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