Key result
Interviews link patient compliance, postoperative assessments, OR equipment, and safety culture to outpatient adverse events.
Qualitative interviews with VHA surgical staff suggest that care processes and safety culture, rather than immutable patient characteristics, are key drivers of adverse events in outpatient surgery.
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Should not yet change outpatient surgical protocols; hypothesis-generating for process and culture interventions in VHA settings.
OBJECTIVES: Little is known about patient safety risks in outpatient surgery. Inpatient surgical adverse events (AEs) risk factors include patient- (e.g., advanced age), process- (e.g., inadequate preoperative assessment), or structure-related characteristics (e.g., low surgical volume); however, these factors may differ from outpatient care where surgeries are often elective and in younger/healthier patients. We undertook an exploratory qualitative research project to identify risk factors for AEs in outpatient surgery. METHODS: We developed a conceptual framework of patient, process, and structure factors associated with surgical AEs on the basis of a literature review. This framework informed our semistructured interview guide with (1) open-ended questions about a specific outpatient AE that the participant experienced and (2) outpatient surgical patient safety risk factors in general. We interviewed nationwide Veterans Health Administration surgical staff. Results were coded on the basis of categories in the conceptual framework, and additional themes were identified using content analysis. RESULTS: Fourteen providers representing diverse surgical roles participated. Ten reported witnessing an AE, and everyone provided input on risk factors in our conceptual framework. We did not find evidence that patient race/age, surgical technique, or surgical volume affected patient safety. Emerging factors included patient compliance, postoperative patient assessments/instruction, operating room equipment needs, and safety culture. CONCLUSIONS: Surgical staff are familiar with AEs and patient safety problems in outpatient surgery. Our results show that processes of care undertaken by surgical providers, as opposed to immutable patient characteristics, may affect the occurrence of AEs. The factors we identified may facilitate more targeted research on outpatient surgical AEs.
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Mull et al. (2017) studied Outpatient surgical patient safety (n=14). Qualitative semi-structured interviews was evaluated on Perceived risk factors for adverse events in outpatient surgery. Qualitative interviews with 14 Veterans Health Administration surgical staff identified patient compliance, postoperative assessments, operating room equipment, and safety culture as key risk factors for adverse events in outpatient surgery.
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