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Application of Information Link Control in Surgical Specimen Near-Miss Events in a South China Hospital:
Tingting Chen1, Xiaofen Tang1, Min Xu1
1Operating Room, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou, Zhejiang Province, 325015, China, 86 13958929969.
Background:
Information control is a promising approach for managing surgical specimens. However, there is limited research evidence on surgical near misses. This is particularly true in the closed loop of information control for each link.
Objective:
A new model of surgical specimen process management is further constructed, and a safe operating room nursing practice environment is created by intercepting specimen near-miss events through information safety barriers.
Methods:
In a large hospital in China, 84,289 surgical specimens collected in the conventional information specimen management mode from January to December 2021 were selected as the control group, and 99,998 surgical specimens collected in the information safety barrier control surgical specimen management mode from January to December 2022 were selected as the improvement group. The incidence of near misses, the qualified rate of pathological specimen fixation, and the average time required for specimen fixation were compared under the 2 management modes. The causes of 2 groups of near misses were analyzed and the near misses of information safety barrier control surgical specimens were studied.
Results:
Under the information-based safety barrier control surgical specimen management model, the incidence of adverse events in surgical specimens was reduced, the reporting of near-miss events in surgical specimens was improved by 100%, the quality control quality management of surgical specimens was effectively improved, the pass rate of surgical pathology specimen fixation was improved, and the meantime for surgical specimen fixation was shortened, with differences considered statistically significant at P<.05.
Conclusions:
Our research has developed a new mode of managing the surgical specimen process. This mode can prevent errors in approaching specimens by implementing information security barriers, thereby enhancing the quality of specimen management, ensuring the safety of medical procedures, and improving the quality of hospital services.
Insights
Implementing information safety barriers in surgical specimen management significantly reduced adverse events and improved specimen quality. This new model enhances patient safety and hospital services by preventing errors in specimen handling.
Area of Science:
- Medical error prevention
- Surgical specimen management
- Healthcare quality improvement
Background:
- Limited research exists on surgical near misses within information control loops.
- Effective management of surgical specimens is crucial for patient safety.
- Current information control methods for surgical specimens require enhancement.
Purpose of the Study:
- To develop and evaluate a novel surgical specimen process management model using information safety barriers.
- To reduce near-miss events in surgical specimen handling.
- To create a safer operating room nursing practice environment.
Main Methods:
- A comparative study involving 84,289 specimens (control) and 99,998 specimens (improvement group) over two years.
- Evaluation of near-miss incidence, pathological specimen fixation quality, and fixation time.
- Analysis of near-miss causes under conventional and information safety barrier control modes.
Main Results:
- The information safety barrier model significantly reduced adverse events and improved near-miss reporting by 100%.
- Pathological specimen fixation quality and speed were enhanced.
- Statistically significant improvements (P<.05) were observed across key performance indicators.
Conclusions:
- A new surgical specimen management model utilizing information safety barriers effectively prevents errors.
- This approach enhances specimen management quality, medical procedure safety, and overall hospital service quality.
- The developed model offers a robust solution for improving surgical specimen handling.
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