Mamta Swaroop

By Leah Tatebe and Mamta Swaroop

Disruptive physician behavior is a pervasive threat to patient safety and a source of emotional and financial hardship on the health care system. It causes increases in medical errors, staff turnover, and risk of litigation. Behavioral problems can be symptoms of underlying issues that must be addressed, such as substance abuse, psychiatric conditions, or burnout. Reporting of disruptive behavior is low, especially by colleagues. Current methods in place in many health care systems do not adequately recognize warning signs or take appropriate corrective actions to limit the effects of disruptive physicians. Changes must be made at a system level to improve rehabilitation of problem physicians.

Part of the book: Vignettes in Patient Safety

By Jonathan F. Bean and Mamta Swaroop

Retained foreign bodies after surgeries or procedures are a rare complication with great consequences. The most commonly retained surgical items are guidewires, surgical sponges, and suture needles. The procedure at highest risk for retained foreign bodies is central venous catheterization. The literature regarding specific risk factors that increase the potential for retained surgical items varies. Evidence suggests that procedures with blood loss over 500 mL, lack of or an incorrect surgical instrument and sponge count, longer procedures, and unexpected intraoperative events all increase the risk of retained surgical items. There is conflicting evidence on the effect that elevated body mass index (BMI) or the emergent nature of a procedure has on retained surgical item risk. Interventions aimed at preventing retained foreign bodies include surgical counts, mandatory imaging after procedures, bar-coding of items used during surgery, and radiofrequency detection systems. These interventions have varying detection rates. Regardless of the safety measures used, none are perfect and a high index of suspicion must be maintained to prevent retained surgical foreign bodies.

Part of the book: Vignettes in Patient Safety

By Alaap Mehta, Ali Khalid and Mamta Swaroop

Sepsis and septic shock are life-threatening conditions that remain an enormous burden of morbidity and mortality to millions of patients globally and cause organ dysfunction, leading to death in as many as one in four patients, often even more. Early management and appropriate treatment are essential to improve outcomes and reduce morbidity and mortality. In 2016, the Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction resulting from dysregulated host responses to infection, and defined septic shock as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are profound enough to substantially increase the risk of mortality. That same year the group also implemented the application of the sequential organ failure assessment (SOFA) score over the systemic inflammatory response syndrome (SIRS) score. Sepsis in pregnancy remains a leading cause of maternal morbidity and mortality worldwide, with no current standard definition for severe sepsis for the pregnant or peripartum woman. The prevalence of pediatric septic shock is on the rise and brings with it the consequences of long-term morbidity and also death. Since the advent of programs for early recognition and treatment, mortality has decreased. Even so, globally, many children succumb to septic shock despite evidence-based care and years of research.

Part of the book: Clinical Management of Shock