Skip to main content

Table 5 Characteristics of recovery factors and corrective measures among the cohort

From: Contributing factors to severe complications after liver resection: an aggregate root cause analysis in 105 consecutive patients

ALARM category

Recovery factors

Corrective measures

N

Description (n associated cases)

N

Description

I. PATIENT

FACTORS

2

- Family support (10 cases)

- Proactive adaptation of intraoperative support to case complexity (6 cases)

5

- To restrict the indications of combined colorectal surgery**

- To implement a protocol for patient psychological assessment**

- To implement a protocol for patient oncogeriatric assessment**

- To implement a protocol for patient nutritional assessment**

- To implement a management protocol for obese patients

II. TASK FACTORS

6

- Proactive readmission to the ICU (5 cases)

- Proactive indication of imaging (4 cases)

- Proactive revision surgery to control complication (4 cases)

- Management of the complication by attendings (2 cases)

- Proactive indication of percutaneous drainage (1 case)

- Complication management handover (1 case)

5

- To implement a protocol for intraoperative changes in strategy

- To mention treatment strategy changes in surgical report

- To implement protocols for operating instructions of medical devices

- To implement management protocols for liver resection complications:

- percutaneous drainage

- pleural effusion

- anastomosis leaks

- To implement postoperative management protocols:

- indications of imaging**

- emergency revision surgery (management and supervision)

- criteria for hospital discharge**

- criteria for ICU discharge**

III. INDIVIDUAL (STAFF)

FACTORS

4

- Proactive call for intraoperative surgical support (6 cases)

- Proactive hemorrhage management by a resident (2 cases)

- Proactive hemorrhage management by a nurse (1 case)

- Complication management handover (1 case)

3

- To check cystic ligature after hepatic pedicle clamping**

- To check the loss of selectivity of the clamping during liver section**

- To discuss a validation for change in intraoperative strategy

IV. TEAM

FACTORS

4

- Shared decision by the surgical team (9 cases)

- Internal multidisciplinary concertation: Surgery-ICU (8 cases)

- External multidisciplinary concertation, e.g.: Thoracic surgery (3 cases)

- Proactive revision surgery to control hemorrhage (1 case)

3

- To offer insight when validation for change in intraoperative strategy

- To optimize internal communication (Surgery-ICU)**

- To optimize external communication (Outside of NIO)**

V. WORK ENVIRONMENT

FACTORS

0

 

4

- To adapt workload during holiday seasons**

- To optimize nurses’ night on-call scheduling

- To optimize records of medical and paramedical procedures**

- To implement a system of patient risk management

VI. ORGANIZATIONAL AND MANAGEMENT FACTORS

1

- Immediate availability of blood* (1 case)

3

- To tackle the failure of bacteriology test circuit

- To report MMR recommendations to the hospital administration

- To tackle the issue of blood shortage

Total

17

Total

23

 
  1. * Near miss, **Ongoing improvement
  2. in Bold: specific to liver resection
  3. BMI body mass index, ICU Intensive Care Unit, NIO National Institute of Oncology