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Background: Stress and human error during perioperative emergency situations can significantly impact patient morbidity and mortality. Previous research has shown that cognitive aid bundles (CABs) minimize critical misses by 75%. This study aimed to compare the effectiveness of two different CAB designs with the same content in reducing missed critical management steps for simulated perioperative emergencies. Methods: A multicenter randomized controlled simulation-based study was conducted including 27 teams, each consisting of three participants; each team performed four simulation scenarios. In the first scenario for each team (Scenario 1), no CAB was used. Scenarios 2 and 3 were randomly allocated to the groups, with either a branched, clustered design (CAB-1) or a linear, step-by-step design (CAB-2) of the cognitive aid. In Scenario 4, the groups used one of the previously mentioned CABs according to their own preference. The primary outcome was the difference in the percentage of missed critical management steps between the two different CABs. Secondary outcomes included user preference for one CAB design and the reduction in percentage of missed critical management steps using any CAB versus no CAB. Results: Twenty-seven teams simulated 108 perioperative emergency situations. The percentage of missed critical management steps was similar between CAB-1 and CAB-2 (27% [interquartile range (IQR) 20-29] versus 29% [IQR 20-35], p = 0.23). However, most participants favored the branched, clustered design CAB-1 (77.8%). Additionally, employing any CAB reduced the percentage of missed critical management steps by 36% (33% missed steps vs. 21% missed steps, p = 0.003). Conclusions: While the two CAB designs did not differ significantly in reducing missed critical management steps, the branched, clustered design was perceived as more user-friendly. Importantly, using any CAB significantly reduced the percentage of missed critical management steps compared to not using a cognitive aid, emphasizing the need for CAB use in the operating room.
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(1) Background: Type A acute aortic dissection (TAAAD) almost always requires emergency surgery, and postoperative complications are common. Quality assurance systems tend to measure only the hard outcomes, e.g., complications and mortality. Our aim was to assess the health-related quality of life of TAAAD survivors. (2) Methods: An anonymized, Dutch language, web-based survey was sent out to all of the participants of the 2022 Annual Meeting of the Dutch National Aortic Dissection (DNAD) advocacy group via their own representatives. The survey was divided into five sections: patient information, global satisfaction, surgery, including complications, and the recovery period. (3) Results: Ninety members of the DNAD group attended the meeting. Seventy-five (83%) participated in the survey, and the responses from 61 (81%) were available for analysis. Despite hindrances in their daily life (complications, changes in physical, cognitive, and social functioning), patients were satisfied with their treatment, and all would undergo the procedure again. In addition they requested better post-discharge guidance and communication (4) Conclusion: The emphasis lies in equipping patients with knowledge about potential outcomes and effective coping strategies. This underscores the importance of communication and expectation management, in line with established literature.
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BACKGROUND & AIMS: Early oral postoperative nutrition is a proven beneficial element of postoperative care, resulting in improvement in quality of life and a shorter hospital stay. Guidelines state that postoperative oral nutrition can safely be started within the first hours after surgery. However, oral nutrition is mainly investigated starting from postoperative day one (POD1). This pragmatic study assessed whether a food service in the Post Anaesthesia Care Unit (PACU) may reduce postoperative fasting times on postoperative day zero (POD0) early after surgery on this high care unit. The primary outcome was postoperative fasting time in the PACU. Secondary outcomes were postoperative patient experiences and nutritional tolerance. METHODS: This pragmatic prospective before-after study, included adult patients with a planned overnight stay in the PACU, and without anticipated postoperative dietary restrictions. A food service was developed, allowing re-uptake of oral nutrition early after surgery, already at POD0. Postoperative fasting time in the PACU was defined as the duration of time between the moment of arrival at the PACU, until first postoperative intake or until 9 a.m. on POD1, when most patients were discharged to the surgical ward. Secondary outcomes such as postoperative patient experiences and nutritional tolerance were scored on POD0 at 8 p.m. and on POD1 at 8 a.m. RESULTS: A total of 235 patients were included, 119 in the pre-implementation (control) and 116 in the post-implementation (intervention) group. Mean postoperative fasting time was reduced by a mean of 6.0 h (95% CI 4.8-7.4, p-value ≤ .001), from 17.5 h in controls to 11.5 h in the intervention group. In the intervention group, 45% of patients had nutritional intake on POD0 (8 p.m.), increasing to 80% of patients on POD1 (8 a.m.), compared to no intake at both time-points in the control group. In the intervention group, average patient satisfaction increased over time. Flatus frequency was higher in the intervention group on POD1 (45% vs. 22%, p-value ≤ .001), while postoperative nausea and/or vomiting, and usage of anti-emetic medication were not different between groups. CONCLUSIONS: In a heterogeneous group of adult post-surgical patients with a planned overnight stay in the PACU, implementation of a food service resulted in a significant and clinically relevant reduction of postoperative fasting time, and increased patient satisfaction without compromising nutritional tolerance. Registered at www.isrctn.org with study ID ISRCTN17976930.