of Investigators 2019, 'Critical errors in infrequently performed trauma procedures after training', Surgery (United States), vol. 166, no. 5, pp. 835-843. https://doi.org/10.1016/j.surg.2019.05.031
the Retention and Assessment of Surgical Performance Group of Investigators. Critical errors in infrequently performed trauma procedures after training. Surgery (United States). 2019 Nov;166(5):835-843. https://doi.org/10.1016/j.surg.2019.05.031
the Retention and Assessment of Surgical Performance Group of Investigators. / Critical errors in infrequently performed trauma procedures after training. In: Surgery (United States). 2019 ; Vol. 166, No. 5. pp. 835-843.
@article{882f4ba9aba4407face756da171114a9,
title = "Critical errors in infrequently performed trauma procedures after training",
abstract = "Background: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. Methods: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Results: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Conclusion: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.",
author = "{the Retention and Assessment of Surgical Performance Group of Investigators} and Mackenzie, {Colin F.} and Shackelford, {Stacy A.} and Tisherman, {Samuel A.} and Shiming Yang and Adam Puche and Elster, {Eric A.} and Bowyer, {Mark W.} and Amechi Anazodo and Brandon Bonds and Guinevere Granite and George Hagegeorge and Megan Holmes and Peter Hu and Elliot Jessie and Nyaradzo Longinaker and Alexys Monoson and Mayur Narayan and Jason Pasley and Joseph Pielago and Eric Robinson and Anna Romagnoli and Babak Sarani and Nicole Squyres and William Teeter",
year = "2019",
month = "11",
doi = "10.1016/j.surg.2019.05.031",
language = "English (US)",
volume = "166",
pages = "835--843",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Critical errors in infrequently performed trauma procedures after training

AU - the Retention and Assessment of Surgical Performance Group of Investigators

AU - Mackenzie, Colin F.

AU - Shackelford, Stacy A.

AU - Tisherman, Samuel A.

AU - Yang, Shiming

AU - Puche, Adam

AU - Elster, Eric A.

AU - Bowyer, Mark W.

AU - Anazodo, Amechi

AU - Bonds, Brandon

AU - Granite, Guinevere

AU - Hagegeorge, George

AU - Holmes, Megan

AU - Hu, Peter

AU - Jessie, Elliot

AU - Longinaker, Nyaradzo

AU - Monoson, Alexys

AU - Narayan, Mayur

AU - Pasley, Jason

AU - Pielago, Joseph

AU - Robinson, Eric

AU - Romagnoli, Anna

AU - Sarani, Babak

AU - Squyres, Nicole

AU - Teeter, William

PY - 2019/11

Y1 - 2019/11

N2 - Background: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. Methods: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Results: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Conclusion: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.

AB - Background: Critical errors increase postoperative morbidity and mortality. A trauma readiness index was used to evaluate critical errors in 4 trauma procedures. In comparison to practicing and expert surgeon benchmarks, we hypothesized that pretraining trauma readiness index including both vascular and nonvascular trauma surgical procedures can identify residents who will make critical errors. Methods: In a prospective study, trained evaluators used a standardized script to evaluate performance of brachial, axillary, and femoral artery exposure and proximal control and lower-extremity fasciotomy on unpreserved cadavers. Forty residents were evaluated before and immediately after Advanced Surgical Skills for Exposure in Trauma training, and 38 were re-evaluated 14 months later. Residents were compared to 34 practicing surgeons evaluated once 30 months after training, and 10 experts. Results: Resident trauma readiness index increased with training (P < .001), remained unchanged 14 month later and was higher, with lower variance than practicing surgeons (P < .05). Expert trauma readiness index was higher than residents (P < .004) and practicing surgeons (P < .001). Resident training decreased critical errors when evaluated immediately and 14 months after Advanced Surgical Skills for Exposure in Trauma training. Practicing surgeons had more critical errors and performance variability than residents or experts. Experts had 5 to 7 times better error recovery than practicing surgeons or residents. Trauma readiness index area under the receiver operating curve with Youden Index <0.60 or <6 decile in their cohort, predicts a surgeon will make a critical error. Conclusion: Low trauma readiness index was associated with critical errors occurring in all surgeon cohorts and can identify surgeons in need of remedial intervention.

UR - http://www.scopus.com/inward/record.url?scp=85071308447&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071308447&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2019.05.031

DO - 10.1016/j.surg.2019.05.031

M3 - Article

C2 - 31353081

AN - SCOPUS:85071308447

VL - 166

SP - 835

EP - 843

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 5

ER -