Safer Surgery
Knowledge and Library Services Evidence Update
Part of the Barts Health Education Academy
Hello and welcome to this edition of Barts Health Knowledge and Library Services’ monthly Safer Surgery Evidence Update.  Please let us know how we can improve future updates by providing feedback, and let us know if there are any resources or publications you would like us to feature.
To find out more about the library services available to you, including our highly-regarded literature searching service and desktop document supply service,  visit our WeShare page at or call 020 7363 8016.

Feel free to cascade this to any colleagues who might be interested. To subscribe to this update and others, go to
Read this update in your browser

Latest safer surgery news and opinion

From BBC News: Covid: Surgery waiting times could be cut with specialist hubs, say surgeons
"The Royal College of Surgeons (RCS) wants a network of hospital sites focused on routine surgery, such as hip and knee replacements. The government says it is working "to accelerate the recovery of services". In March, around five million patients were waiting for surgery - the highest number since modern records began...."
From HSJ:
  • Modern surgery is harming surgeons, the NHS must invest in robots or see them quit
    "CEO of Milton Keynes University Hospital, Professor Joe Harrison, explains why UK surgeons need greater
  • Exclusive: NHS plans to keep electives at 80pc in next covid surge
    "Wlliam Harrop-Griffiths, vice president of the RCoA, said: “We as clinicians are aware of the target and the importance of elective surgery for the more than five million people on waiting lists... We will do whatever we can but if the [fourth] wave places extra pressure on critical care, anaesthesia will step to the front and treat urgent patients first. There is a possibility elective surgery could be impacted. We will do everything we can to make sure it’s minimally impacted”..."

Latest safer surgery guidance, reports, and institutional publications

NEW addition to the Getting It Right First Time (GIRFT) Best Practice Library: Spinal Services
"A new page for spinal surgery (now separate from orthopaedics), including the national report, surgical pathways and best practice case studies...”
From Healthcare Safety Investigation Branch (HSIB): Wrong site surgery – wrong patient: invasive procedures in outpatient settings
"This investigation drew on the field of human factors to understand how the outpatient context influences the reliability of patient identification. It sought to identify the risks associated with the identification of patients specifically attending for invasive procedures in outpatients, and potential opportunities to manage or minimise them. As a result, HSIB recommends that NHS England and NHS Improvement leads a review of risks relating to patient identification in outpatient settings, working with partners to engage clinical and human factors expertise..."
From The Royal College of Surgeons of England: A new deal for surgery
"This report highlights the challenges that exist on access to NHS surgical services in England due to the impact of the Covid-19 pandemic and provides recommendations for recovery. These include asking the government to support adoption of the ‘surgical hub’ model across England for appropriate specialties, to help reduce elective waiting times and ensure surgical patients can be treated safely. The report also asks the government to adopt longer-term aims of increasing the number of hospital beds and doctors to reach the OECD average..."
From Health Education England (HEE): National patient safety syllabus 2.0
"Written by the Academy of Medical Royal Colleges and commissioned by HEE, the new National Patient Safety Syllabus outlines a new approach to patient safety emphasising a proactive approach to identifying risks to safe care while also including systems thinking and human factors. The syllabus applies to all NHS employees and will result in all NHS employees receiving enhanced patient safety training..."


Latest safer surgery research articles

A Scoping Review of Strategies Used to Implement the Surgical Safety Checklist
"In 2007, the World Health Organization initiated the Surgical Safety Checklist (SSC) as part of an initiative to improve patient outcomes. After publication of the SSC, perioperative nurses identified challenges with implementing it and questioned its effectiveness. We desired to summarize the state of the science on the effectiveness of strategies that perioperative personnel have used to implement and assess the SSC; therefore, we conducted a scoping review. We searched several databases and identified 28 articles that described the three key stages of SSC implementation (ie, before, during, and after). Half of the identified articles addressed intervention strategies and most articles provided strategies for SSC implementation. The literature also indicated that effective implementation occurred when there was adequate planning. Perioperative leaders should work with nurses when implementing the SSC and monitor its use after implementation to verify compliance and help prevent negative patient outcomes..."
Retained Surgical Objects: The Centuries-Long Search for Solutions
"Retention of sponges and other items in surgery is a problem that has not been solved despite centuries of work... The problem of retained sponges was reported as early as the beginning of the modern era of surgery, in the mid-1880s, when ether was first available, says Robert R. Cima, MD, MA, professor of surgery and medical director of the hospital practice at the Mayo Clinic. “It’s been a continuing problem,” he says. “We talk about prevention now, and it was the same thing 100 years ago...”
Reflecting on why surgical swabs are being left behind and exploring how this could be prevented
"Although a rare occurrence, a retained surgical swab is the source of high morbidity (infection, pain, secondary postpartum haemorrhage and psychological harm). It is also important to mention the financial burden and the legal implications affecting healthcare providers worldwide. Over the years, several strategies have been implemented in clinical practice to reduce such risk. However, none of these seem to provide a definitive answer. Having offered a brief overview of the evidence surrounding retained surgical swabs, this article presents an innovative approach based on creating a physical barrier by introducing an anchoring point linking the swabs together, making it physically impossible to leave one behind. At present, these modified swabs are undergoing development and testing..."
[Conference abstract] Snapshot Re-Audit of Implant Checks in SWLEOC Theatres
"Never events represent a huge cost burden to the NHS due to litigation. One such event occurred at a high-volume orthopaedic unit involving the wrong implant being inserted into a patient. An extensive investigation was undertaken which highlighted a combination of human error in the implant checking process and implant storage system. As a result, local guidance was developed to ensure a ‘prosthetic pause’ was performed prior to implant opening..."
[Letter] Linguistic Structure of Surgical Checklists
"Suboptimal use of the checklist, such as partially completing the checklist, or not having all members present during the checklist, may have a negative impact on team function... WHO encourages modifying the checklist to suit local requirements and to give individual institutions a feeling of ownership in the checklist... In our institution, the checklist has undergone transformations over time and we use it consistently… There is a tendency to go through the checklist perfunctorily; consequently, we explored the literature on thelinguistic structure of checklists and how they are enacted to affect checklist efficacy…”
[Preprint] Impact of the Surgical Safety Checklist on Surgical Site Infections, Antimicrobial Resistance, Antimicrobial Consumption, Costs and Mortality
"Use of the surgical checklist was associated with a significant reduction in SSI. When comparing the two time periods, we also identified a reduction in infections due to microorganisms in the ESKAPE group (from 90.7% to 73.9%, p<0.001), a reduction of SSI in patients with contaminated, infected and potentially contaminated wounds, and for those in whom perioperative antimicrobial prophylaxis was discontinued in less than 48 hours. Overall, there was a reduction in antimicrobial resistance, though there was increased resistance to carbapenems for Klebsiella pneumoniae, to glycopepetides for Enterococcus faecium, and to clindamycin for Staphylococus aureus. We also detected increased antimicrobial consumption of 2nd and 3rd generation cephalosporins and clindamycin. We observed a reduction in hospital deaths from 6.4% to 3.2% (p=0.001), but we did not observe any reduction in costs..."
Implementation Strategies and the Uptake of the World Health Organization Surgical Safety Checklist in Low and Middle Income Countries: A Systematic Review and Meta-analysis
"We screened 1562 citations and included 47 papers. Median number of discrete implementation strategies used per study was 4 (IQR: 1–14, range 0–28). No strategies were identified in 12 studies. SSC implementation occurred with high penetration (81%, SD 20%) and fidelity (85%, SD 13%), but we did not detect an association between implementation strategies and implementation outcomes. SSC use was associated with a reduction in mortality (RR 0.77; 95% CI 0.67–0.89), all complications (RR 0.56; 95% CI 0.45–0.71) and infectious complications (RR 0.44; 95% CI 0.37–0.52)..."

Library COVID Update

All staff are now required to sign-in, and wash their hands with the gel provided, when entering our libraries.

St Bart’s Hospital Library has moved back to its original space in the department of diagnostic imaging, on the ground floor of the KGV Building. It will be staffed from 10am-4pm, Monday to Friday, and available to staff 24/7. The phone no. there is 020 3465 5467.

At Whipps Cross and Newham Hospitals we offer comfortable seats and computer access, with tea and coffee, from 10am-4pm. Please check local notices for details. Staff can continue to access our 24/7 knowledge hubs (computer rooms) on each site.

Our Library Hub at the Royal London continues to be available to staff 24/7.

Please see our new website and our Digital Library WeShare page for more information

Visit Our Website

Our Leadership and Management subject guide collects all our services and resources on the topic, and signposts to external help.

Browse resource collections within our COVID-19 pages; plus further services, resources, and NHS discounts have been added to our Wellbeing pages.

You can now search the entirety of our collection from the website homepage below via the Discovery search bar too...


Our Other Recent Updates

Read our latest Staff Wellbeing Update (published 10/6/21) here.
Read our round-up of research published by Barts Health authors in the month of May 2021 (published 9/6/21) here.
Read our latest COVID-19 Update (published 8/6/21) here.
Read our latest monthly Leadership Update (published 7/6/21) here.
Read our latest Health Services Management Update (published 4/6/21) here.
Read our latest Inclusion and Diversity Update (published 28/5/21) here.
Read our latest monthly Delirium in ICU Evidence Alert (published 17/5/21) here.
Read our latest COVID-19 and TB Update (published 5/5/21) here.
Read our previous Safer Surgery Update (published 18/5/21) here.

Catch up with all our archived updates on our Digital Library Weshare page.

Happy to help.

If you require the full text of any of the articles mentioned above, or any other assistance, please email

If you were forwarded this email and would like to receive them directly in future, please sign up here
Copyright © 2021 Barts Health NHS Trust, All rights reserved.

Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.

Email Marketing Powered by Mailchimp